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Putting the COVID-19 pandemic in perspective (Number 6)

This series was spawned by my reaction to reporting on the COVID-19 pandemic that focused on raw numbers. Big numbers are impressive, even frightening, and hard to comprehend, but rarely have we been given a context that helps lead to better understanding of the numbers or how to make comparisons between the U.S. and the rest of the world. This series has turned from occasional pieces to a monthly summary setting the U.S. numbers in global perspective. This analysis is based on data from worldometers.info.

Report Sections:
• December at-a-glance • Scope of This Report
• Where We Are Now (Global, Continental and Country Analysis)
• COVID Deaths Compared to the Leading Causes of Death in the U.S.
• Profile of Monitored Continents & Countries

December at-a-glance

• Global cases increased by 32% in December 2020, to 83.8-million. Deaths increased 24%, to 1.8-million, for a mortality rate (deaths as proportion of cases) of 2.4%, headed steadily down from 3.0% in September.
• The U.S., with 4% of the world's population, remains on top for cases, up 47% to 20.4-million, with nearly one-quarter (24.4%) of the world total. Deaths increased 29% to 354-thousand, 19.4% of world deaths. By rate of increase, the U.S. was fifth in cases, behind Germany, France, Canada and the U.K. The U.S. was fourth in the rate of increase in deaths, behind Germany, Russia and Italy.
• Is COVID surging? Against a widespread impression that COVID is out of control everywhere, only a third of the 21 countries monitored increased at rates above global levels (7 countries for cases, 6 for deaths). These surges occurred in Europe and North America. Cases in Germany doubled in November, then went up another 63% in December. Deaths in Germany doubled in both November and December.
• Mortality Rate: U.S. cases increased at a faster pace than deaths, allowing the mortality rate to drop to 1.7%,, putting it 19th among the 21 countries monitored. Mexico had to highest mortality rate, at 8.8%, with 16 of the 21 countries above the global rate of 2.4%.
• Testing. The U.S. leads in number of tests by a wide margin, though it is No. 20 in tests-per-million, behind countries with much smaller populations who have been able to reach a larger proportion of their people with far fewer tests. Keep in mind that multiple tests reduces the total number of people covered, so caution is needed in applying raw numbers of tests to the population.

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Scope of This Report

What we track

From the worldometers website we track the following Categories:

• Total Cases • Cases per Million
• Total Deaths • Deaths per Million
• Total Tests • Tests per Million (not reported at a Continental level)
• From Cases and Deaths, we calculate the Mortality Rate

Instead of reporting Cases per Million and Deaths per Million directly, I try to put raw numbers in the perspective of several key measures. These are a different way of expressing "per Million" statistics, but it seems easier to grasp when you see it in a table.

• Country population as a proportion of global population
• Country cases and deaths as a proportion of global cases and deaths
• Country cases as a proportion of its own population

Who we monitor

Our analysis covers countries that have appeared in the top-10 of the worldometers categories since September 2020. This includes most of the world's largest countries as well as some that are much smaller. A chart profiling the monitored countries and the five major continents will be found at the end of this report.

Changes in the December 2020 report

Turkey appeared in the top-10 for the first time, for Cases, so it is now included in this analysis. Some of the projections and comparisons to the 1918 Spanish Flu have been updated. As analysis has become more extensive, I acknowledge a tendency to get too "deep in the weeds" in level of detail, so I' have attempted to simplify some of the reporting. You will find two charts replacing detailed narrative for comparison of continental and country data.

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Where We Are Now

The reported surges in cases during December do not appear as widespread as the news would indicate. In fact, as I prepared this report it struck me that there is something of a disconnect between the media reports that suggest that the pandemic is generally out of control and the numbers analyzed. You may not agree with me, but as I go through the numbers, the picture I get is that in some places there are very serious surges, but it is not reflected in the global numbers. That is why I expanded these reports over recent months to compare the U.S. numbers with to her countries and the world.

Of the 21 countries tracked for this analysis, seven were at or above the global level of increase in cases at the end of December (32%): Germany, France, Canada, UK, USA, Russia and Italy. Except for Russia and Canada, the others have been prominent in news reports in December. Six of the 21 were at or above the global increase in deaths at the end of December (24%): Germany, Russia, Italy, USA, Canada, and UK. Germany was far ahead of the others with an increase of 67% in cases and 103% in deaths compared to November. All the other countries saw cases growing at a slower pace, even though their total cases and deaths exceeded the global level.

Thus, my argument that focusing on the hot spots can give news consumers the impression that everywhere things are as bad as the worst, which get the media attention. That makes understanding and empathy difficult. While there are genuine hot spots—places where the situation is extremely dire—there are other places, where many of us live, that are affected more by the threat than the reality of runaway disease and death.

Looking at the December data, the growth in global cases from month to month is actually slowing in rate of increase, so it is important to look at regional and country data to explain the sense that things are out of control. Public officials warned against travel at Thanksgiving in the U.S., and similar warnings went out on a much broader scale for the Christmas holidays in December. We can see evidence of the impact of Thanksgiving surges in the December numbers, but will need to wait for the January numbers to see whether the added travel and increased COVID-fatigue seen around Christmas had an impact, and if so, whether it is global or focused on some countries or regions.

My efforts in this series are not meant to downplay or deny reality, but to provide perspective that looks beyond hype that can actually serve as a kind of misinformation, even if inadvertent. Events like this pandemic are complicated and do not affect all of us (the whole world, in this case) with the same intensity at the same time.

The Global View

At the end of December there were 83.8-million confirmed COVID-19 cases around the world, an increase of 20.3-million, or 32%, since November.

While the number of cases has increased over the previous month, the rate of increase each month is actually dropping on a global scale: October was 39% higher than September with 12,900 new cases; November was 37% over October, with 17,129 new cases, and December was 32% more than November, with 29,274 cases. How could the rate go down if the numbers are going up? It seems counterintuitive, but consider this: if the rate of increase remained constant at 39% each month, we would have seen global cases at 89.6-million by the end of December, nearly five million more than actually reported.

To date, 1.1% of the world's population of 7.8-billion has been reported as having confirmed or suspected COVID-19 cases.

The criteria has evolved somewhat since the pandemic was declared in March. In the state of Illinois, USA, where I live, original reporting included only "confirmed" cases. As testing has expanded, that has expanded in recent months to include "probable" (asymptomatic, non-hospitalized) cases. While the reporting of cases may be subject to definitional ambiguity, the report of deaths is a more concrete number (though there have been arguments that COVID is assigned as the cause of death when it should more rightly be a serious underlying condition triggered by the virus). For the purposes of this report, we have to deal with the numbers as reported.

1.8-million have died—up 352,339 (24%) over November. This represents a mortality rate of 2.2% (deaths as proportion of cases), which is down slightly from 2.3% in November.

The global mortality rate has fallen steadily since we first reported it in September at 3.0%. This is not unexpected since the reporting of cases has increased as testing has accelerated, increasing the gap between reported cases and deaths, lowering the mortality rate. As reported last month, some experts feel the infection rate is as much as ten times higher than the recorded case rate, which would make mortality that much lower. For our purposes, that is not as important as the fact that the most compelling statistic is the death toll. Also, for my analysis, even with differences of opinion on definitions, as long as the methods and criteria remain fairly stable, it provides a means of seeing trends over time.

PERSPECTIVE: The 1918-19 Spanish Flu pandemic is estimated to have struck 500 million people, 26.3% of the world population of 1.9-billion at that time. By contrast, we're now at 1.1% of the global population. Deaths a century ago have been widely estimated at between 50- and 100-million worldwide, putting the global mortality rate somewhere between 10 and 20-percent. It has been estimated that 675,000 died in the U.S.

IF COVID-19 hit at the same rate as 1918, we would see about 2-billion cases worldwide by the time COVID-19 is over, with the global population now at 7.8-billion—four times what it was in 1918. There would be 200- to 400-million deaths. For the U.S., this would mean cases approaching 90-million and deaths of nearly 9-million and perhaps as high as 18-million.

However, at the present rate of confirmed cases and mortality while the total number of global cases could approach 500 million or more—comparable to 1918 in number, that would be one-quarter of 1918 when taking population growth into account . .. and assuming the pandemic persists as long as the Spanish Flu, which went on in three waves over a two year period. With a vaccine already in early stages of distribution, the end of COVID-19 could come sooner. Like 1918, however, there could be complicating factors such as the mutation in Britain, now discovered in Colorado, that is more highly transmissible (but not necessarily more deadly).

Using the mortality rate of 2.2% in December, total deaths with the above projection of cases, would be over 12-million worldwide, tragic but far below the number reported for 1918 (50-million) with an even wider gap (200 million) when taking population growth into account.

The contrast demonstrates the vast difference in scale between the Spanish Flu pandemic a century ago and COVID-19 now. Key differences are the mitigation efforts and available treatment today (though still leaving the health care system overwhelmed in some areas), and the beginning of vaccine distribution. In addition, in 1918 much of the world was focused on a brutal war among nations (World War I) rather than waging a war against the pandemic, which ran its course and was undoubtedly made much worse by the war, with trans-national troop movements, the close quarters of trench warfare, and large public gatherings supporting or protesting the war.

The Continental View

This analysis covers the five major continents. The population and resultant numbers for Oceana are too small to be significant, so it is not included. Instead of reporting cases-per-million or deaths-per-million, it is easier to grasp those numbers as a proportion of population. Tests and Tests per Million are not reported at the Continental level.

GLOBAL cases increased 32% in December, to 83.8-million; deaths increased 24% to 1.8-million, for a mortality rate of 2.2%, down from 2.3% in November.

It is clear from the chart for December that Europe, North America and South America represent the overall "hot spots," with numbers disproportionate to their population. As pointed out last month, Asia and Europe appear comparable by raw number of cases, but Asia has six times the population of Europe. However, the 40% increase in cases for Asia is worth watching (though its change in deaths is below the global level). It should be noted that numbers for China have not increased since I began monitoring of worldometers data in September.

Even though the rate of change for new cases in Europe was above the global level, it has dropped from 102% in October to 74% in November, and 37% in December. North and South America were both below the global level of 32% in December.

Comparing Countries

As with the Continental perspective, you will find a chart rather than the detailed narrative used in past reports. I hope you will find this change helpful.

The U.S. (cells highlighted with a red border), remains at the top of cases, deaths, and more positively, in the number of tests. It also continues at the top in the proportion of its own population reported as cases. The level of change for cases, however, is behind Germany, France, Canada and the UK. The level of change in deaths, likewise is below that of Germany, Russia and Italy. Because the U.S. is so strikingly high in cases and deaths, it is notable that its mortality rate—deaths as a proportion of cases—is near the bottom of the 21 countries in our analysis, and below the global rate. More general comments follow the chart.

For four months, (September-December), the highest cases were recorded by the U.S., India, Brazil, and Russia. That is true also for deaths, with the U.S., India and Brazil in the top three rankings each of those four months. Below that the order becomes more mixed each month, reaching down as far as Peru, ranked No. 43 by population, which came in at No. 10 for total deaths at the end of October. The U.S. has been No. 1 in tests for two months, up from No. 2 in September and October. The U.S., China and India have shared the top three rankings in number of tests reported since September. (See the note below the chart about the percentage figure under the number of tests).

The shading indicates countries at or above the global level, shown in the first row. Because the countries tracked are or have been high on the list of 218 countries reported by worldometers, it is not surprising that most or all of the 21 countries reported here will be at or above the global level. That is certainly the situation with the number of cases and deaths, as well as the proportion of cases against each country's own population. More significant is the amount of change, for both cases and deaths, which is not tied as tightly to the global level, so from month to month we will be able to observe shifting patterns, particularly in looking for surges. Indeed, the highest levels of increase in cases and deaths for December are seen in Europe and North America, where we have heard reports of surges. .

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COVID Deaths Compared to the Leading Causes of Death in the U.S.

According to the CDC, the 10 leading causes of death in 2018 (the latest year available) were as follows. These total just over 2-million deaths per year. COVID death milestones are shown in red. Even if the final toll by the end of 2020 is well below worst-case projections (upwards of 2-million deaths), it is striking how rapid the rise in deaths has been since early March.

COVID-19 death "milestones"

updated since the last report with data for 2018—most are up from 2017, but all remain in the same order of ranking

1. Heart disease: 655,381 (up from 647,457 in 2017)
2. Cancer: 599,274 (up from 599,108)
   • COVID-19 deaths as of December 31, 2020: 354,215 out of 20.4-million cases, or 1.7% mortality—(47% increase in cases, 23% increase in deaths since November 30, drop in mortality of 0.3%).
     The CDC's National Ensemble Forecast  for December 28, the latest as of this writing, forecasts a total of 383,000 to 423,000 deaths by January 23. (The link will take you to the latest report.)
   • COVID-19 deaths as of December 12, 2020: 306,4770 out of 16,7-million cases, or 1.8% mortality.
   • COVID-19 deaths as of November 30, 2020: 274,056 out of 13.8-million cases, or 2.0% mortality—(48% increase in cases, 16% increase in deaths since October 31, drop in mortality of 0.5%)
     The CDC's National Ensemble Forecast for November 23 forecast a total of 294,000 to 321,000 deaths by December 19." (The link will take you to the latest report.)
   • COVID-19 deaths as of October 31, 2020: 236,072 out of 9.4-million cases, or 2.5% mortality—(28% increase in cases, 17% increase in deaths since Sept. 24, drop in mortality of 0.2%)
     The CDC's National Ensemble Forecast for October 26 forecast a total of 243,000 to 256,000 deaths by November 21, indicating "an uncertain trend in new COVID-19 deaths . . . "
   • COVID-19 deaths as of September 24, 2020: 200,705 out of 7.3-millions cases, or 2.7% mortality
     latest number from WHO as of this writing
     The CDC's National Ensemble Forecast for September 17 forecast a total of 207,000 to 218,000 deaths by October 10.
3. Accidents (unintentional injuries): 167.127 (down from 169,936)
   • COVID-19 deaths as of August 23, 2020: 167,201
4. Chronic lower respiratory diseases: 159,486 (down from 160,201)
   • COVID-19 deaths as of August 10, 2020: 160,989
5. Stroke (cerebrovascular diseases): 147,810 (up from 146,383)
   • COVID-19 deaths as of July 27, 2020: 146,331
6. Alzheimer's disease: 122,019 (up from 121,404)
   • COVID-19 deaths as of June 26, 2020: 121,645
   • COVID-19 deaths as of May 18, 2020: 91,985
     latest number as of my May 19 report
     The CDC's National Ensemble Forecast at the time suggested that "the number of cumulative deaths are likely to exceed 100,000 by June 1st." As I stated then: "We will certainly surpass that number. The forecast is extended only four weeks at a time. If a downturn in deaths becomes reality, as expected, how will the final number at year's end compare to the 200,000 upper end of the window that gained currency in April? If deaths were to continue at the present rate—about 10,000 per week, the total by year's end would be around 372,000."
7. Diabetes: 84,946 (up from 83,564)
   • COVID-19 deaths as of April 28, 2020: 58,365
     not only surpassed Vietnam (58,318), but flu and pneumonia in 2017
8. Influenza and pneumonia; 59,120 (up from 55,672)
9. Nephritis, nephritic syndrome, and nephrosis: 51, 386 (up from 50,633)
10. Intentional self-harm (suicide): 49,344 (up from 47,173)
    • COVID-19 deaths as of April 11, 2020: 18,516
      date US surpassed Italy in deaths
    • COVID-19 deaths as of March 28, 2020: 1,296
      date US surpassed Italy in reported cases (85,840)

There are those who question the veracity of assigning COVID-19 to many deaths among people with underlying conditions, such as heart and respiratory disease. Still others have suggested a rise in other health issues, including death, because of deferred health care. It will be years before all of that is sorted out. For my purposes here, I can only go by the most reliable sources available.

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Profile of Monitored Continents & Countries

(Data from worldometers.info).

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This article was also posted on SeniorLifestyle, which I edit