COVID-19: Tracking the Changes

We look at the disease and how it's consumed the world

By Anthony Lee, MD

Faculty, Harvard Medical School

As we make our way through this pandemic, many of us are wondering about its scale and what's in store for the future. Objectivity is lost in the swamp of catastrophic thinking, conflicting opinions, and political agendas. To regain our objectivity, we must examine the numbers.

Many different sources supply us with numbers describing past, present, and future trends in various places around the globe. These numbers tend be focused regionally and are often used in conjunction with info relating to Italy as the de facto standard.

This makes sense, given that data should be relevant to local needs and that Italy has been through the worst of it. Hospitals are using this information to predict how this pandemic will affect their areas locally and allocate resources accordingly. Public policy should also be driven by this data.

Like most authors, I have included Italy in the mix, and I've highlighted the effects of its lockdown on March 9th in terms of cases and deaths. I've added Belgium because it locked down 9 days after Italy, and it would be useful to see if their results resemble Italy's.

The UK's situation is an interesting one; initially it just let things happen so that herd immunity would develop, then later mandated social distancing followed by a relative lockdown. Ireland and Northern Ireland were added separately to represent progressively smaller scale versions of the UK only in terms of when they started social distancing (March 23-24) and eventual relative lockdowns (March 26-27).

New York State was included because it carries approximately 36% of all cases in the US and roughly 10% of all cases in the world. Finally, Sweden is noteworthy because it enacted measures very late (March 29). But when it did, the measures were significantly less restrictive than those of other countries.

The charts used below present data as cases vs. time, or deaths vs. time. With this presentation, it appears that the US has the most cases, and that things must be terrible here. In places such as NY State, it is.

But keep this in mind: the population of the entirety of the US is 331 Million, while the population of NY State and NYC is 19.5 Million and 8.6 Million, respectively. While the US has about 422,800 cases in total as of today, NYC has roughly 78,000 cases.

If these numbers were expressed on a per 100,000 population basis, you'd get a clearer picture of specific geographic severity. For example, the US situation is better expressed as 128 cases per 100,000, and NYC's very concerning 903 cases per 100,000.

By comparison, Italy, a known hot spot for the COVID pandemic, has 139,442 cases today with a population of 60.48 Million. That's 230 cases per 100,000 people. Therefore, for charting both the number of cases and deaths with respect to time, the values will be expressed as per a 100,000 population basis.

Due to time differences, US data reports lag behind the UK and European countries. Therefore, US plots are likely to be limited to the day before a report is published. In some cases, late reporting from European countries and the UK may also limit plots to the day before.

Cases

Coronavirus confirmed case statistics

Figure 1. Cases per 100,000 population by location and correlated rate of change.

Looking at Figure 1, we can see the effects of lockdowns and social distancing. It took Italy 10 days to finally reduce the number of daily new cases (basically, the rate of change curve has flattened). This trend has continued for the last 20 days, producing the trailing edge of Italy's pandemic.

Within 9 days Belgium reduced the number of daily new cases and continued on a downward trend for the last 12 days. It took Ireland 6 days of lockdown to reduce their daily new cases, and this trend has continued over the last 6 days. Northern Ireland took 7 days of lockdown to reduce their daily new cases, and this trend has continued over the last 5 days.

Despite loose social distancing, Sweden continues on a low and flat trajectory. Perhaps this can be accounted for by lack of testing.

Due to the setting of social distancing policies, the UK remains on a low and flat trajectory.

Despite a shortage of testing NY State and NYC cases are rising dramatically. Testing has increased in Massachusetts over the last 2 weeks, and this is reflected in the figure. While NY has been about 5-8 days behind Italy over the last several weeks, Massachusetts has been roughly 21-23 days behind.

Although both NY and Massachusetts started their social distancing advisories at the same point in time. Relative to Italy's social distancing, Massachusetts had a roughly 2-week head start on NY. This may have caused the relative flattening of new cases in Massachusetts over the last 6 days. This may change, however.

Rates-of-change plots appear in surges or waves. In locations that are improving, each subsequent wave is smaller than the previous one. This forms the trailing edge of the pandemic in a given location. In locations that are worsening, each subsequent wave is larger than the previous one, forming the leading edge of a worsening pandemic.


Deaths

Coronavirus Death rates


Figure 2. Deaths per 100,000 population by location and correlating rate of change.

In Figure 2, we can see the rising deaths by location.

In the rates-of-change chart, the number of daily new cases flattened are delineated by date.

From the point of delineation rightward, we can see when daily deaths begin to decrease. This lag time varies with locations. For Italy, this lag time was 8 days. For Ireland, these reversals were basically at the same time. For Northern Ireland, the lag time was 1 day.

For these countries, the time between lockdown/social distancing and reduction of daily deaths was 18 days for Italy, 6 days for Ireland, and 8 days for Northern Ireland.

I will update and discuss these charts in future installments of this series.

Sources of data: Worldometer.com, Spectrum News NY1, Massachusetts Department of Public Health, HSC Public Health Agency

How the Coronavirus Spreads: Government Failure and "Incompetence"

Lies and cover-ups resulted in failed containment.

As the number of coronavirus cases worldwide rises to nearly 80,000, experts say the renamed COVID-19 is "almost certainly going to be a pandemic," with some saying it already is "in all but name."

But public information about the latest coronavirus, which describes a group of viruses that have crown-like spikes on the surface of the virus, has disseminated slowly considering the novelty of COVID-19. While coronaviruses are common and include SARS and MERS, they commonly cause mild to moderate respiratory infections similar to the common cold. However, COVID-19 is a new form that has caused serious respiratory illness in individuals with compromised immune systems, killing over 2,100 individuals worldwide. That's more than twice the number of deaths caused by SARS and MERS combined.

In China, where the virus originated and the vast majority of cases and nearly all of the casualties have taken place, the government has gone from being commended by the World Health Organization for their swift response to the disease to vilified by the international health community. Despite the government enforcing strict quarantines, the virus has continued to spread. What mistakes were made?

First, the Chinese government's strict media censorship resulted in Chinese citizens remaining unaware of the virus weeks after the government shared the information with the international community. Government officials not only limited the spread of information but downplayed the severity of the virus and its ability to spread from person to person. Writer Youyou Zhou of Quartz details how the doctor who first tried to warn the global community about the dangers of the virus, the late Dr. Li Wenliang, received a warning letter from the Wuhan police. Dr. Wenliang was one of eight doctors who were "reprimanded for [their] illegal activity of publishing false information online." He was forced to sign a statement that admitted he had violated the law and "seriously disrupted social order."

Zhou concludes, "The delayed information disclosure by the government combined with the population migration during the lunar new year caused the virus to spread quickly all over China. By Feb. 13, 1,383 have died from the virus around the world, and all except three took place within mainland China. On the same day, Beijing replaced the top officials of Wuhan and Hubei province with new party officials to contain the outbreak."

Second, when Dr. Wenliang himself was tested to have contracted the virus on January 11, officials should have publicly confirmed that the virus could be transferred from person to person. Instead, they issued straightforward denials that there was "no proof" that human transmission was possible. The Wuhan Health Commission only admitted how quickly the disease was spreading and its severity when confronted with irrefutable proof, with inconsistent numbers given in multiple reprots.

Third, when Dr. Wenliang, age 34, died on February 7 in Wuhan, the Chinese government took steps to suppress news of his death. Once word spread, the Chinese public grieved and expressed widespread frustration and anger at the government's censorship, which had proven to cost people's lives. On China's social media app Weibo, "We want free speech" trended with almost 2 million views before being censored.

Ultimately, the Chinese government's authoritarian censorship, cover-ups, and direct lies to the public resulted in failed containment of the coronavirus at the very outset. Global concerns about the virus have intensified due to doubts about the accuracy of the data released by the Chinese government.

But other global agencies are also being placed under intense scrutiny in regards to their response to the coronavirus. WHO Director-General Tedros Adhanom Ghebreyesus has been criticized for waiting to declare the outbreak a global health emergency.

Now, with a global pandemic "almost certain," government lies and cover ups have irrefutably resulted in an international health risk that may have been preventable if the Chinese government had practiced transparency and put human lives above party lines.