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Covid 19 Performance
March 15 to April 21st 2020
Dr.Andrew Black,
Digit Ltd, Brunel Business School, GPI
April 2020 ,
Digit Ltd & Brunel Business School 1
Covid 19
Situation Report March/April 20th 2020:
by Dr. Andrew. Black
Digit Ltd & GPI London 2
• These slides provide a global overview of the
development of COVID 19, the number of
cases, the number of fatalities, and fatality
rates.
• These are shown for 7 main regions.
• Data is from John Hopkins Covid data archive
Digit Ltd & GPI 3
Introduction
Broad Conclusions I
• March saw the explosion of Covid out of its original area, China, and into Europe.
• Since then Covid has infected the USA. The US now has the largest number of cases of a single country.
• The first week of April saw a substantial deterioration in fatality rates. This is largely a function of the rate of infection, and the type of patients infected
• Infection rates are higher than originally expected, with a r (reproduction rate) of between 2.5 and 3.2 (Imperial College).
• The main centres continue to be Europe , N.America. And China.
Digit Ltd & GPI London 4
Broad conclusions II
• Regions such as Africa, S.Asia and S.America
still have small numbers of Covid19 patients
• Their numbers are growing very fast,
• The rate of increase in the number of cases is
starting to fall in some regions (Europe,
N.America)
• The absolute number of new cases continues to
rise, or is stabilizing at a high level
Digit Ltd & GPI London 5
Broad Conclusions III: Fatalities
• There are substantial differences in the performance of fatalities. The worst performing countries are Spain, Italy, Britain and France.
• Some countries have markedly better fatality performance, particularly Germany, Finland, S.Korea, Taiwan and Singapore
• This is due to a combination of better social control methods (including testing), and partly due to better legacy medical systems with better equipment levels and standards
Digit Ltd & GPI London 6
Covid Stages:
Suggested Sequence • The disease is spreading out from its ground zero, China/Hubei province/Wuhan.
• Stage 1: Few cases, mostly contained. Few fatalities. Virus appears to be under control and is “trapped”. Person to person transmission relatively low
• Stage 2: Escape. Covid infects others outside of original areas. Infection clustes occur in densely populated cities and areas with many vulnerable people (the elderly and those with existing medical conditions). Very rapid growth occurs. Daily growth rate in new cases 30% plus per day
• Stage 3: Lock downs and introduction of other social measures. Infection rates come down as a proportion of total cases. However, in absolute number the daily increase can still be rising
• Stage 4: Stabilization. Lock down starts to work. More testing and protective equipment reduces cases/fatalities. There is still some overall growth in cases, fatalities stabilize
• Stage 5: Declines in the number of new cases. Declines in the number of fatalities. Probably accompanied by reduction in severity of social control measures.
• Stage 6: Relaxation of social control and distancing measures. Introduction of measures to proect the vulnerable. Danger of a further second or tertiary infection wave.
Digit Ltd & GPI London 7
Overall Situation
April 21st 2020
• 2.469 million Covid Cases world wide
(0.032% of the global population)
• 169,961 fatalities
• A fatality rate of 6.9 % - rising steadily
• Significant variation in fatality rates:
Digit Ltd & GPI London 8
High Fatality Countries
Fatalities % Confirmed Cases Apr 06 and Apr 20
Digit Ltd & GPI London 9 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00%
Algeria
Antigua and Barbuda
Bahamas
Belgium
Congo (Kinshasa)
Egypt
France
Guyana
Honduras
Hungary
Indonesia
Italy
Liberia
Mexico
Netherlands
San Marino
Spain
Sudan
Sweden
Syria
Togo
Trinidad and Tobago
United Kingdom
Zimbabwe
Bangladesh
Colombia
Mali
Antigua and Barbuda
Honduras
Highest Fatality Rate Countries
Apr 06 and Apr 20th Compared
Fatality Rate Apr 06th Case-Fatality 20 Apr
High Fatality Countries
(Death traps)
• Many of them have fatality rates over double the global average
• European countries perform badly – higher proportion of elderly patients ?
• List is not stable. During April most European countries in this group performed worse
• Some developing countries dropped out of this list, e.g. Bangladesh, Colombia
• Most of the new entrants are from outside of Europe.
Digit Ltd & GPI London 10
Low Fatality Countries (Less that 25%
of the global fatality average):A varied list. • Australia
• Israel
• Chile
• Kuwait
• Latvia
• Malaysia
• New Zealand
• Russia
• Singapore
• Taiwan
• Thailand
• Some are at early stages
• Some have better social control systems
• Some have poor records
• AsiaPac countries well represented.
• Experience with SARS and MERS acted as a wake up call.
Digit Ltd & GPI London 11
During March shift in centre of Gravity away from AsiaPac,
towards Europe & N.America
• A big rise in share of
N.America.
• Europe remains the hot
spot: its relative share
declined slightly in early
April
• AsiaPac share fell steadily
• Numbers in Africa and
S.Asia still low, rising
very rapidly
Digit Ltd & GPI London 12
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
s.Asia Europe MENA AFRICA S.AMERICA CIS ASIAPAC N.AMERICA
REGIONAL SHARE COVID CASES
MARCH/APRILS 2020
Share March 15
Share March 31
Share April 20
Fatalities lag the new cases:
Europe still the main centre for fatalities
Digit Ltd & GPI London 13
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
s.Asia Europe MENA AFRICA S.AMERICA CIS ASIAPAC N.AMERICA
REGIONAL SHARE COVID FATALITIES
MARCH/APRILS 2020
Share March 15
Share March 31
Share April 20
After initial high volatility, daily
growth rates of new cases settling down
AsiaPac cases still growing
Digit Ltd & GPI London 14
CIS
AsiaPac
Eur
N.Amer
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00% Daily Compound Growth Rates
COVID cases by Region: Major Regions
Europe MENA ASIAPAC N.AMERICA
Daily growth rates in higher
income regions are decelerating
• Daily Growth rates of new cases are falling
• They are still in the region of 5% per day,
which is still a high rate
• This will keep pressure on health systems
Digit Ltd & GPI London 15
Daily growth in new Cases
around 10% in lower income regions
Digit Ltd & GPI London 16
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%Daily Compound Growth Rates
COVID cases by Lower Income Regions
s.Asia MENA AFRICA S.AMERICA CIS
Daily growth rates in new cases
now higher in the lower income regions
• Still some volatility in the growth rates
• Unclear whether the lock down measures are
working. Many countries still at stages 1 and 2
of the cycle
Digit Ltd & GPI London 17
Number of New Cases Still Growing
Very Fast. Between 20 and 30k per day
in Europe and N.America. On the ground the crisis persists
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
17
-Mar
-20
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-Mar
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20
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-20
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-Mar
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-Mar
-20
29
-Mar
-20
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-Mar
-20
31
-Mar
-20
01
-Ap
r-2
0
02
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r-2
0
03
-Ap
r-2
0
04
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r-2
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r-2
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r-2
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r-2
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r-2
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r-2
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r-2
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r-2
0
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r-2
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r-2
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r-2
0
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-Ap
r-2
0
19
-Ap
r-2
0
20
-Ap
r-2
0
DAILY INCREASE IN COVID CASES BY REGIONMARCH/APRIL 2020
s.Asia
Europe
MENA
AFRICA
S.AMERICA
CIS
ASIAPAC
N.AMERICA
Digit Ltd & GPI London 18
Crisis severity unequal around the
world
• Europe and N.America are both experiencing around 30k new cases per day
• Covid 19 has essentially “escaped” in these regions.
• Their experience very differnt from that of AsiaPac (China)
• Lower income regions are experiencing growth in new cases less than 10k per day
• There are signs that the absolute number of new cases is still accelerating in CIS and S.America.
Digit Ltd & GPI London 19
AsiaPac eclipsed by Europe and N.America
in terms of Share of Covid Fatalities
Digit Ltd & GPI London 20
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
s.Asia Europe MENA AFRICA S.AMERICA CIS ASIAPAC N.AMERICA
REGIONAL SHARE COVID FATALITIES
MARCH/APRILS 2020
Share March 15
Share March 31
Share April 20
Covid Fatalities
(mid April 2020)
• Europe the global hot spot, followed by
N.America
• AsiaPac and MENA shares are falling steeply
• S.America, S.Asia & CIS likely to be entering
accelerating growth phase
• Africa may be the last continent to experience
rapid increase in Covid cases & fatalities
• Fatality numbers lag the number of new cases
Digit Ltd & GPI London 21
Comparisons with Spanish Flu
• Estimated that 25% of the global population caught the Spanish Flu. Global population then was just over 1 billion.
• Today’s global population is 7.8 billion.
• If Covid infection rate similar to Spanish flu, this could lead to as many as 1.95 billion cases
• If fatality rates remain at current levels (4.84%) , this would then lead to 93.6 million fatalities
• If the fatality rate is closer to 2%, then the expected number of fatalities would be in the region of 49 million.
• That is the potential scale of the problem.
Digit Ltd & Brunel Business School 22
Following slide shows
changes in fatality performance by countries
to April 6th compared with March • Many more countries show a deterioration in
fatalities.
• Improving performance on relatively small countries. Trends are volatile and will change.
• Countries included only where there is a a continuous record of fatalities since early March.
• Global fatality rate continues to rise.
• National fatality rate variations substantial. Some are considerably more effective in saving lives than others.
Digit Ltd & GPI London 23
Digit Ltd & GPI London 24
COUNTRY
Most Recent Fatality
Rate worse or better
than average
COUNTRIES BETTER 18
COUNTRIES WORSE 61
Afghanistan BETTER
Albania WORSE
Algeria WORSE
Andorra WORSE
Argentina WORSE
Armenia WORSE
Aruba
Australia WORSE
Austria WORSE
Azerbaijan BETTER
Bahrain BETTER
Bangladesh BETTER
Belgium WORSE
Bosnia and Herzegovina BETTER
Brazil WORSE
Bulgaria WORSE
Burkina Faso WORSE
Canada BETTER
Chile WORSE
China BETTER
Colombia WORSE
Costa Rica BETTER
Croatia BETTER
Cuba WORSE
Cyprus BETTER
Czech Rep WORSE
Dem Rep of Congo WORSE
Denmark WORSE
Diamond Princess WORSE
Dominican Republic WORSE
Ecuador WORSE
Egypt WORSE
Finland WORSE
France WORSE
Germany WORSE
Ghana BETTER
Greece WORSE
COUNTRY
Most Recent Fatality
Rate worse or better
than average
Hungary WORSE
Iceland WORSE
India WORSE
Indonesia BETTER
Iran BETTER
Iraq BETTER
Ireland WORSE
Israel WORSE
Italy WORSE
Jamaica WORSE
Japan BETTER
Lebanon WORSE
Lithuania WORSE
Luxembourg WORSE
Malaysia WORSE
Netherlands WORSE
North Macedonia WORSE
Norway WORSE
Pakistan WORSE
Panama WORSE
Paraguay BETTER
Peru WORSE
Philippines BETTER
Poland WORSE
Portugal WORSE
Romania WORSE
Russia WORSE
San Marino WORSE
Serbia WORSE
Singapore WORSE
Slovenia WORSE
South Korea WORSE
Spain WORSE
Sweden WORSE
Switzerland WORSE
Taiwan WORSE
Thailand WORSE
Tunisia WORSE
Turkey WORSE
UK WORSE
Ukraine WORSE
United Arab Emirates BETTER
US WORSE
Infection Rates &
Cumulative Covid cases
Hypthetical Pandemic Cycle
Digit Ltd & GPI London 25
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
-30.00%
-20.00%
-10.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
Start po
int
1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677
Number of new casesper day
DailyGrowth
Rate
(Assumed)
Time (Days)
Assumed Daily Infection Rates Covid (LHS)and Cumulative cases (RHS)
Assumed Infection Growth rate (LHS)
Cumulative Net number of cases RHS
Summary & Comments
• Model assumes daily growth rates rising to 40%, before dropping back, fairly quickly to lower daily rates (blue line).
• Red line shows the number of new daily cases of Covid.
• Even as the rate of infection declines, so the absolute number of new cases continues to rise
• The situation only improves when the rate of new cases goes to zero, and then starts to fall.
• Note, there are still new cases appearing in China – at a very low rate.
• Negative rates can be thought of as recovery of survivors reducing the overall number of cases
Digit Ltd & GPI London 26
Relevance to actual Covid
• Daily rates of new patients have been in excess of 25%
• This example creates a peak number of patients/cases as 3.5 million
• This is the equivalent of 4.5% of UK’s population. If achieved this would be a good result.
• This scenario plays out over 11 weeks.
• The zig-zag rate of decline is a function of the reducing daily rates.
• Following chart shows development of the cumulative number of cases over the same time period
Digit Ltd & GPI London 27
Regions Defined
• N.America: USA & Canada
• S.America: S.America + Caribbean+Mexico
• Europe: East and West Europe
• CIS: Russia, Ukraine, former parts of the USSR, the “stans” in central Asia, Mongolia
• MENA: Middle East and North Africa. Includes Turkey, Saudi Arabia, Iraq, Syria+ N.Africa
• AsiaPac: All of Asia, and Pacific region. Includes China
• S.Asia: India, Pakistan, Bangladesh, smaller nations in region + Indian Ocean islands
• Africa: Africa south of the Sahara.
Digit Ltd & Brunel Business School 28
On-going issues
with data quality • Most countries have reported Covid cases. Not all of
them have reported consistently (on a daily basis)
• Reporting on fatalities much worse than for the number of cases.
• Difficulties with definitions even in advanced countries. Are COVID deaths outside of hospital included ? Should the right measure be the number of deaths from pneumonia ?
• Are deaths being “correctly” ascribed to Covid 19?
• It is highly likely that both the number of cases and the numbe of fatalities are under-estimates. The true picture is worse than that shown here.
Digit Ltd & GPI London 29