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This post is a summary of reported COVID-19 cases and deaths in the US and Western Europe, for the month of March. My data source is Johns Hopkins (here), and they have posted their data through March 31. Their cutoff time is before the end of the day in the US, so while there may be additional cases and deaths reported from Tuesday, such reports will be included in the April figures.
My focus in this series of analyses has been on the US and Western Europe. This is not due to any lack of care for other countries. My special interest in the US is obvious, and I have principally focused on comparisons with the countries of Western Europe because: (1) they are the hardest hit thus far, particularly Italy and Spain; (2) they have health care systems relatively comparable to the US; and (3) I have greater confidence in the reliability of reporting from these two regions.
The Western European countries are essentially everything west of the old Iron Curtain, ranging in population from Germany to Luxembourg. I did not include the tiny countries such as Andorra or San Marino.
I. I Read The News Today, Oh Boy.
It’s been a rough month. On March 1, the US reported a mere 74 cases of COVID-19 and one solitary death. Western Europe reported 2,166 cases and 36 deaths as of March 1, almost all in Italy (1,694 cases, 34 deaths).
By March 31, 2020, the US has reported 3,873 deaths, with an additional 29,847 in Western Europe. Total reported cases are 188,172 in the US and 427,748 in Western Europe. Of course, this includes only cases that have been confirmed positive for COVID-19 infection. We have reason to believe that many more people have been infected, but I do not believe that we have a reliable way to estimate the totals at present.
Tuesday was a particularly bad day. The US reported 895 new deaths Tuesday, a new daily high for the second day in a row, and significantly more than the 511 deaths reported Monday. Western Europe also had a new daily high for the second day in a row, reporting 3,148 additional deaths, up from 2,769 Monday.
The US reported the largest daily increase in new cases, again for the second day in a row, up to 26,365 Tuesday from 20,921 Monday. Western Europe had more reported cases Tuesday, 32,932, but this was not a record high in this region.
There is mixed news regarding the decline in rates of increase, which I will cover in greater detail in Section IV below.
II. Deaths by Country
I have two charts to illustrate the increasing COVID-19 death toll.
The first chart is adjusted for population, showing total reported deaths by country, with the small countries of Western Europe combined (their combined population is about the same as Germany’s). This chart illustrates the low death toll in the US, thus far, compared to Western Europe. The chart shows total deaths reported by calendar date, but the trend line for each country starts when it first exceeded 0.5 deaths per million.
You can see the significantly higher death rates in Italy (light blue) and Spain (green), and an elevated rate in France (yellow). The graphs for the US (blue with yellow glow) and Germany (orange) largely overlap at the very bottom.
These figures look alarming, particularly for Italy and Spain, due to the scale. This chart reports deaths per million, so Italy’s figure, slightly over 200 deaths per million, is approximately 0.02% of the population. The US figure is about 12 deaths per million, which is approximately 0.001% of the population.
There is significant variability in the smaller countries that make up the Other Western Europe category. Two of them — Belgium and the Netherlands, at around 60 per million — have a death rate somewhat higher than France, and Switzerland, at around 50 per million, is only slightly below France. The others are lower.
The second chart is a bit confusing. It shows the daily rate of growth in reported deaths, by country. As you can see, the figures often vary significantly, and this is even after data smoothing using a four-day moving average.
You can see that the general trend line for the various countries is downward, which is good news. Italy’s reported deaths (light blue) are now increasing at less than 10% daily, and Spain (green) is under 15%.
The general tendency has been for a high rate of growth in the early period, later declining.
The trend line for the US (blue with yellow glow) is at about 25% daily growth, and generally declining.
I think that it is helpful to visualize these trends, and encouraging that they are generally heading downward. However, there is no guarantee that the decline in the growth rate will continue.
III. Reported Cases by Country
I have similar graphs for reported cases by country. I consider reported cases to be a less reliable indicator than reported deaths, due to limitations in testing. But it remains the second most important source of information, at present.
This chart shows reported cases per million, by country. As before, the chart shows figures by calendar date, but the trend line for each country begins when the country passes 10 cases per million.
Much has been made in some news reports about the US having the highest number of reported cases. This is true, with the US reporting 188,172 cases as of March 31, followed by Italy with 105,792. But the US has about 5.5 times the population of Italy. This chart puts the number of reported cases in the proper perspective.
Another thing that you should note is that the trend lines for reported cases are often quite different than for reported deaths. Italy and Spain are at the top in both measures, but notice that Germany, France, and Other Western Europe follow very similar trajectories in cases per million, while France is much higher, and Germany very low, in deaths per million. Also note that the UK is notably lower in reported cases per million than the United States, but notably higher in deaths per million.
In reported cases per million, Switzerland (at about 1,900) is higher than Italy. The highest of all is tiny Luxembourg, with almost 3,500 reported cases per million.
The next chart is the daily rate of growth in reported cases, by country. This one is a bit easier to read than the comparable chart in the preceding section. As you can see, it shows a general downward trend in all countries.
This does not mean that the number of cases reported each day is decreasing. On the contrary, it is generally increasing. But the rate of growth is declining, which is good news.
Some may claim that this chart demonstrates the effectiveness of the “lockdown” and other remedial measures. It does not. This information neither proves nor disproves the effectiveness of such measures. Italy did not implement a regional “lockdown” until March 8 (in Lombardy), and extended it to the nation on the following day (March 9). As you can see, the rate of growth in reported cases was already decreasing in Italy (light blue) before these measures.
This does not show that the lockdown was ineffective, either. Evaluating the effectiveness of such measures would require more information. I urge you not to jump to conclusions either way.
IV. General Improvement But A Dreary Tuesday
I have two more charts for you, as an alternative way to visualize the decline in the rate of growth in recent days. The first addresses deaths and the second addresses reported cases.
This chart shows the rate of growth in reported deaths, in four bars from each country, with the oldest dates on top. So for each country, the blue bar shows the average daily rate of growth for March 21-24 (4 days); the orange bar shows the average for March 25-28 (4 days), and the final three bars show the rates of growth for the past three days.
You can see that the general trend was downward in all countries, until March 31. Tuesday was a difficult day for the US, the UK, and the Other Western European nations, with a notable increase in reported deaths.
Thankfully, the news remains quite favorable in Italy and Spain. Remember that they are vastly harder hit than we are — Italy has 17 times more deaths per million than the US, and Spain has 15 times more.
Despite the uptick Tuesday in some countries, the rate of increase in reported deaths has been lower over the past three days, in all of these nations, than it was in the four preceding days.
Here is the same chart for the growth in reported cases. Here the news is better, with significant declines everywhere except France Tuesday.
The very low rate of growth in reported cases in Italy — around 5% or less each day for the past three days — is extremely good news. The growth rate has been under 10% in Spain for three days, as well. This is a good sign that these hardest-hit countries may be turning the corner quite soon.
I expect that a decline in the growth rate in reported cases will lead to a similar decline in the growth rate in deaths, with a lag of perhaps 10-15 days.
There may be a way to test this hypothesis, perhaps with a regression analysis of the growth rate in deaths (the dependent variable) as a function of the growth rate in reported cases (the independent variable) with a selected lag time. It’s getting late, so I’ll consider this Wednesday.
I wish that I could tell you that April will be a better month than March. I think that this is possible for Italy and Spain, but only because they had such a terrible March. I expect that April will be a significantly more difficult month than March for the US but hope that the worst will be over by the end of April. There is no guarantee of this.
For some reason, in my consideration of the coronavirus pandemic, I’ve been reminded of two things over the past couple of days. The first is the great speech that Morpheus gave in Matrix Revolutions:
Believe me when I say we have a difficult time ahead of us. But if we are to be prepared for it, we must first shed our fear of it. I stand here before you now truthfully unafraid. Why? Because I believe something you do not? No! I stand here without fear because I remember. I remember that I am here not because of the path that lies before me but because of the path that lies behind me.
The path that lies behind me is the path that lies behind us all. Our friend Bryan Stephens has a great post on this (here). We have faced war and pestilence and economic crisis before, and always emerged stronger.
The second thing that comes to mind is the various chapters in Churchill’s The Second World War dealing with the Battle of the Atlantic. This was the crucial battle for the Western Allies, on which all else depended. But there was no obvious victory in the battle against the U-boats. It was the numbers, and the charts, and the graphs that showed when the tide had turned, when increased Allied effectiveness at sea and in the air started driving down the number of U-boats, and losses declined, and the titanic shipbuilding efforts of the US ultimately made good all of the losses and allowed us to transport the men and material that laid low the Third Reich.
It will happen again. As Morpheus ended his speech — the great Laurence Fishburne in his greatest role delivering his greatest line — “Tonight, let us make them remember. This is Zion, and we are not afraid!”
You can watch it here, if you’re so inclined.
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