by Frank Schnittger
Wed Apr 22nd, 2020 at 01:05:52 AM EST
Table 1 - countries listed in order of cases per million people (Source Real Clear Politics). All data taken at midnight GMT 21/22 April.
We are used to seeing these league tables with the USA, Italy, Spain, France and the UK on top, but when you adjust the data for population size, it turns out that Luxembourg, Spain, Belgium, Ireland and Switzerland are the hardest hit so far. Of course that may also be due to the fact that these countries have tested more than others - see table 4 below.
Table 2 countries listed in order of deaths/million
However if you sort the table by deaths/million, it turns out that Belgium, Spain, Italy, France and the UK are the hardest hit. Why do these countries have a higher fatality rate? Part of the reason may be the date the disease first arrived in a country, but the fatality rates vary enormously from country to country.
Table 3 lists countries in order of confirmed case fatality rate.
It turns out that Belgium, the UK, Italy and France are up there with Nicaragua and Algeria as having the highest confirmed case fatality rates - is that because their health care systems are overwhelmed, or because they have tested only on hospital admission with the result that many milder infections aren't included in the denominator resulting in a higher % death rate?
Table 4: Countries listed in order of tests/million people. (Source: Worldometer).
Well none of these countries are anywhere near the top of the list of countries listed in order of their testing rate/ million inhabitants. So why is it that predominantly smaller and/or island countries dominate this table - Iceland, Faroe Islands, Falkland Islands, UAE and Malta? How come they don't appear to have been effected by shortages of testing kit and reagents? Could it be that many larger more populous countries simply gave up on wider testing as part of their containment strategies?
Certainly the UK only bothered to test on hospital admission, with the result that their testing rate, at 7,886/million is only a third of the Irish rate, 22,598 /million despite the fact that Ireland had difficulty sourcing testing equipment and reagent until recently.
And how have the low testing rate countries been faring in terms of deaths? France, UK, Iran, Brazil, Turkey and Sweden have all got testing rates below 10,000 /million population, and all have been moving up the deaths table.
So how come Ireland is so high up the deaths/million table, despite having a relatively high testing rate and a very comprehensive contact tracing operation? Firstly, it was a very open country with a lot of international movement of people. The Dublin strain of the virus is associated with northern Italian skiing resorts, the Cork Strain is identical to that in Boston, and the Limerick strain is the same as the Copenhagen strain.
Secondly, 60% of Irish deaths have been in nursing homes and residential settings with a median age of 83. Clearly there was a problem with infection control in these institutions, an issue which is only now being belatedly addressed in a systematic way.
Thirdly, while relatively quick to cancel mass sporting events and closing schools and businesses, some high profile events slipped under the radar, Thousands of Irish racing fans attended the Cheltenham festival in England (10-13 March) which has now been shown to have been a major vector of infection. And although the Ireland Italy rugby match (7th. March) was cancelled, thousands of Italian Rugby fans (primarily from Northern Italy) had bought tickets and still made their way over to Dublin for the week-end.
The good news is that the Irish epidemic may be under control: Deaths appear to have peaked and new cases have been declining for some days:
The peak in deaths on the 20th. April actually relates to the correction of an undercount over the previous 18 days).
Similarly, the peak in new cases on the 10th. April actually relates to a catching up of the analysis system with samples taken over the previous two weeks. Most new infections now appear to be confined to nursing home settings resulting in a high death rate, but also, hopefully, making it easier to contain further spread in the wider community.
In common with much of Europe, the Irish government is now talking about relaxing some restrictions on May 5th. Let's hope its not a false dawn and we won't be hit with further waves of infection. The Irish government is also hoping to agree on a suite of measures with the N. Ireland authorities to enhance controls at air and sea ports to prevent further vectors entering the island.
So far the available evidence suggests that while the infection began in both parts of Ireland within 24 hours of each other, the death rate in the republic of Ireland is two thirds the N. Ireland rate.
Whether we like it or not the island of Ireland has become a laboratory experiment for two approaches to Covid-19 infection and mortality control, and so far the focus on earlier closure of schools and businesses and much greater testing and contact tracing in the south has been shown to have resulted in a one third lower mortality rate.