gallowaypatriot.com

This is the fourth in a series of reflections aimed at putting what we know about the scale of the COVID-19 pandemic in perspective. The first, "Ode to Joy," posted April 9, looked at examples of the human spirit rising to the challenges of the pandemic. The second, "About Those Numbers," posted May 19, looked at projections, reporting of milestones, and historical comparisons. The third, "Another Milestone," posted September 28, looked at the COVID numbers as American deaths passed the 200,000 mark. This report uses a similar format to that report, comparing different countries one month later.

This report is an update of the last one in this series (see links above). The analysis compares data for October 31 with the last report, September 28 (that date was used because it was close to the U.S. death rate passing the 200,000 mark, which now makes it appropriate to make ongoing updates at the end of each month).

Where We Are Now

While anticipated in the cautious predictions of some experts, a global surge in COVID infections began to occur in the past two weeks,catching some by surprise and forcing many governments to impose new social restrictions—in some cases walking back to the severe lock-downs of the early days of the pandemic in the spring.

When I wrote in May, there were hopeful signs that the daily numbers of cases and deaths were trending down, but then as states began to open (especially those without strict mitigation requirements) and as a new school year approached, areas of resurgence began to appear. Indeed, university campuses, with all their careful planning to stem an outbreak, were ambushed by the death-defying quest to party.

In my own area, an exception has been Wheaton College, a Christian liberal arts institution of about 2,400 resident students, which is always at the bottom of lists of party schools. The college converted part of a remote campus location to serve as a quarantine center if needed, has required testing, use of a hybrid model of in-person and remote learning, and emphasized strict mitigation efforts in housing, dining and other campus activities. To encourage small, safe gatherings, the college installed fire pits around the campus, even supplying fire wood and ingredients for S'mores (Wheaton's answer to binge drinking!). Within the last month, it is my understanding that a large campus-wide COVID test revealed only one student and one staff member who tested positive.

A report on the PBS News Hour of a small college in Maine about the size of Wheaton showed similar good results. My daughter, who works at Northwest University in Kirkland, Washington, a slightly smaller campus, reports similar results with its own adaptation to mitigation while maintaining a resident student population. So, it is possible to prevent or greatly reduce chances of an outbreak, though it appears to be most successful in institutions that are far smaller and more homogeneous in culture than very large university campuses. (See the National Geographic report "The colleges with virtually no coronavirus cases")

Since late summer the general upward trend has intensified and some states (like Illinois, where I live) have responded by re-imposing bans on bars and indoor dining in designated regions (the state is now divided into 11 zones). Those businesses affected are crying foul and pointing to an increase in larger and less-protected, even defiant, gatherings of friends and family as a deeper problem. In the area where I live several restaurants have defied the governor's order and remain open, accusing the governor of arbitrary judgment in allowing other businesses to remain open..

At least one restaurant near us has sued the governor and gotten a court-approved restraining order allowing it to remain open while the suit advances. Some local authorities have indicated they will not enforce the governor's order on indoor dining. As far as I know, those restaurants that have chosen to continue indoor dining have not flouted mitigation requirements but in some cases intensified to promote themselves as a safe place to gather. Interestingly, one factor that is gaining attention is the quality of indoor air handling, with high levels of air exchange and use of highest quality air filters, and some establishments have begun to include air quality in promoting their own safety.

Despite good examples, all of this represents a growing desire of people to gather, some in defiance of the mitigation efforts that are needed to effectively stem the advance of COVID-19. That raises serious questions of the direction we are headed as we move into cooler weather and the normal flu season, as well as traditional times of gathering during Thanksgiving and the longer Christmas-New Year's holiday season. The numbers could, indeed, get far worse. The one glimmer of good news is that while infections climb in the U.S., the death rate is not rising as rapidly. This is reflected in growing infections among the 15-29 year-old group, where illness may be less severe and recovery more certain. That does not diminish the concern of health care systems in areas of intense surges who fear for their ability to manage a rapid rise in those needing hospitalization.

So, let's review the current nationwide numbers. Once again, I will look at the data from two viewpoints: how the COVID-19 death rate in the U.S, compares to the 10 leading causes of death in America, and how the U.S. compares to other countries in the world.

COVID deaths compared to the leading causes of death in the U.S.

According to the CDC, the 10 leading causes of death in 2017 (the latest year available) were as follows. 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" (2020) against the 10 leading causes of death in America (2017)

1. Heart disease: 647,457
2. Cancer: 599,108
   • 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, the latest as of this writing, forecasts a total of 243,000 to 256,000 deaths by November 21, indicating "an uncertain trend in new COVID-19 deaths . . . ". (The link will take you to the latest report.)
   • 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): 169,936
   • COVID-19 deaths as of August 23, 2020: 167,201
4. Chronic lower respiratory diseases: 160,201
   • COVID-19 deaths as of August 10, 2020: 160,989
5. Stroke (cerebrovascular diseases): 146,383
   • COVID-19 deaths as of July 27, 2020: 146,331
6. Alzheimer's disease: 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: 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; 55,672
9. Nephritis, nephritic syndrome, and nephrosis: 50,633
10. Intentional self-harm (suicide): 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.

The U.S. compared to the World

Is the U.S. the worst in the world in terms of COVID-19 statistics? Overall, we are being hit harder by COVID than many other countries, sometimes with well-deserved criticism for the free-wheeling, anti-establishment, "cowboy" stereotype through which much of the world views the United States. However, in recent weeks there has been news of surges in Europe and other parts of the world.

To help frame the analysis that follows, consider a quick profile of a range of different countries that appear near the top of the measures included. (Data from worldometers.com as of September 28, 2020, with several additional countries and corrections of density numbers as of October 31, 2020).

Here is the latest (October 31) from worldometers.info, which reveals a complicated mix of cases versus population, mortality rates among those who do become infected, testing levels and other factors.

It does show how one can cherry pick statistics to some extent to support a point of view. As stated in my previous articles, raw numbers can be powerful but somewhat misleading, so it is necessary to compare them with rates and shares, which the worldmeter data provides:

Remember, this is a snapshot of a particular day (October 31), so running the reports again in the future will change both the numbers and the rankings. The threshold for highlighting changes in each category was selected to easily point out the most significant changes.

• TOTAL CASES: 46.4-million worldwide, up 39% from 33.5M in September
  Those with an increase of 50% or more from September 28 highlighted in red
  • TOP TEN MONITORED COUNTRIES + EUROPE, BY CASES (OCT. 31)
  • The total comes from 215 countries and represents 0.6% of world population of 7.8-billion
  • All of Europe combined has 9.9M cases, 1.3% of its population (up 102% from 4.9M— with 9.6% of world population, Europe accounts for 21.3% of world cases (up from 14.6%)
  • USA (1—same), 9.4M cases, 2.8% of it population (up 29%, from 7.3M)—with 4.3% of world population, the U.S. accounts for 20.3% of world cases (down from 21.8%)
  • India (2 -same), 8.2M cases, 0.6% of its population (up 34% from 6.1M—with 17.6% of world population, India accounts for 17.7% of world cases (down from 18.2%)
  • Brazil (3—same), 5.5M cases, 2.6% of its population (up 17% from 4.7M)—with 2.7% of world population, Brazil accounts for 11.9% of world cases (down from 14.0%)
  • Russia (4—same), 1.6M cases, 1.1% of its population (up 33% from 1.2M)—with 1.9% of world population, Russian accounts for 3.4% of world cases (down from 3.6%)
  • France (5—up from 11), 1.4M cases, 2.1% of its population (up 158% from 543K)—with 0.8% of world population, France accounts for 3.0% of world case (up from 1.6%)
  • Spain (6—up from 7), 1.3M cases, 2.8% of its population (up 66% from 784K)—with 0.6% of world population, Spain accounts for 2.8% of world cases (up from 2.3%)
  • Argentina (7—new this report), 1.2M cases, 2.7% of its population—with 0.6% of world population, Argentine accounts for 2.6% of world cases
  • Colombia (8—new this report), 1.1M cases, 2.2% of its population—with 0.7% of world population, Colombia accounts for 2.4% of world cases
  • UK (9 0—up from 14), 1.0M cases, 1.5% of its population (up 128% from 439K)—with 0.9% of world population, UK accounts for 2.2% of world cases (up from 1.3%)
  • Mexico (10—up from 9), 919K cases, 0.7% of its population (up 26% from 730K)—with 1.7% of world population, Mexico accounts for 2.0% of world cases (down from 2.2%)
  • OTHER MONITORED COUNTRIES WITH AN INCREASE OF 50% OR MORE 
  • Italy (13—up from 19), 679K cases, 1.1% of its population (up 118% from 311K)—with 0.8% of world population, Italy accounts for 1.5% of world cases (up from 0.9%)
  • Germany (15—up from 22), 532K cases, 0.6% of its population (up 84% from 289K)—with 1.1% of world population, Germany accounts for 1.1% of world cases (up from 0.9%)
  • Belgium (18—up from 33), 412K cases, 3.6% of its population (up 261% from 114K)—with 0.1% of world population, Belgium accounts for 0.9% of world cases (up from 0.3%)
  • Canada (31—down from 26), 235K cases, 0.6% of its population ( up 52% from 155K)—with 0.5% of world population, Canada accounts for 0.5% of world cases (same as September)
  • The 1918-19 Spanish Flu pandemic is estimated to have infected 500 million, 26.3% of the world population of 1.9-billion at that time. If COVID-19 hit at the same rate, about 2-billion would be infected worldwide. At the present rate of infection after seven months, the number could be closer to 110-million after two full years. That is admittedly too simplistic, but it shows the vast difference in scale between the Spanish Flu pandemic a century ago and COVID-19 now (even without adjusting the numbers for the four-fold growth in population since 1918).
    
• CASES PER MILLION
  Increases of 50% or more highlighted in red
  • The top ten, led by Andora, Bahrain, and Qatar, are mostly small countries (most with less than 10-million population)
  • TOP TEN MONITORED COUNTRIES, BY CASES PER MILLION (OCT. 31)
  • Belgium (5—up from 36), 35,524—up 261% from 9,841
  • USA (15—down from 12), 28,351—up 28% from 22,166
  • Peru (17—down from 8), 27,246—up 12% from 24,343
  • Spain (18—up from 19), 27,042 - up 69% from 16,003
  • Chile (19—up from 20), 26,616 - up 11% from 23,996
  • Brazil (20—down from 19), 25,981—up 17% from 22,246
  • Argentina (22), 25,740 - not included in last report
  • Colombia (26), 21,036 - not included in last report
  • France (27—up from 44), 20,931—up 152% from 8,309
  • UK (41—up from 58), 14,876—up 130% from 6,409
  • OTHER MONITORED COUNTRIES WITH AN INCREASE OF 50% OR MORE
  • Italy (56—up from 70), 11,249—up 118% from 5,152
  • Germany (86—up from 95), 6,240- up 81% from 3,442
  • Canada (88—down from 85), 6,195 - up 52% from 4,088
    
  • The rate for the Spanish Flu in its entirety would be approximately 265,000 cases per million worldwide, with the U.S. number close to that—roughly ten times the current U.S. rate, but we're only 7 months into COVID-19 and the Spanish Flu went on for two years. As cases continue to rise, so will cases per million, though unless something drastically alters current patterns, the final rate will remain well below the Spanish Flu, both in real numbers and the 2.7-million it would represent today with population growth.
    
• TOTAL DEATHS—1,199,743 worldwide, up 19% from 1,005,057
  Increases of 20% or more highlighted in red
  
  • TOP TEN MONITORED COUNTRIES + EUROPE, BY DEATHS (OCT. 31)
  • All of Europe, 265,547—up 20% from 220,822—22.1% of all deaths (up from 22.0%)
  • USA (1—same), 236,072—up 13% from 209,682—19.7% of all deaths (down from 20.9%)
  • Brazil (2—same), 159,902—up 13% from 141,887—13.3% of all deaths (down from 14.1%)
  • India (3—same),122,149—up 27% from 96,351—10.2% of all deaths (up from 9.6%)
  • Mexico (4—same), 91,289—up 20% from 76,340—7.6% of all deaths (same as last month)
  • UK (5 -same), 46,555—up 11% from 42,001—3.9% of all deaths (down from 4.2%)
  • Italy (6—same), 38,618—up 8% from 35,851—3.2% of all deaths (down from 3.6%)
  • France (7—up from 8), 36,788 - up 16% from 31,808—3.1% of all deaths (down from 3.2%)
  • Spain (8—up from 9), 35,878—up 14% from 31,411—3.0% of all deaths (down from 3.1%)
  • Iran (9—up from 10), 34,864—up 35% from 25,779—2.9% of all deaths (up from 2.6%)
  • Peru (10—down from 7), 34,476—up 7% from 32,262—2.9% of all deaths (down from 3.2%)
  • OTHER MONITORED COUNTRIES WITH INCREASE OF 20% OR MORE
  • Russia (13—down from 12), 27,990—up 37% from 20,385—2.3% of all deaths (up from 2.0%)
  • Deaths from the Spanish Flu have been widely estimated at between 50- and 100-million worldwide, with 675,000 estimated in the U.S. (information gathering then was not nearly as good as now, though current efforts are not without problems). At the rate experienced over the past seven months, the total for the pandemic could exceed 3-milliion worldwide.
    
• DEATHS PER MILLION
  Increases of 20% or more highlighted in red
  • Unlike Cases Per Million, the top-10 ranking for deaths per million is dominated by larger countries
  • TOP TEN MONITORED COUNTRIES, BY DEATHS PER MILLION (OCT. 31)
  • Peru (2—same), 1,041—up 7% from 975
  • Belgium (3—same), 987—up 15% from 860
  • Spain (5—same), 767—up 14% from 672
  • Brazil (6—up from 7), 750—up 13% from 666
  • Bolivia (7—down from 6) 743—up 11% from 671
  • Chile (8—same), 741—up 12% from 663
  • Ecuador (9 same), 715—up 12% from 637
  • USA (10—same), 712—up 13% from 638
  • Mexico (11—up from 14), 706—up 20% from 591
  • UK (12—down from 11), 685—up 11% from 618
  • OTHER MONITORED COUNTRIES WITH AN INCREASE OF 20% OR MORE
  • Russia (51—up from 54), 192—up 37% from 140
  • India (67—up from 78), 88—up 26% from 70
    
• MORTALITY RATE (Deaths as proportion of cases— worst to least, using countries listed throughout this analysis). While deaths per million seems to provide a fair gauge of how countries are doing, another significant measure is the mortality rate—which can be seen as relative risk of death for those who become infected. Except for Bolivia, which went up slightly, all other countries in the report since last month went down, an indication that surges may be hitting younger age groups less vulnerable to death from COVID. While the U.S. is at the top of cases and deaths, it's mortality rate has been at the lower end of countries monitored for this report—down from 2.9% in September to 2.5% in October.
  • Mexico—9.9% (down from 10.5%)
  • Ecuador—7,5% (down from 8.4%)
  • Bolivia—6.1% (up from 5.9%)
  • Italy—5.7% (down from 11.5%)
  • Iran—5.7% (unchanged)
  • China—5.4% (unchanged)
  • UK—4.7% (down from 9.6%)
  • Canada—4.3% (down from 6.0%)
  • Peru—3.8% (down from 4.0%)
  • Indonesia—3.4% (added this month)
  • Brazil—2.9% (down from 3.0%)
  • Colombia—2.8% (added this month)
  • Chili—2.8% (unchanged)
  • Belgium—2.8% (down from 8.8%)
  • Spain—2.8% (down from 4.0%)
  • All of Europe—2.7% (down from 4.5%)
  • South Africa—2.7% (added this month)
  • France—2.6% (down from 5.9%)
  • Argentina—2.6% (added this month)
  • USA—2.5% (down from 2.9%)
  • Iraq—2.3% (added this month)
  • Pakistan—2.0% (added this month)
  • Germany—2.0% (down from 3.3%)
  • Nigeria—1.8% (added this month)
  • Russia—1.7% (unchanged)
  • India—1.5% (down from 1.6%)
  • Bangladesh—1.5% (added this month)
  • The local COVID dashboard that I have been following, as well as news reports from around the world, indicate that black and Hispanic populations are hit with notably higher rates of infection than whites or the general population. What has also been apparent, at least in the Chicago area, is that while both blacks and Hispanics have higher infection rates, mortality rates have been higher-than-average for blacks and lower-than-average for Hispanics. In general, mortality is concentrated in people over 60 and particularly those in nursing homes and similar settings.
    
• TOTAL TESTS
  Total tests and Tests per million will grow increasingly vague as testing methods improve and testing of individuals is done with varying frequency (i.e., some colleges and places of business requiring weekly tests, which will inflate the number of tests, but not provide a true sense of coverage of the population).
  Increases of 40% or more highlighted in red
  • TOP TEN MONITORED COUNTRIES, BY TESTS (OCT. 31)
  • China (1—same), 160.0M—no change from last month in rank or number reported)
  • USA (2- same), 144.2M - up 37% from 105.1M
    
  • India (3—same), 108.8M - up 51% from 71.9M
  • Russia (4—same), 60.4M - up 33% from 45.4M
  • UK (5—same), 33.5M - up 40% from 24,0M
  • Brazil (6—same), 21.9M—up 22% from 17.9M
  • Germany (7—same), 21.9M—up 40% from 15.6M
  • Spain (8—same), 16,8M—up 32% from 12.7M
  • France (9—up from 10), 16.1M—up 50% from 10.7M
  • Italy (10—down from 9), 15.8M—up 42% from 11.1M—down 1 in rank)
  • OTHER MONITORED COUNTRIES WITH AN INCREASE OF 40% OR MORE
  • Belgium (19—up from 28), 4.9M—up 58% from 3.1M
  • Mexico (41—up from 43), 2.4M - up 41% from 1.7M
    
• TESTS PER MILLION
  Increases of 40% or more highlighted in red
  • As with cases per million, the top 17 countries by tests per million all have populations below 10-million.
  • TOP TEN MONITORED COUNTRIES, BY TESTS PER MILLION (OCT. 31)
    all will show increases in number, so percentage change shows magnitude of change
    up in rank means relatively worse, down relatively better position than previous month
  • UK (18—same), 492K—up 39% from 353K
  • USA (19—up from 20), 434,750—up 37% from 317K
    
  • Belgium (20—up from 29), 422K - up 56% from 270K
  • Russia (22—down from 21), 414K—up 33% from 311K
  • Spain (28—same), 356K—up 36% from 262K
  • Italy (37—up from 41), 261K—up 42% from 184K
  • Germany (38—up from 40), 261K—up 40% from 184K
  • Canada (39—same), 258K—up 37% from 188K
  • France (42—up from 49), 246K—up 50% from 164K
  • Chile (46—up from 47), 225K—up 32% from 170K
  • OTHER MONITORED COUNTRIES WITH AN INCREASE OF 40% OR MORE 
  • India (105—up from 109), 791K - up 52% from 52K

What to Make of All This

I am admittedly a number cruncher and pattern seeker, so there are two broad conclusions to make at this point during the COVID-19 pandemic.

First, it does not look like COVID-19 will come anywhere near the truly apocalyptic toll of the Spanish Flu a century ago. That was exacerbated by a world war, which in many ways pushed the pandemic itself into the background. Together, the war and flu accounted for 72-million to perhaps 100-million deaths, roughly 4% of the world population at the time.

Second while the U.S. mortality rate is relatively low (down to 2.5% in October, compared to 2.9% in September), the U.S. so far is poised to come out of COVID-19 looking much worse than many other countries because the number of cases is so high. A lot of blame is heaped on the Trump administration, which may be deserved, but we also have to account for significant differences in responses by state and region. In some respects our federal republic looks like 50 different countries and the profiles above show how different they can be.

I have tried to help guide you through some of the numbers to add perspective and an understanding of how to read the numbers.

Moving ahead into the potentially dangerous winter months will require more resolve than we've demonstrated to date—and sadly I don't see reasons to be very optimistic right now. America, prove me wrong!

This article was also posted on SeniorLifestyle, which I edit