There’s no “I’m alright Jack” with COVID-19 — a pandemic is everyone’s problem

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The coronavirus is about 0.12 microns in size and has brought the planet to its knees.

Here in the UK and as of early July 2020, COVID-19 cases are much lower than in the recent past. Broadly speaking, much of Europe remains in a similar looking boat (some are running at greater knots and on a better course, but we’re all roughly in the same hypothetical nautical alignment).

But, it’s a global problem. The pandemic is not conquered until all corners of the globe are recording zero cases of COVID-19. That is going to be minimum one year, probably several years in the future. The pandemic is globally gathering pace, not in decline.

In countries where we may previously have looked at the numbers and thought “not too bad”, we can now review the stats and revise our thinking to “that’s really worrying”. At the start of July, the WHO pointed out 60% of all confirmed COVID-19 cases to date were recorded in the month of June. Everywhere you look, so many graphs are leaning to the wrong side of ‘worse than before’

The USA

If we look outside the UK and European borders, we can easily note that many other countries are suffering. There is of course the USA, generally suffering anyway from having Trump in charge, and now the double-whammy of having him in charge during a pandemic.

‘Daily new cases’ is the focus here. The USA graph has both a worrying incline, and a very big number of the y axis. See this figure from the Financial Times

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Various sources have put together some nice customisable visualisations of the data. Using the FT’s tool as an example, we can look at the path of a few countries. See how the US compares to the UK, Germany, France and China. It’s a bumpy road to zero for all these countries but arguably, the USA is in the worst position at the start of July 2020.

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India and Brazil

But we must look beyond the usual suspects. India and Brazil have drawn global attention across June, and they will continue to do so, as the pandemic becomes a bigger problem within their borders. Both countries have a huge population, big cities and crowed households, with limited resources to distribute among them all. India and Brazil also have complicated healthcare systems that mix public and private healthcare, with the health facilities in particular often overloaded in ‘normal’ times, let alone during a pandemic. It’s going to be tough — very tough — for both countries to get new daily cases down to a level that can be described as ‘dwindling’.

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Sub-Saharan Africa

And elsewhere, so many countries are experiencing an upsurge in cases. There are strong arguments that the pandemic is only really now starting to grip sub-Saharan Africa, with many countries recording their highest daily levels and their national graph pointing up rather than down. See examples of South Africa, Nigeria, Ghana, Kenya and the Democratic Republic of Congo. Their total numbers are lower than India, Brazil or the USA, which means there is hope that outbreak measures can restrict the spread and reduce the burdens. But these are worrying trends, nonetheless.

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Do we yet know the true global picture?

In short, no we definitely do not. Moving track to the excellent Our World in Data project, they highlight (among many other factors) the proportion of tests that are positive. Many countries have 20–50% (or greater) positive tests. That reflects a concern that countries are not able to pick up anywhere near the true number of cases. They will be limited by the number of tests available, and number of laboratories that can do the tests. Distance and terrain can easily make it a 48-hour round trip to send a member of staff to take test samples from a rural area to the capital city where the main testing facility is usually located (do not underestimate the importance of a reliable and swift transport network in order to transport tests, PPE, vaccines, medicines etc).

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Also note in the above image that there is not the testing data available from many countries (e.g. across much of sub-Saharan Africa). So it is difficult to judge the true situation there. Concerns remain for several reasons. See this direct link to Nigeria testing information, where proportion of positive testing is roughly 20–25% at each data point. For Mexico, the end of June shows them recording 60% of their COVID-19 tests as positive. The true situation in each country is unknown.

What are the implications of this?

Well, we know full well that COVID-19 is having a big impact upon routine healthcare services. In the UK, the NHS has postponed or cancelled non-urgent activities. In countries with a much weaker health system, the impact will be devastating. Routine vaccination programmes have been reduced or halted. Given how infectious measles is, we can be sure that many countries will experience an increase in outbreaks of measles, which always happens after public health emergencies. It’s guaranteed.

Modelled estimates predict an extra 253 500 additional child deaths and 12200 additional maternal deaths, in 6 months, in 118 low- and middle-income countries, in the least severe scenario. The most severe scenario calculates >1 million extra child deaths and 56700 extra maternal deaths. We can also expect to see big increases in malaria as routine distribution of medicines and bed nets are affected. And really, you can assume impacts across any area of health. In years to come, we will look at 2020 and 2021 as showing big spikes in the burden of disease.

How does this affect me?

Second waves, yes? Or, perhaps, the first wave doesn’t end. Regardless, we’ve seen how big and bad COVID-19 can be, with a hefty death toll and an under-appreciated number of long-term health issues that patients suffer long after the initial infection has gone.

The end game for new cases is a vaccine. Until that point, it’s a problem everywhere. We have seen further outbreaks and new lockdowns in China, and at time of writing, the UK city of Leicester has restrictions in place. A second wave is clearly already under way in Israel, and therein lies the problem.

Until COVID-19 is conquered everywhere, it can be reintroduced anywhere. It remains your problem.

I’m am a researcher focusing on infectious diseases, I have a background in public health research and epidemiology.

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