The focus of the pandemic seems to have shifted from Europe to Latin America, while the situation in the US is slowly improving.
The extent to which the disease has spread and the intensity it has received in each country is the result of the complex combination of many different and heterogeneous parameters.
The first and most important uncertainty lies in the very data presented by each country, either due to political expediency (Russia and Turkey are almost certain to present incomplete data), or due to the inability of state mechanisms to collect and monitor the data, in combination with poor public health infrastructure and the inability of a large part of the population to access them (as is the case in many of the poorest countries in Asia, Africa and South America).
Undoubtedly, the adequacy and readiness of the public healthcare system has played a very important role in the proper and effective management of hospitalized cases and the avoidance of in-hospital spread of the epidemic, with Austria and Germany being among the main examples.
Taking measures to limit social and economic interactions has not been as effective in all countries. Their timing was extremely crucial (as in the case of Greece), while initial hesitation (Great Britain) or even small delays (France, Spain), were significantly less effective.
Quarantine of cases and contacts’ tracking has been implemented in most countries. Some of them (South Korea and Taiwan), used extensive, controversial and possibly extreme, electronic surveillance methods. Combined with their experience of previous viral outbreaks, these measures appear to have contributed to the rapid spread of the spread.
Social habits, lifestyle, age composition of the population are also parameters that affected the spread and results of the epidemic in each country. Sweden, with almost zero measures to reduce social and economic interactions, to this day, presents a picture comparable to France, proportionally to the respective populations, although a definite weakening trend is not yet apparent.
Countries that show significant flows of visitors for business, political and tourist reasons (Italy, Spain, France, Germany, Great Britain, Belgium), and / or are significant transit hubs for air transport, were much more exposed to imported cases.
Random factors, such as sporting and cultural events, which brought together large numbers of people before the actual magnitude of the pandemic was acknowledged, certainly contributed, to some extent. to the spread.
Temperature and humidity conditions, directly and indirectly, affect if not the virus itself, at least the ease of transmission, but also form different local lifestyles.
The actual effect of each of the above factors (and possibly several others), for each country, may never be accurately established, but a qualitative evaluation will be valuable for the control of future outbreaks of the same, or other infectious diseases.
The data for the selected group of countries will continue to be updated periodically, without always being accompanied by commentary. Individual overviews for each country are becoming available in order to monitor the effect of restrictions being gradually lifted.
The criteria on the selection of the countries monitored and the explanation of the parameters can be found here.
It is noted that the present analysis has exclusively informational character and in no case constitutes a specialized statistical processing and a tool for making or evaluating decisions and measures.
The process of lifting the restrictive measures and the gradual activation of the various activities includes the continuous monitoring of the numerical and qualitative data of the evolution of the pandemic.
As part of this process, it is extremely likely that measures will need to be adjusted, possibly partially restored, locally or across the country.
The evaluation of the course of the pandemic will not be based on a single parameter (eg the number of cases), but will be a complex assessment of many different parameters.
Another factor that should be taken into account in the evaluation of the data of the next few days is the differentiation in the policy of conducting test, with increasing the number of tests and the range that they will cover. An increase in the number of confirmed cases in the coming days, both due to the increase in the number of tests and due to the lifting of restrictive measures, should be considered extremely likely. Up to 50 new cases per day should not be considered a concern. On the contrary, numbers of new cases approaching 100 per day, depending on their quality composition (concentration, dependence, origin) and their time evolution, will be a possible factor in reviewing the process of lifting the measures.
The rate of increase in the number of deaths will be one of the important parameters, as it has been an absolute measure of the evaluation of the epidemic in Greece and is independent of the change in policy in conducting tests.
Particularly important is the number of critically ill patients typically translated into ICU beds. The possible growth rate will be a criterion of particular importance, as it will result in the projection of its evolution at numbers initially above 100 and especially above 150. It is noted that a projection that will lead to prices above 200 will be the absolute worst scenario.
Finally, the effective reproduction rate of the disease, which is calculated from mathematical models for monitoring the epidemic, will be the main decision-making tool.
Regarding the progress of the pandemic in other countries, Turkey and Russia have been added to the group of countries whose data are being monitored in the context of this effort. It should be noted that there is a lot of skepticism around the world about the accuracy of the data they publish, mainly Turkey and secondarily Russia. Of course, the accuracy of the data, either as a result of incomplete / delayed collection of data or as a state policy direction, is the subject of discussion for several other countries, such as Great Britain, which states that the deaths so far concern only those who have taken place in NHS institutions.
In almost all of Europe, the pandemic is weakening, and most countries are turning their attention to the next day.
The main exceptions are Great Britain and Sweden. In the UK, the number of cases and deaths remains high, while the lack of updated information for critically ill patients does not allow for a complete picture. In Sweden, the rate of increase in deaths remains significant, while the number of critically ill patients is slowly but steadily increasing.
In Greece, the rate of increase in cases and deaths is constantly decreasing, as well as the number of patients in critical condition. However, it should be noted that the local outbreaks in clinics that have been noted in the last few days in clinics are high risk factors.
During the gradual lifting of the measures, it will be particularly important to be able to conduct much more examinations than have been done to date.
Another important parameter is the proper information-training of the public on how to use masks and gloves, as their use by the general population to date, including employees in grocery stores, is in many cases wrong and a possible source of more problems.
One of the most interesting announcements of the day came from China, which revised the death toll in Wuhan by adding 1,290 deaths and increasing the total by 40%.
The announcement comes at a time of increasing skepticism about the numbers of cases and deaths in China, as more data are becoming available from many countries at an advanced stage of the pandemic. Either due to inefficiencies in data collection inside China, or because of under-reporting, it is quite possible that the actual numbers may be significantly higher. It should be noted that if that is the case, it may have contributed to the poor assessment of the magnitude of the risk in several of the countries that were subsequently hit by the epidemic.
In most European countries, the epidemic seems to be declining, with different rates in each country, depending on the extent to which it has spread.
Great Britain is in the most difficult situation and will continue to record significant numbers of deaths for at least another 5 days, while Belgium has the highest number of deaths in proportion to its population, worldwide.
In Germany, the weakening the epidemic is not yet completely clear, as there are significant fluctuations in the rates of cases and deaths, creating some concerns.
Sweden's "experiment" hangs in the balance and next week will show whether the country's special conditions (low population density, low sociability, low average age, de-facto social distancing and isolation of the elderly) will be enough to replace the restrictive measures that have not been implemented.
In most European countries, the increase rate of cases and deaths is steadily declining, as is the number of critically ill patients.
Austria appears to be in the most advanced phase. As in the case of Germany, the healthcare system has been very effective in absorbing the effects of the epidemic without showing signs of high pressure. Both countries have mortality rates below 3%, and more than 50% of patients have recovered.
The Netherlands, Portugal and Switzerland also show clear signs of gradual weakening of the epidemic, which, if continued until the end of the week, could be considered safe.
Italy and Spain are also showing signs of weakening, albeit at a very slow pace. A particularly positive element for Italy is the significant relief of the healthcare system.
The weakening trend in France is less clear, as the data on cases and deaths of many previous days represent cumulative records. It is mainly supported by the slow but clear reduction in the number of patients in critical condition.
Sweden, one of the few countries to pursue a policy of very mild measures to reduce the spread, still has no significantly worse picture than other countries, despite the fact that it seems that the healthcare system is under significant pressure.
In Belgium, it seems that the weakening has not begun and the country is probably going through the most difficult week of the epidemic.
The situation in Great Britain is worse than in other European countries as the epidemic is still in full swing. No exact figures are available on the number of patients who have recovered, while the number of critically ill patients has not been updated in the last 9 days.
In the United States, while New York appears to be gradually entering a phase of weakening, another 12 states are recording more than 10,000 cases and 9 of them more than 500 deaths.
In the last 2 days, there has been an increase in the number of cases recorded in China, which have been reported as having been detected upon entry into the country.
In Greece, the most encouraging element is the reduction, for the 8th consecutive day, of the number of patients in critical condition and the manageable pressure on the health system. Potentially dangerous is the occurrence of cases in nurseries hosting the elderly and among vulnerable populations.
In most European countries, discussions have begun on lifting restrictions and it seems that the first to move forward in April, is Austria.
The programming of the gradual removal of the measures, is a process that will follow a reverse order in relation to their imposition, and the succession of steps will take into consideration the incubation period of the virus and the onset of symptoms. It is also likely that the targeting of the tests will change, which will not only be suspected cases, but also samples from the general population, combined with antibody tests to investigate the actual spread of the virus.
Greece's size and population density in large urban centers are factors that can contribute to the easy and rapid spread, of initially small outbreaks of the epidemic.
In this sense, the up-to-day relatively mild nature of the epidemic in Greece can be overturned very easily and very quickly. After all, in most countries facing the most acute manifestation of the epidemic, there are specific geographical areas that have borne the brunt (eg Lombardy, New York).
A sharp accumulation of serious incidents in the hospitals of an area can in 1-2 days lead to the local overload of the hospitals, which if they exceed their limits will become themselves outbreak epicenters.
The optimistic, tangible scenario of a gradual return to a form of normalcy from the beginning of May is much further than the 25-30 days that elapse.
Within 3 months and a few days, more than 81,000 people have died from the pandemic, which has now covered almost the entire planet.
In the United States, deaths in less than a month are about twice the average monthly loss the U.S. military had during World War II. Unfortunately, the epidemic is spreading in more and more states: 9 out of 50 states have more than 10,000 cases and 4 of them have more than 500 deaths.
Spain unfortunately still has very high pressure on the healthcare system and an increase in the number of critically ill patients, and unfortunately, despite a very significant proportion of recovering patients, the situation is still extremely difficult.
In Italy, the epidemic continues to weaken in a painfully slow pace, with the most encouraging element being a steady decline in critically ill patients, combined with a steady increase in recovering patients, now 18% of confirmed cases.
France is in a difficult situation to assess, as it continues to report large numbers of cases and deaths from previous dates, mostly from nursing homes. Judging by the increase in the number of patients in critical condition, the epidemic is still in full swing.
Belgium, the Netherlands, Sweden and Portugal continue to show significant death increase rates.
In Germany, the slowdown in the rate of increase in cases is accompanied by a significant increase in the daily number of deaths, which, together with the rapid increase in critically ill patients, is a major cause for concern.
In Austria, there is a slowdown in the epidemic, which is combined with keeping the number of patients in critical condition within the capacity of the healthcare system and even with decreasing trends.
The most worrying picture comes from the UK, which has a significant rate of increase in cases, a high rate of increase in deaths and a small percentage of patients who have recovered.
In Greece, the picture remains unchanged, with justified optimism. The goal of maintaining patients in ICUs in numbers that can be managed by the healthcare system seems to be achieved, as the number of intubated patients is kept below 100. Holy Week will be really big and important, both in terms of numbers and in terms of possible mass travel.
The attempt to monitor the SARS – CoV-2 virus pandemic is affected by many uncertainties about the accuracy of the data announced by the various countries. Nevertheless we will try to follow the evolution of the epidemic in various countries, by presenting comparative, raw and calculated figures.
As the pandemic progresses, it is clear that the absolute number of confirmed cases is becoming less and less important for comparative monitoring of local epidemics, as the scope of the tests is different in each country, either by choice or due to lack of technical resources. The death tolls provide a clearer picture, while the number of critically ill patients (usually representing intubated ICU patients) and the rates of change are of paramount importance.
As has been seen around the world, the effort to tackle the epidemic is being lost or won on two fields: the effectiveness of social distancing measures and the situation in hospitals in terms of infrastructure (ICU beds) and the contamination of healthcare professionals. A major risk factor is the significant shortages of personal protective equipment (appropriate masks at least FFP2, eye protection, protective clothing) of doctors and nurses, and also for the cleaning staff of the hospitals which is exposed to the same degree.
The United States is in the midst of an exponential growth of deaths and case across throughout the country. In addition to New York, which has been the epicenter of the epidemic to date with 38% of cases and 42% of deaths, 4 other states (New Jersey, California, Michigan and Louisiana) have exceeded 10,000 cases, with fewer cases occurring in all of the other states. Within the next 5 days, it is estimated that at this rate, the total number of cases will have approached or even exceeded 500,000, while the number of deaths will approach 20,000.
Spain is at an advanced stage of the exponential growth curve with a relative slowdown in the cases, but very high daily death tolls that will unfortunately be maintained for several more days. The most worrying element is the steady increase in the number of critically ill patients, which keeps a huge pressure on the healthcare system. An optimistic figure is the growing percentage of patients who are reported to be recovering from all cases (26%).
In Italy, the epidemic appears to have peaked between 21-27 / 3 and the growth curve has begun to normalize. Deaths remain high on a daily basis, but the rate of increase in critically ill patients has fallen sharply. If the epidemic does not escalate in other parts of the country, it is estimated that in a few days one will be able to talk about a gradual weakening.
In the UK, there are consistently high rates of increased deaths and deaths that are of great concern. The data on the number of patients recovering and those in critical condition remain very low and have not changed in the last 10 days, making it impossible to assess the state of the health system by numerical criteria.
France presents several variations in the development of cases and deaths, which is partly due to the updating of data with data from previous days (p.e. on 2/4, 884 deaths representing cumulative data from previous days). Judging by the number of patients in critical condition in relation to the capabilities of the healthcare system and their growth rate, the epidemic in France is still in full evolution and this situation is expected to continue for several days.
Sweden, with its rather "loose" model of dealing with the epidemic, does not seem to be following a much worse course than other countries, possibly because of the way of life in the country, which contains elements of social distancing even under normal conditions. However, there is a significant and alarming rate of increase in patients in critical condition.
The case of Iran presents a different picture than other countries, with successive outbreaks of the epidemic. It is unknown whether this is due to the appearance of new local outbreaks, cumulative reporting of cases and deaths of previous days, or a review of the criteria for recording cases and attributing deaths to COVID-19.
As global interest focuses on larger countries, Portugal continues to wage a difficult battle, with significant growth rates in both deaths and cases, combined with significant pressure on the healthcare system.
Switzerland, Belgium and the Netherlands are experiencing declining growth rates, but are still experiencing significant increases in deaths. In all three countries, the concern is the growing level of pressure on healthcare systems.
In Germany, although there has been a significant increase in deaths and the corresponding rate in relation to figures at the beginning of the epidemic, the rate of increase in cases is relatively low, taking into account the large number of tests performed. The main feature of the epidemic in Germany is the effectiveness of the healthcare system which manages to absorb the effects, showing a significant percentage of patients recovering from cases (28%) and adequacy in intensive care beds (after all, Germany has one of the higher ratios of ICU beds per population, worldwide).
The situation is similar in Austria, with a low rate of increase in cases and a good state of the healthcare system.
In Greece, reserved optimism is now expressed in the official statements and is well-founded. The growth rates of both deaths and cases are in single digits (6% and 8% respectively), while the number of critically ill patients remains under control (92). If this number remains below 150 by mid-April and there is a further reduction in the rate of increase in cases and deaths close to 4-5%, restrained optimism will be perfectly justified. Unfortunately, it is expected that for several more days the daily number of deaths corresponding to or greater than today's (6) will continue, as the course of the already critical patients will evolve.