Current estimates are that the death rate from COVID-19 from global figures has risen from 5%, or 1 in 20 on average to 6.9%. However, it is higher for figures given by some countries. For example, Italy has a mortality figure of about 13%, the UK also has a figure of 13%. This may be the result of insufficient testing, such as only testing admissions to hospital.
For comparison, Measles kills 1 in 500, a previous coronavirus – SARS - killed almost 1 in 10. Seasonal flu usually has a death rate one tenth that of COVID-19.
- Eight countries have 1000 -2,000 cases: Bosnia and Herzegovinia, Bulgaria, Estonia, Iceland, Lithuania, North Macedonia, Slovenia, Slovakia.
- Twelve countries have more than 2000 - 11000 cases: Armenia, Australia, Croatia, Czechia, Denmark, Finland, Greece, Hungary, Luxembourg, Norway, Republic of Moldova, Serbia.
- Eleven countries have 10,000 to 50,000 COVID-19 cases - Austria, Ireland, Japan, The Netherlands, Poland, Portugal, Romania, South Korea, Sweden, Switzerland, Ukraine.
- Ten countries have more than 50,000 cases of COVID-19: Belgium, China, France, Germany, Iran, Italy, Russia, Spain, the United Kingdom, the USA.
I use the data from the WHO Situation Reports, which reflect figures that lag about 12-24 hours behind the final figures on any date. They are at least consistent and allow trends to be observed over time. US figures have been obtained from the CDC or the Worldometer when CDC unavailable at Weekends, and UK figures from Public Health England. (UK counts now include the results from the expanded testing from the beginning of May.)
By the morning of
15 May, 2020, more than 4,338,658 total cases of COVID-19 had been reported worldwide.
Figure 4 below shows that after the leveling off of cases in China by the 16th February, cases in the rest of the world began, and still are, increasing (figures 4 and 5) but the rate of increase is linear, not exponential (figure 4 & 5,) at a rate of half a million cases per week. The number of deaths to date globally is 297,119 (figure 4 and 5). There is still a daily increase.
The top scoring locations are USA and a number of European countries, who account for most of all cases (figures 6,7, 8 and 9). Cases in the USA exceed those of other countries more five and a half times.
Some European countries and the USA have now implemented measures to relax their strict lock-down measures. The number of new cases in European countries is beginning to slow down, judging by data from the past few weeks (figures 6 and 7).
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| Figure 4. Total counts of global accumulated COVID-19 cases and recorded deaths over time |
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| Figure 5. Same data as figure 4 but as a logarithmic plot (base 2) of global cases of COVID-19 and global deaths. Horizontal lines for values increasing 2 fold. |
I have introduced two new charts which show the number of new cases per day (figures 6 and 7). Daily figures do vary a lot, so I have used an average of the previous 7 days for each day which smooths the curve. The climb to a peak, leveling off and decline is seen much more easily.
It looks as if Spain and Italy have reached the peak and are on the decline. Germany and France also appear to be past their peak. The UK at last shows a similar trend though the sign of decline in new cases is only just appearing. USA values are so high, they merit their own graph (figure 6) but appear to have reached a peak at 32,000 new cases per day are declining slowly.
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| Figure 06. The number of new COVID-19 cases in the USA per day, Seven day average. |
The dates of the peaks of
new cases per day are interesting: Italy 26th March; Spain 31st March; Germany, France and Iran by the 2nd-4th April, USA 10-14th April; the UK 13th - 16th April. Among lower scoring countries, Austria and Switzerland peaked at almost the same time. Belgium and The Netherlands show a similar pattern of reaching a peak at about the same time and then plateauing off without a significant decline for more than a fortnight afterwards.
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| Figure 07. The number of new COVID-19 cases in countries other than the USA per day, Seven day average. Note the 10 fold differences in scales in these two figures. |
The following graphs show the cumulative number of COVID-19 cases over time for selected countries. USA has had five and half times as many cases than any other country so is shown separately in some of the charts. Russia is showing a late rapid increase in cases but has reached its peak.
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| Figure 8.Ten countries have more than 50,000 total cases of COVID-19: Belgium, China, France, Germany, Iran, Italy, Russia, Spain, the United Kingdom, the USA. The graphs is also shown without the US as the values in the US are more than five times higher than any other country. |
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| Figure 9. The same data as figure 8 but using a logarithmic plot (base 2 ). Horizontal lines for values increasing 2 fold. Ten countries have more than 50,000 cases of COVID-19: Belgium, China, France, Germany, Iran, Italy, Russia, Spain, the United Kingdom, the USA. |
Most countries with 10,000 plus cases out of their exponential growth phase as seen in figures 8 and 9, showing a slow down in the number of new cases over the past few weeks (figures 10 & 11).
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| Figure 10.Eleven countries have 10,000 to 50,000 COVID-19 cases to date - Austria, Ireland, Japan, The Netherlands, Poland, Portugal, South Korea, Romania, Sweden, Switzerland., Ukraine. |
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| Figure 11.Logarithmic plot, base 2. Eleven countries have 10,000 to 50,000 COVID-19 cases to date - Austria, Ireland, Japan, The Netherlands, Poland, Portugal, South Korea, Romania, Sweden, Switzerland., Ukraine. |
Taking the UK as an example, the rate of increase of new cases is slowing down. Figure 12 below shows that the time taken for a ten fold increase in cases in the UK has come down from ten-fold every 7 days to two-fold every 46 days and declining. Hopefully the rate will continue to slow down.
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| Figure 12. Graph showing the change in the rate at which new cases arise in the UK. The rate of increase in COVID-19 cases, based on the last 7 days, is about two fold every 46 days and declining. |
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| Table 3. Showing data for countries with more than 10,000 cases of COVID-19 |
Public Health England map and charts of COVID-19 across the UK
Will I be infected?
Information was that you have to be within 2 meters of someone. The consensus is that the main route of infection to avoid is - touching surfaces contaminated by the virus and then touching your mouth or eyes. Even when you do, this does not mean that you will always become ill (see 'How can I protect myself' below) as you have to receive a certain dose of virus for successful infection.
- The virus is possibly shed into the air by an infected person.
- The virus can even be spread by people who are not displaying obvious symptoms like fever or a cough.
- The highest shedding of virus occurs just before the onset of symptoms and then declines.
- Your risk of infection is dramatically reduced the further away you are from ill people.
However, it is possible that a significant percentage of the population will be infected eventually.
What does the virus COVID-19 do?
The COVID-19 coronavirus infects the cells lining the airways of the body, the epithelial cells. In severe cases it seems to progress to the lungs, causing pneumonia.
The virus has a complex protein capsule that contains the virus genes. The virus genes are on a single strand of RNA – not DNA. This strand is 29903 bases (units) long. Numerrous isolates of the virus have been sequenced and their sequences made publically available for all scientists - see
https://www.ebi.ac.uk/ena/browser/text-search?query=Wuhan%202019%20nCoV.
On contact with one of your epithelial cells, the cell is triggered to take up the virus. Inside the cell, the virus hijacks your cell’s own functions to make copies of its single RNA strand. The genes encoded on the virus RNA are translated into a range of virus proteins by the cell. New virus particles are then assembled within the cell. They are then either exported by the cell or released when the cell dies. Neighbouring cells are then infected. If the conditions are right, the virus begins to spread along your airways.
COVID-19 can be symptomless in some people for between 5 to 12 days. If they appear, the symptoms you may get range from fever, sore throat, dry cough, fatigue and breathing difficulties. A recent paper in the American Journal of Gastroenterology suggests that digestive problems may be an early indicator of COVID-19 in nearly 49% of cases, in advance of other symptoms.
They are in part due to the virus affecting/killing cells but also due to your body going into overdrive to try to fight the virus infection (often described as a cytokine storm). How ill you are is a balance between virus multiplication and how fast and effectively your body defence works. There is more information below in the next section on how you can protect yourself.
How can I protect myself?
Your choices NOW affect how many cases the NHS has to deal with in 14 days.
There is no vaccine for COVD-19 yet – but with the full sequence of the virus available, work is in progress to provide a vaccine in the next months. Therefore isolation and quarantine remain the most effective means to prevent the spread of the disease. Things you can do are:
- Keeping healthy by eating and sleeping well, exercising*
- Avoiding locations and people with the illness
- Hand-washing
- Use hand sanitisers
- Good personal hygiene generally
- Use the new tracking and trace app when it is on general release
*Keeping healthy is a great prophylactic as it means that your immune system is in best condition. Our bodies are actually geared to be alert to any foreign invaders and illnesses and the incoming virus does not have it all its own way.
Get the COVID Symptom Tracker app
You can join in with research on the progress of COVID 19 in the UK by downloading the COVID Symprom tracker app from
https://covid.joinzoe.com/
Disinfecting smooth surfaces:
You can use:
- 70% or stronger alcohol to wipe surfaces (preferred - effective and leaves no residue)
- Thin bleach or diluted thick bleach
- Soapy water.
Remember to wear rubber gloves. Wipe with paper towels you can throw away. AND WASH YOUR HANDS AFTERWARDS.
Clothing/ cloth articles
- Wash in washing machine with your usual detergent.
- WASH YOUR HANDS AFTER placing possibly contaminated clothes into washing machine.
Possible UV inactivation of CoV SARS 2
Hospitals and laboratories often use special flow cabinets with UV lights to sterilise surfaces. From the publications I looked at, RNA viruses in aerosols are quite resistant to UV exposure, requiring times of half an hour or more with shortwave UV (about 254 nm). For those wanting to pursue this further, the following may be of interest.
Your body - your best defender!
If a cell in your body is overcome by an infection and dies, this triggers other chemical signals which alert a variety of white blood cells. Some, called macrophages, come to absorb the invading foreign viruses and take the information back to T-cells. The T-cells in turn use this information to help create killer T-cells and antibodies. There are also memory cells that will remember the antibodies required to fight any future infections by the same strain of virus.
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Some of my neutrophils from a cold,
photographed at over 1000x magnification
using anoptral contrast |
In the meantime, a whole army of another type of white cell, neutrophils, invade the infected area and gobble up all the debris of damaged cells and the viruses they come across. When you have pus from a spot, or your runny nose produces the thick white stuff, or you cough up thick phlegm - that is mostly made up of these short lived neutrophils that have gorged themselves on what is infecting you.
Incoming coronaviruses also trigger the production of interferons within the cell and initiate other yet unknown responses. These seem to slow down virus action. In turn, viruses continually evolve to overcome the cell’s defences. (
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593566/).
In chemotherapy and radiotherapy, these immune systems are weakened, hence you become more susceptible to infections taking over. So take extra care.
What nations and the international community can do
Countries and the World Health Organisation have plans and structures in place to trigger action when diseases are spreading. The WHO had expressed its opinion that this was still a controllable pandemic and that a shift from containment to mitigation would be wrong and dangerous.
UK Response
PM Boris Johnson acknowledged that this was "the worst public health crisis for a generation".
- The UK is trying containment by restrictions on movement and will be introducing track and trace in the near future.
- The UK is ramping up testing for all critical care workers (hospitals, care homes, emergency services, including police, teachers etc.).
- Individuals with a fever or cough must self isolate for seven days. Families with one infected person need to self isolate for 14 days to ensure everyone is in the clear.
- Schools and non-critical businesses have been closed from the weekend of 21st March, exceptions are for critical care workers and essential functions to keep the country running.
- People over 70 and those with pre-existing health conditions have been told to self isolate for the foreseeable future.
- Travel locally and abroad is strongly discouraged
- The NHS has survived the current peak and people with symptoms are no longer required to call NHS 111. They are instead directly to look for information on the NHS website and 111 online.
Latest Documents from the UK Government accessible here:
The plan
The aim is to slow down the rate of infection so that the peak in hospital cases is lower and spread, so that the NHS can cope.
Even after the virus has been brought under some degree of control, the virus and some degree of control measures are with us for the foreseeable future - possibly more than one year.
The number of tests for infection is to be dramatically increased to determine which key workers are affected and which individuals can work in critical posts. The UK is still lagging behind in testing compared to a number of other developed countries.
In the near future, testing to see who has been infected and recovered will be possible. This will most likely be by using mass produced antibody kits, similar to pregnancy tests. Knowing someone has recovered and is resistant to the virus will give reassurance that they can return to work without being at risk to themselves and others.
Ultimately, the country needs to gain a significant proportion of the population that is resistant to the virus. This "herd immunity" (see below) can be obtained both by recovery from being infected and from vaccination.
Vaccines are being developed and tests have begun both in animal and small scale human studies. It could take a year or more before a vaccine is generally available.
Herd Immunity and Vaccination
Herd immunity by recovery is a real effect with a number of diseases. Governments around the world expect that a significant percentage of the population will be infected over the coming year. The hope is that recovered individuals will be immune.
Note of caution, immunity to existing corona-viruses, such as those causing the common cold, disappears quickly. We do not yet know if we gain immunity after infection with the SARS CoV2 and how long the immunity will last.
Natural herd immunity occurs when a significant proportion of the population has been infected and survived. The survivors are resistant to the illness and, if their numbers are high enough, it becomes more and more difficult for the disease to find uninfected persons. The progress of an epidemic slows or can even peter out if herd immunity is high enough.
With the current estimate of an average rate of one person infecting between 2 to 4 people for COVID-19, this could mean that 50% to 80% of the population would have to go through infection to achieve full herd immunity against COVID-19 (based on figures in
https://en.wikipedia.org/wiki/Herd_immunity#Mechanism).
However, it could be that the UK is hoping that a lower figure of herd immunity may reduce the level of general infection in the population, if not achieving outright cessation of the epidemic.
In the meantime, vaccine development, testing and then mass production will be undertaken as fast as possible to provide our protection in future years. The first safety trials of some vaccines have already started. Earliest prospects for a possible vaccine in low numbers suggested for end of year. Realistically we might have to wait till 2021.
Other countries' responses
As Europe was the new focus of the pandemic, the US and other countries stopped people from European countries (including the UK and Ireland) entering.
Within Europe, France, Germany, The UK and Spain had joined Italy and also introduced more control measures, promoting self isolation, banning public gatherings and restricting movement within and between countries. Now the controls are being relaxed gradually. The aim is to allow more and more freedom but to a level that we do not have another sudden flash of cases and allows the health systems cope at a reasonable level.
The USA had implemented more testing and stringent control measures to try and limit the escalating crisis in its states. However, there is very strong pressure to relax controls and get the economy going again and different states are opening up to varying degrees, often contradicting the recommended scientific tests. The balance between scientific modelling and advice and political decision making is beginning to lean towards the latter. So far this has worked OK as new cases continue to decline.
The differing responses of countries to the coronavirus epidemic have in effect been a global experiment whose results will reveal best strategies for future epidemics. The same is now true for the rate of relaxation of controls in different countries - it is the next global experiment.
The general global practice with new diseases prior to COVID-19
Every year, new strains of influenza arise naturally by mutation as the virus adapts to us changing humans. Rather than letting a large proportion of the world’s population become ill (letting many people die) with the survivors therefore gaining resistance to the newest strain, we humans are proactive. Up and coming new strains of viruses are identified and vaccines produced so that by the time the disease arrives in your part of the world, you are protected in advance and do not get ill, or only have mild symptoms
With totally new viruses, like the COVID-19 coronavirus, there is no immediate vaccine defence. It is therefore vital that a country keeps tabs on new illnesses that arise. They need to have plans in place to deal with the isolation of infected people. They also need to provide care whilst patients go through the illness, to mitigate symptoms until they get well.
Until we have a vaccine, severe cases may be helped by giving them antibodies from people who have recovered from the disease. This method was used against diphtheria in the early 1900's in Alaska, though the antibody serum was actually derived from horses. I do not know if this is currently being pursued. Cloned antibodies might be an alternative solution.
Update 08/03/2020 re using antibodies from people who have recovered: first reports in news that Germany and USA looking to use plasma from recovered patient for serious cases.
Update 20/04/2020: Plasma treatment (using antibodies from people who have recovered) being trialed in the UK, including Addenbrookes, Cambridge.
In this interconnected world, nations also have a responsibility to alert the WHO early about upcoming diseases. This time round, full marks for the Chinese response, because we were made aware of the issue earlier than in the past. The world was able to start monitoring for carriers of the illness and put in place travel restrictions.
Despite the WHO advice to act quickly and decisively, most countries underestimated the speed at which the COVID-19 spread in the population and held back from mass testing and tracing whilst numbers were still low. Now, outbreaks such as those in the USA and most of western Europe are now challenging us with a significant number of deaths and stretched healthcare systems.
Information, documents and guidance from the WHO, the UK and US.
The UK and WHO have the following information on responses to epidemics and the teams and mechanisms in place. They can be found in public documents such as:
So, should I be concerned?
Yes. COVID-19 is still affecting many people in Europe and the US. The disease could be with us for the next few months and possibly into the coming years.
The hard containment measures have slowed down the number of new infections in a number of countries. Relaxation of restrictions is gradually being introduced but with an eye being kept on the effect on virus reproduction in the population.
Look out for public advice from the authorities dealing with the outbreak. The following advice is practical not just in this instance but to minimise your risk of getting ill from any disease that is circulating:
- Keep healthy by eating and sleeping well and exercising
- Avoiding locations and people with the illness
- Regular hand-washing
- Use of hand sanitisers where there might be a risk in public
- Note, the use of masks is best for protecting others from you when you are ill rather than protecting you from others.
If you have returned from a region seriously affected by COVID-19, or met an individual who has subsequently succumbed to the illness, and begin to experience chest and cough symptoms, stay at home and look online at NHS 111 in the UK https://111.nhs.uk/covid-19. This ensures that you get the right response and treatment and do not accidentally spread the disease further, endangering people in public places, doctors surgeries or hospital reception.
