A CSH overview on the COVID-19 pandemic

UPDATED ON April 6th 2021

The COVID-19 epidemic:

The years 2020 and 2021 will be forever associated to the COVID-19 epidemic. They will for this reason become a landmark in the history of the humankind. Surprisingly enough, it is not so much the health consequences of the epidemic itself – however severe these may seem – that will make 2020 and 2021 famous in the history. COVID-19 is estimated indeed to have killed a little less than 2.9 million people worldwide since its beginning 16 months ago. While this is certainly not the final assessment of the epidemic, there is now some hope that the vaccination process that is gaining momentum will reduce the severity of the disease and bring many regions of the world to herd immunity, at least for a while. Yet, as the graph below clearly indicates, we are not quite there yet, and the humankind is currently hitting a fourth wave of the epidemic. 

Figure 1: Dynamic of the daily COVID-19 related deaths

The not less spectacular current resurging of the Indian epidemic, depicted on the figure below, suggests that this global fourth wave has not yet reached its peak.

Figure 2: History of the COVID lethality in India

While the death toll of COVID-19 may seem to be impressive, it remains quite modest when compared to those of past epidemics, be they relatively recent, or more ancient. The Hong Kong flu epidemic of 1968-1969 for instance is estimated to have killed from 1 to 4 million people worldwide, for a world population of 3 billion (as compared to the 7 billion people who live on Earth nowadays). The 1957-1958 H2N2 pandemic is also estimated to have killed around 1.1 million people worldwide, for a world population of 2.5 billion. And these figures are obviously very low when compared to the 20-50 millions of death caused by the Spanish Flu in 1918-1923 (over a population of 1.5 billion), or to the third of the European population that was apparently killed by the Black Death of 1346-1353.  The health consequences of COVID-19 are also modest when compared to those of other major causes of death – many of them avoidable – that the humankind is facing. According to the World Health Organization, in 2017, 1.3 million people worldwide died from road accidents, 15.2 million people died from cardiovascular diseases, and 9.6 million died from cancers.

The main reason why COVID-19 will become an episode of significant importance in the human history is the astonishing fear it has caused, and which is responsible for the adoption of policy measures of unprecedented stringency to prevent its spreading. While the actual impact of those measures on mitigating the health consequences of COVID-19 is far from clear, their dire economic and social consequences are amazing, and unprecedented in the last century. The following table, showing some recent estimations of the economic growth rate for 2020 in some of the largest economies, is clear from that perspective.

Country name Estimated GDP growth rate 2020 (%),
(source: the Economist, January 31st 2021)
Australia -2.9
South Africa -7.3
Brazil -4.4
Canada -5.5
China 1.9
France-9.2
Germany -5.4
India -7.9
Italy -9.1
Japan -5.3
Pakistan -2.8
Russia -3.8
South Korea -1.1
UK -11.4
US -3.6

If we except China, all countries of the table are therefore estimated to have experienced severe reductions in their national income in 2020. The drops of GDP by 8% and 9% observed in India and France respectively are unprecedented in the history of these two countries. Behind these (spectacularly) negative numbers lie the dire realities of 150 millions of people worldwide who have been plunged into the hell of extreme poverty (defined by an income of less than 1.9 US dollar per day in purchasing power parity) according to the most recent estimate of the World Bank. It is the first time in the last 20 years that the world is experiencing an increase in the rate of extreme poverty.  India, which concentrates one-third of the world’s population of extremely poor people is obviously heavily concerned by this descent into hell.  

COVID-19 has hurt us. The policies that we have put into place to prevent its adverse health consequences have hurt us even more. This is what makes the COVID-19 epidemic so exceptional.

The next table provides numbers that describe the current state (as of April 5th, 2021) of the COVID epidemic in East Asian countries as well as in a few others that are “salient” in terms of their population size, severity of the COVID, or their geographical localization. Countries in this table are ranked decreasingly in terms of the lethality rate of the COVID-19. As can be seen, countries are extremely diverse on this matter. In the world’s most severely affected country so far, Czechia, more than 2500 people per million have died from COVID-19. Italy, UK and the US are other countries that have paid a heavy death toll of above 1500 deaths per million people to COVID-19. Latin American countries have all paid a surprisingly severe dead toll to COVID-19 given their young population. At the other extreme, one finds East Asian countries such as Cambodia, Laos, Taiwan and Vietnam who have seen less than 1 person out of a million dying from COVID.

Country Number of cases Number of deaths Country population Median age Number of tests per million Number of deaths per million people Fraction of population fully vaccinated (%)
Czechia 1 555 245 27 169 10 689 209 42,10 1 124 762,08 2 541,72 5,46
UK 4 362 150 126 862 67 530 172 40,50 1 838 396,00 1 878,60 8,04
Italy 3 678 944 111 326 60 550 075 45,50 830 036,00 1 838,58 5,75
US 31 496 976 569 282 329 064 917 38,10 1 142 600,64 1 730,00 18,96
Peru 1 590 209 53 138 32 510 453 28,00 139 632,94 1 634,49 0,98
Spain 3 311 325 75 783 46 736 776 42,70 776 702,76 1 621,49 6,10
Mexico 2 251 705 204 399 127 575 529 28,30 44 447,86 1 602,18 0,92
Brazil 13 023 189 333 153 211 049 527 32,60 30 426,23 1 578,55 2,29
France 4 833 263 96 875 65 129 728 41,40 990 191,55 1 487,42 4,77
Colombia 2 456 409 64 293 50 339 443 30,00 253 332,40 1 277,19 0,78
Germany 2 903 036 77 653 83 517 045 47,10 602 631,39 929,79 5,19
South Africa 1 552 416 52 995 58 558 270 27,10 167 420,78 905,00 0,46
Iran 1 963 394 63 506 82 913 906 30,30 142 853,34 765,93 N.A.
Israel 834 222 6 253 8 519 377 29,90 1 762 862,71 733,97 57,06
Russia 4 597 868 101 106 145 872 256 39,60 829 284,63 693,11 3,18
Canada 1 014 374 23 118 37 411 047 42,20 742 294,52 617,95 1,92
Turkey 3 529 601 32 456 83 429 615 30,90 465 323,91 389,02 8,63
Saoudi Arabia 393 377 6 704 34 268 528 27,50 443 097,85 195,63 N.A.
Indonesia 1 542 516 41 977 270 625 568 30,20 31 577,32 155,11 1,48
Philippines 812 760 13 817 108 116 615 23,50 89 174,22 127,80 0,03
Maldives 25 053 67 530 953 28,20 1 218 680,37 126,19 N.A.
Egypt 205 732 12 210 100 388 073 23,90 N.A 121,63 N.A.
India 12 686 049 165 577 1 366 417 754 28,10 179 968,82 121,18 0,79
Nepal 278 210 3 036 28 608 710 24,10 79 540,11 106,12 N.A.
Japan 485 325 9 231 126 860 301 47,30 73 196,41 72,77 0,19
Pakistan 696 184 14 924 216 565 318 23,80 47 549,37 68,91 N.A.
Myanmar 142 511 3 206 54 045 420 28,20 45 929,70 59,32 N.A.
Bangladesh 644 439 9 318 163 046 161 26,70 28 816,01 57,15 N.A.
Malaysia 353 329 1 300 31 949 777 28,50 241 358,49 40,69 0,87
Australia 29 377 909 25 203 198 38,70 619 493,61 36,07 N.A.
South Korea 106 230 1 752 51 225 308 41,80 150 658,79 34,20 0,05
Hong Kong 11 532 205 7 436 154 44,40 1 505 304,09 27,57 1,21
Sri Lanka 93 595 581 21 323 733 32,80 114 159,47 27,25 N.A.
New Zealand 2 531 26 4 783 063 37,90 397 844,44 5,44 0,34
Singapore 60 519 30 5 804 337 34,60 1 472 407,44 5,17 8,06
China 90 341 4 636 1 433 783 686 37,40 N.A 3,23 N.A.
Thailand 29 571 95 69 037 513 37,70 45 091,41 1,38 0,07
Cambodia 2 915 22 16 486 542 25,30 N.A. 1,33 N.A.
Bhutan 896 1 763 092 27,60 768 579,67 1,31 N.A.
Taiwan 1 050 10 23 773 876 40,70 8 035,80 0,42 N.A.
Vietnam 2 658 35 96 462 106 30,50 25 733,44 0,36 N.A.
Laos 49 0 7 169 455 23,00 N.A. 0,00 N.A.

The following map shows how unequal the lethality of COVID has been across countries.

A common explanation put forth to explain the diversity of the countries in terms of their Covid death toll is their age structure (COVID tends to hit more severely old people). Hence, one could expect countries with a young population to pay a lower death toll to COVID than countries with an older age structure. Figure 3 below shows that this impression is corroborated by the existing data, even though the relationship between the countries’ age structure – measured by median age – and the lethality of COVID is far from perfect. For one thing, Latin America countries have a very young population structure and yet they pay an impressive dead toll to Covid. At the other extreme, countries like Taiwan and Japan have a rather aged population structure and do not suffer much from the direst consequences of COVID mortality.

Figure 3: number of death per million people

Another commonly heard explanation for the amazingly different performances of the countries in avoiding COVID-19 mortality is their differing testing capacities. Yet, there does not seem to be a significant correlation between a country’s testing capacity – measured by the number of tests performed per million people – and its performance in avoiding COVID-19 test. As shown in Figure 4 below, countries that pay the largest death toll to COVID tend to be those who test the most, even though the relationship is extremely weak. The reason for this lies in the simultaneous determination of COVID epidemic and the testing policy. On the one hand, a wide and generous testing policy may reduce the death toll from COVID by easing the tracking of people, and preventing, therefore, the spreading of the disease.  This direction of causality would suggest a negative impact of testing capacity on COVID lethality. On the other hand, when COVID is very active and people get infected and develop symptoms, they want to be tested. This demand-induced testing goes in the direction of a positive relationship between the intensity of COVID and the number of tests done. The balance between the two effects is what is captured on Figure 2. 

Figure 4: number of tests per million people

What about vaccination?

Vaccination has started in December 2020, albeit at a various pace in the different countries in the world. As of now, almost 147 million people have been completely vaccinated worldwide (which means, for most vaccines, receiving two shots). The following picture, which shows the evolution of this number of “completely vaccinated” vaccinated people suggests that the vaccination effort has not yet been sufficient to affect the dynamic of the epidemic. Indeed, the steep increase in the total number of fully vaccinated people worldwide observed at the beginning of January does not seem to have impacted the decreases in the daily number of cases already observed before the beginning of the vaccination.

Figure 5: World history of Covid deaths and vaccination

However, the Israel experience may make one somewhat optimistic about the impact of vaccination if performed at a very large scale. Indeed, Israel is by far the country in the world that has vaccinated the largest fraction of its population (above 50%). The following picture, showing the evolution of the total number of totally vaccinated people (in thousands) and the daily number of new covid cases, is suggestive of a clear impact of the former on the latter. What is unclear however is the duration of the protection that vaccines are likely to provide against COVID-19.

Figure 6: History of Covid and vaccination in Israel

Nicolas Gravel, Director of the CSH.

Regarding the CSH scientific production linked to the topic:

  • Nicolas Gravel in conversation with Ms. Abantika Ghosh “InResearch” on the topic Why does the lethality of COVID-19 differ so much across countries? The recording of the interview is available at https://fb.watch/4Q3SSw6A8S/

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