Three pieces written at the beginning of the blog are reviewed and updated here. Together they show that whilst we have more insight into some aspects of COVID-19, there is still much we do not yet know.
Sweden - Standing Alone? (click here to read) written on 30 March 2020.
Sweden did not lockdown to the same extent as other countries in Europe. Gatherings of more than 50 people were banned and social distancing encouraged but schools, shops, bars, clubs and restaurants remained open. Rather than impose strict rules, the Swedish government instead issued guidelines and hoped that people would take their individual responsibilities seriously and adhere to them. The guidelines emphasise the need for regular hand washing, working from home if possible and limiting travel. The elderly and medically frail were advised to stay at home. There were no restrictions on going out into public places. The prime minister, Stefan Löfven, in a televised address said "We who are adults need to be exactly that: adults. Not spread panic or rumours." (1)
Not everyone agreed with the approach with experts such as virologist Professor Björn Olsen calling on the government to “shut down everything that’s possible to shut down” as quickly as possible. (2)
By mid-April, with cases and deaths rising substantially compared to its Scandinavian neighbours, 22 researchers publicly criticized the strategy and called on politicians to make changes but no further restrictions were implemented. More than half its deaths, around 60%, have been in the elderly. (3)
This is the current data for Scandinavia:
Total cases of COVID-19:
Sweden 73,344
Norway 8,947
Finland 7,265
Denmark 12,900
Norway, Finland and Denmark have very similar population sizes of approximately 5.5 million people each, the population of Sweden is just under twice that at 10 million. However it can be seen that Sweden has had between six and ten times as many cases. Adjusting for population size, the figures are:
Total cases of COVID-19 per 1 million people:
Sweden 7,261
Norway 1,650
Finland 1,311
Denmark 2,227
For comparison the UK's figure is 4,218 cases per 1 million people and Italy's is 4,002.
In terms of deaths, the data for Scandinavia shows:
Total number of deaths from COVID-19:
Sweden 5,447
Norway 251
Finland 329
Denmark 609
And adjusting for population sizes:
Total deaths from of COVID-19 per 1 million people:
Sweden 539
Norway 46
Finland 59
Denmark 105
For comparison the UK's is 654 deaths per 1 million people and Italy's is 577. (4)
One of the prime reasons given for a limited lockdown is to keep the economy stable but in reality economic benefit was not seen in Sweden. Problems with supply chains meant many businesses still could not work at their normal capacity. The shops may have remained open but people started to limit their shopping and avoid places such as shopping malls and restaurants. However the reduced foot fall in public places, whilst hurting the economy, was not enough to limit the virus spreading. (5) (6)
Sweden remains in the position of standing alone, but for very different reasons now. It has been excluded from the UK's air bridges arrangements and most European countries remain closed to Swedes including its Scandinavian neighbours. The UK government is still advising against all but essential travel to Sweden. (7) (8) (9) (10)
The loose lockdown measures in Sweden were very similar to those first instigated in the UK before the latter imposed a much tighter lockdown just one week after announcing its initial measures. I commented at the time that only hindsight would tell us which countries had fared the worst but it is looking increasingly likely that by not adopting a stricter lockdown regime, Sweden forfeited the chance to have final case numbers akin to its Scandinavian neighbours.
COVID-19 and the Low Income Countries of the World (click here to read) written 3 April 2020.
At the time, and in further updates to the piece, it was noted that India, Pakistan and Bangladesh were seeing exponential rises in their number of new cases and deaths each day and that all three countries were yet to reach the peak of their outbreaks. It is still the case that the pandemic is accelerating in these countries with India now overshadowed by only the USA and Brazil in its case numbers. (4)
South America as a whole continues to be in the grip of its outbreak but Brazil is now second only to the USA for the total number of cases and is still not near the peak of its outbreak. Brazil's president, Jair Bolsonaro, continues to attract severe criticism both at home and internationally for his refusal to acknowledge the seriousness of the pandemic although he tested positive for COVID-19 on 7 July 2020. There are fears that should he have the mild version of the disease this will harden his approach of describing COVID-19 as a minor ailment. (11)
In Bangladesh, there have now been 49 cases of COVID-19 and five confirmed deaths in the refugee camp in Cox's Bazar but more detailed information is hard to find. Given the fact that refugee camps and city slums provide an ideal environment for the virus to spread it is highly likely the true figures are much higher. (12) (13)
Africa appears on an initial glance to be faring better than the rest of the world in terms of its figures but they are more likely to reflect the fact very few African countries have the kind of testing capacity seen elsewhere in the world than a true lack of disease. South Africa with its better health infrastructure and testing capacity has had more than 200,000 cases. Where figures are available for individual countries, they are all showing an exponential rise in cases. (14)
You can find more detailed pieces on Malawi, Tanzania & Nigeria and South Africa & DRC by clicking on their names.
COVID-19 - Why Is Race Playing a Role in Outcome? (Click here to read) written 14 April 2020.
At that time concern was growing that people from the BAME community (Black, Asian and Minority Ethnic) were disproportionately dying from COVID-19. Twelve UK doctors had died from COVID-19 and all were men over the age of 50 and of BAME origin. In the US and other countries in Europe the BAME population were disproportionately represented in both the number of cases and deaths from COVID-19.
Many theories were muted as possible reasons for this including socio-economic factors, genetic pre-susceptibility and the presence of other co-morbidities such as diabetes which are more prevalent in the BAME community.
As of 9 July 2020, more than 300 NHS staff have died from COVID-19 and 60% were from the BAME community. (15)
Weekly analysis by Public Health England (PHE) shows that the spread of the COVID-19 virus is now more concentrated in the Asian community. Numbers of cases in both the black and white populations are reducing but they have stayed at a constant level in the Asian population. (16)
It is still not clear if the BAME population have a specific predisposition to COVID-19 or if it is a combination of underlying medical conditions and health inequalities that is the real reason they are disproportionately represented in the COVID-19 data.
Scientists continue to research the link between ACE2 receptors , their role in COVID-19 and if they are the possible link between infection and worse outcome in the BAME community. (17)
Meanwhile, the UK government has started a public inquiry entitled "Unequal impact? Coronavirus and BAME people" in an attempt to establish the root causes of the issue. (18)
(7) https://www.telegraph.co.uk/news/2020/06/27/portugal-sweden-turkey-fighting-secure-air-bridges-uk/
(12) https://www.devex.com/news/as-covid-19-deaths-rise-in-cox-s-bazar-is-increased-testing-enough-97412
