COVID-19: Middle East and North Africa Report, Omnibus Edition

This is the third of my “omnibus” reports on the statistics of the COVID virus. Today, I’m going to tackle the Middle East and North Africa; in essence, the Arab and Muslim world, excluding the former Soviet republics, and Muslim countries in South-East Asia.

There is also some news to report on the vaccinations front. One country, Israel, has already vaccinated more than 40% of its population. With both jabs! And the results appear, at first sight, encouraging.

I divided the area into three regions. Middle East (North) is a long strip of land, running from Turkey, via Syria and Lebanon, to Pakistan and Afghanistan. I included Armenia in this group too, because of its close relationship with its neighbour Iran. Middle East (South) comprises Saudi Arabia, the Gulf states, Jordan, Israel and Palestine. And North Africa covers the African countries north of, and including, the Sahara Desert. I excluded Burkina Faso, preferring to put it with its West African neighbours.

Here is the list of 28 countries:

Middle East (North)	Middle East (South)	North Africa
Afghanistan	Bahrain	Algeria
Armenia	Israel	Chad
Iran	Jordan	Egypt
Iraq	Kuwait	Libya
Lebanon	Oman	Mali
Pakistan	Palestine	Mauritania
Syria	Qatar	Morocco
Turkey	Saudi Arabia	Niger
	UAE	Sudan
	Yemen	Tunisia

Once again, the data sources are (for epidemic data) Our World in Data and (for lockdown regulations) the Blavatnik School of Government, both at Oxford University. The data I used included figures up to and including March 7^th.

In this edition, I have added three new scatterplots. These show cases per million, deaths per million and deaths per case, plotted against average lockdown stringency. As these plots for Europe and the Americas will be of interest too, I’ll include those at the end of each section.

The countries

Here are bar charts of the United Nations HDI (Human Development Index) ratings for the countries in each of the three groups.

These three groups of countries look to be at different development levels from the UN’s point of view. Except for Yemen which is a war zone, the southern Middle Eastern countries tend to be at a higher development level than the rest. The Middle East (North) group are at a somewhat lower development level; and North Africa, in general, lower still.

Here are the corresponding Freedom House ratings. According to Wikipedia, the rating “measures the degree of civil liberties and political rights in every nation and significant related and disputed territories around the world.” Like the HDI rating, it is a percentage:

It’s worth pointing out that Syria has a rating of zero, while Palestine doesn’t get a rating at all. And that, except for Israel and Tunisia, this is not a very free part of the world!

I’m not going to bother with population densities, as neither Europe nor the Americas showed any kind of correlation between national population density and the course of the virus. So, I’ll go straight to…

Cases

Here are the spaghetti graphs of daily cases per million (weekly averaged) for each of the three groups:

So far, the only countries in the area to have breached the WHO’s 200 cases per million per day “endemic” threshold are Armenia, Lebanon, Qatar, Israel and Tunisia. All towards the top of their regions in the UN rating.

Now for a scatterplot of cumulative cases per million against HDI rating:

The slope of the straight trend line here is comparable with the slope for the Americas, and very much greater than in Europe. Looking at this particular graph, it’s even possible that a power function might have been a better fit than a straight line. So, I added such a line:

Well, maybe that’s a bit close to torturing the data until it confesses! But it does make the point that the more developed countries get many, many more cases per million.

Lastly for cases, here is a list of all the countries, ordered by cumulative cases per million:

The penetrations of the virus in terms of cases per million in the top five countries in this region – Israel, Bahrain, Armenia, Lebanon and Qatar – are comparable with the levels in countries such as the UK, USA and Belgium. So, they are some of the highest among major countries in the world. North Africa, on the other hand, does not seem to have been hit as hard by the virus yet as the Middle East. That may, in the longer term, be bad news for them.

Case Growth and Lockdowns

As was the case with the Americas, the weekly case growth graphs don’t show anything of great interest. So, I’ll skip them, and go for the R-rates instead.

In the north Middle East, apart from Turkey which goes all over the place, there seems to be a general downward trend in the reproduction rates. In the south Middle East, it is Yemen which goes all over the place; probably because, due to their situation, they are not spending as much effort on finding COVID cases as the other countries. (But unlike Nicaragua, I have no reason to suspect that they are doing anything less than their best in how they report the figures). And in North Africa there is again a general downward trend. Niger is set apart by its high degree of humps and troughs; probably because, like Yemen but presumably for far more enviable reasons, it has found relatively few cases per million of population.

I’ll skip the individual lockdown stringency graphs, as they too are all over the place. So, here’s the list of average lockdown stringencies:

Libya is not a good place to be right now. In contrast, Niger seems to have been doing pretty well; few cases, and a generally low lockdown level. Afghanistan also stands out.

Let’s see what happens if we plot average lockdown stringency against Freedom House rating:

No real trend up or down there. But now, let’s have a look at the first new plot, of cases per million against average lockdown stringency:

Who’d a’ thought it? The more cases per million, the harder they lock down. Or could it be, the cynic inside me asks, that harsher lockdowns tend to lead to more cases per million?

Ah, but I can apply this new plot to Europe and the Americas, too. Here they are:

In the Americas, there’s a positive correlation between cases per million and lockdowns, but it is less strong than in the Middle East and North Africa. But in Europe, the correlation all but disappears. This suggests, to the cynic in me, that many European governments have been treating the whole epidemic rather like a game of “copycat” or “follow-my-leader.” At best, they have been reacting to shortages of hospital beds or intensive care beds.

Tests

Only about half the countries in the Middle East and North Africa are reporting any testing data at all. Here is the list of countries, with total tests per hundred thousand:

The top three, the UAE, Bahrain and Israel, have already done more than 150% as many tests as their total populations. As to how effective the tests have been, here’s the list of countries with the cumulative percentages of cases per test:

This suggests that Armenia and Iran, at least, are under-resourced with test kits. And the three countries which have done most tests per head of population, have three of the four lowest rates of cases per test.

Hospitalizations

The only country in the entire Middle East and North Africa area, which is reporting any data at all on COVID hospitalizations, is Israel:

This shows that they have had a three-peak epidemic, with each peak bigger than the last. The peak in the number of hospital beds occupied by COVID patients was 4.5% of capacity. No sweat at all, in comparison to countries like Spain, Portugal, Italy, the UK and the USA.

Deaths

Total deaths per million in each region are as follows:

Here’s the league table of deaths per million:

While these are mostly low in comparison to European figures, it is concerning that some countries, like Iran, have both low cases per million and relatively high deaths per million; and the virus still shows no sign of abating there. So, there may be far more deaths to come in this part of the world.

Here’s the plot of deaths per million against HDI rating:

Just for fun, I’ve added an exponential trend line to this one!

Now for the second new plot, of deaths per million versus average lockdown stringency:

Well, whaddayaknow? The tighter the lockdown, the more the deaths per million! (Or vice versa, of course).

Let’s compare this with the Europe and Americas equivalents. (I’ve removed Nicaragua from the Americas graph, because its figures are unreliable).

Looks much of a muchness to me; the trend lines all point roughly the same way. Maybe the politicians are using deaths per million, rather than cases per million, in deciding when to lock down?

Now for cumulative deaths per case. As I’ve said before, if there is one COVID metric on which to judge a country’s health care system, this one is it. High means bad.

Yemen, obviously, has problems that are not under the control of its medical people. Syria, Sudan and Egypt are high compared with Europe and most of the Americas; comparable with Ecuador, but far less bad than Mexico’s 9%. It’s interesting to see Kuwait, Bahrain, the UAE and Qatar all together at the bottom; they must be doing something right! And Israel is just one place above them.

Let’s now look at the third new plot, deaths per case versus average lockdown stringency.

As the average lockdown stringency goes up, the deaths per case go down. Or, as the deaths per case go up, the lockdown stringency goes down. That seems a bit strange. But maybe that outlier in the top left-hand corner, Yemen, is biasing the real trend? Let’s take it out:

Cherry-picking? Moi? Encore? But seriously: Still a downward trend, but far smaller than before. I suspect it may be because those countries with poor testing capability are having a lot of infections which never get reported as cases. So, they aren’t locking down until the cases figures tell them to, as prompted by the UN’s WHO.

Now let’s look at the graphs for Europe and the Americas (minus Nicaragua):

Hel-lo! The trend in Europe is upwards! Suggesting that the countries with the worst health care systems (and we all know which ones they are) feel more need to lock down hard than the others. Or, maybe, those countries where the political class have a yen to lock people down for the sake of locking them down (and the UK is certainly one), also have the worst health care systems? Both believable inferences.

Again, a positive trend; but a much smaller one this time. It will be most interesting to see, when the epidemic has been beaten and the dust has settled, whether those countries which failed to detect early cases, so did not lock down too hard, may not end up with less deaths per million from the virus that those that put their people through the lockdown wringer?

Vaccinations

Since not many of these countries are yet reporting any vaccination data, I’ll start with the totals of people vaccinated and fully vaccinated up to March 7^th:

Look at those Israelis go! More than 40% of the population fully vaccinated! The UAE is in second place, with about 22%. Both have another 10% and more who have had one vaccination. If anywhere in the world is going to show positive effects from the vaccine already, it will be these two countries. The UK had the opportunity to beat them both, but due to the stupid twelve-week gap between jabs policy, failed to do so. Sigh.

Here’s the fully-vaccinated data for the Middle East (South) region:

That means, assuming the second jab takes two weeks or so to become effective, we can’t use the UAE as a test bed yet. Israel, on the other hand, we can try. As time is of the essence in this matter, I have updated the Israeli data to the very latest at the time of writing (March 12^th.) Here is the graph of daily cases and deaths (weekly averaged) for Israel so far:

And here’s the graph of weekly case growth, R-rate and lockdown stringency:

They have done some significant unlocks in February, but the R-rate has stayed below 1. And, although the weekly case growth did go positive around the middle of February, it has since gone negative again. Of course, it’s possible that they were already so close to the herd immunity threshold that vaccinating 40% of the population, or even less, pushed them over it. Time will tell, when the results from other countries roll in.

Anyway, let’s go to the Blavatnik data, and find out what the Israelis did. I’ll take the history forward from the start of the second phase of lockdowns, at the beginning of November.

Date	Stringency	Measures
20201104	65.74	Events: Mandatory cancelled Stay at home: Required with exceptions (Regional) Travel: Mandatory restrictions (Regional) International: Ban some arrivals Testing: Open
20201215	71.3	Public transport: Recommended closed Face covering: Required when with others
20201222	74.07	International: Ban all arrivals/border closure
20201227	82.41	Workplaces: Mandatory closed Stay at home: Required with exceptions Travel: Mandatory restrictions
20210107	85.19	Gatherings: Up to <=10
20210131	87.04	Schools: Some closed
20210207	64.81	Workplaces: Some closed Stay at home: No measures Travel: No restrictions
20210211	62.96	Schools: Some closed (Regional)
20210221	57.41	Events: Recommended cancelled
20210225	73.15	Workplaces: Mandatory closed (Regional) Stay at home: Required with exceptions (Regional) Travel: Mandatory restrictions (Regional)
20210228	57.41	Workplaces: Some closed Stay at home: No measures Travel: No restrictions
20210307	54.63	Gatherings: Up to 11-100

            

Apart from the regional excursion near the end of February, that looks like a moderately impressive set of unlocks. The R-rate has stayed under 1 throughout, and after the wobble, cases are dropping again. They still have the following measures in place, though: Schools: Some closed (Regional). Workplaces: Some closed. Events: Recommended cancelled. Gatherings: Up to 11-100. Public transport: Recommended closed. International: Ban all arrivals/border closure. Public info: Co-ordinated. Testing: Open. Contact tracing: Comprehensive. Face covering: Required when with others.

In particular, they still need to re-open all workplaces, including bars and restaurants. And to get rid of face coverings. And further, to re-open the borders; which may prove a harder task.

So, to sum up: The immediate effects of the Israeli vaccinations look encouraging. But the fat lady has not yet picked up her microphone.