Friday, 27 August 2021

COVID-19 World Review, Part 2: Cases

This is the second of my review reports on COVID-19 worldwide as at August 20th 2021. This report will cover cases. I’ll show graphs of cumulative case counts and daily new case counts for countries in different regions of the world. To enable inter-country comparisons, I’ll use cases per million population (or per hundred of the population) throughout.


Again, I’ll start in the core of Western Europe:

There is a factor of 2.6 between the total cases in the top country (Luxembourg – 12% of the population) and the bottom (Germany – about 4.6%). Many of the countries seem to have had peaks and troughs of daily new cases at much the same times; while, at other times, one country seems to come out above the rest. And several times, a pattern has been followed where new cases in several countries have suddenly increased one after another.

The first wave, in March 2020, peaked higher in Luxembourg and Spain than anywhere else, followed a month later by peaks in Ireland and France. This was followed by a period of longer and lower peaks, in Sweden, then Luxembourg again, then Spain again. Then, starting in October, daily cases reached new heights; first in Belgium, then proceeding through Switzerland, Luxembourg again, and France. Followed, in the new year, by peaks in the UK, Ireland, Portugal and Spain again. There was a lesser series of peaks in April, affecting mainly Sweden, France and the Netherlands. After a quiet period in the first half of June 2021, the UK’s cases started to climb, ushering in in a new series of peaks in July, mainly in the Netherlands, Spain and Portugal, and also rising cases in France, Ireland and Switzerland.

This tends to suggest that, when a new and more transmissible variant gets loose in Europe, it tends to hit several countries in quick succession. This is characteristic of an area with (relatively) free movement across borders. This happened first with the initial strain, then with the one that hit Belgium in October (which may or may not have been the “beta” variant). Whether the peaks in April were caused by the same variant or a different one is not clear. But the very steep climbs in new cases in early July in several countries are one of the signatures of the “delta” variant, which is the primary variant now in the UK and many other countries.

In the northern part of Eastern Europe, Czechia is way ahead, with almost 16% of the population having become cases. The remaining countries range from Lithuania and Estonia just above 10%, down to Belarus at 5% and Russia at 4.5%. Russia (dark brown, relatively smooth line) is always likely to be an outlier in this group, as due to the country’s large size the virus is likely to spread slower there than further west.

Eastern Europeans did not suffer from the first wave as badly as those further west. But the virus would not be denied! The peaks in daily new cases from October onwards were in Czechia first (with a smaller peak in Slovakia), then Lithuania, then Czechia again (twice), then Estonia, and later Hungary, Poland, Lithuania and Latvia. By June, things seemed to be fairly well under control – except in Russia, which as above is an outlier. The sudden spurts in cases in Lithuania and Estonia during July suggest that they may have been among the first in the area to receive the delta variant.

Here, it is Montenegro which has the most cases per head of population, at 17.3%. (It is unfortunate that Montenegro is one of the countries which is not reporting any stringency information, which may make it difficult to work out why their cases are so high.) The other countries range from Slovenia and Cyprus, both just above 12%, down to Greece at 5.3% and Albania at 4.8%.

Apart from Montenegro, big peaks in daily cases per million have been experienced in Slovenia, Serbia and Croatia. The two recent large peaks come from Cyprus. And the recent upturns in daily new cases in virtually all the countries except Cyprus suggest that the delta variant may well have found its way to this part of the world too.

Andorra and San Marino, small communities sandwiched between France and Spain and within Italy respectively, have the highest cases as percentage of population here, at 19.4% and 15.4% respectively. Iceland, Norway and Finland are at the other end with just 2.9%, 2.7% and 2.2%. The Vatican (black line, horizontal in the first graph since October) has 3.3%. Liechtenstein and Monaco, both landlocked, and Malta, an island, are all close to 8%.

The graph of daily cases per million doesn’t really show much. The two biggest peaks are both from the Vatican (with a total of 27 cases and no deaths), and the remaining peaks are dominated by Andorra and San Marino. There is, however, a suggestion of a delta variant signature in early July 2021 in Andorra, Malta and Monaco, and a little later in Iceland.


In North and Central America, the USA tops the list with about 11.4% of the population having become cases. Panama and Costa Rica also have cases per million comparable to European levels. All the other countries (even Canada!) are below 4%, with El Salvador coming in at 1.4%, and Nicaragua at a hard-to-believe 0.16%.

As far as daily new cases are concerned, the graph shows many of the same features as the European ones, with significant peaks during the Northern Hemisphere winter, and the characteristic shape of the delta variant hitting the USA in about the third week of June.

In South America, Argentina and Uruguay lead in cases as a percentage of population, with just over 11%. Other cases per million levels, down to Bolivia at 4.2%, are comparable with Europe, and generally higher than in North and Central America – a little bit unexpected. Venezuela is a low outlier, with only 1.1%.

The case of Uruguay is salient. Having been bottom of the list in December, less than six months later they had risen to the top, and are now in second place. Uruguay is also the highest vaccinator in South America; although its full vaccination rate didn’t really start to pick up until June. By which time, the damage had been done. This goes to show that, however well a country does against the virus early on, if there’s still a significant population of susceptibles, it will get among them in the end!

The daily cases per million in different countries look to be more independent than in Europe; perhaps because there is less international travel between them.

Cases per million in the West Indies are lower than in Europe and South America, and comparable with Central America.

The “Uruguay syndrome” of doing well against the virus to start with, then suffering a major and sudden spurt in cases, has happened in Cuba, Dominica, Saint Lucia and Saint Kitts and Nevis recently. It also happened earlier in 2021 in Saint Vincent, Saint Lucia, Trinidad and Tobago and Saint Kitts and Nevis; and in the Bahamas earlier still. I would guess that this pattern may have something to do with a country being relatively isolated from other countries around it. Also, the most recent outbreaks (except possibly Cuba) may be due to the import of the delta variant.

Middle East and North Africa

These countries divide into two groups: low-case and higher-case. The low-case countries are Syria, Afghanistan and Pakistan, in all of which less than 0.5% of the population have become cases. Two of these, of course, have political problems at the moment. The higher-case countries have cases in the 4% to 9% range. There is an obvious multiple-wave pattern in most of the countries.

Lebanon (light blue), Turkey (dark brown) and Iran (grey) are concerning. You can control cases, up to a point; you can lock down, and so recover from a spurt. But if susceptibles are there, the virus still has them in its sights. Particularly if it is a relatively new variant.

Many of these countries have cases per million comparable with Europe. In Bahrain, 16% of the population have become cases; and in Israel, an early vaccinator, 11.3% and rising fast. There are two outliers on the low side: Saudi Arabia at just 1.6%, and Yemen at a mere 0.25%. But Yemen, too, has its political problems; COVID is not their highest priority.

Again, there are multiple waves in many of the countries. And the peaks are tending to get higher as time goes on. Not good. Though Bahrain, the UAE and Kuwait seem to have escaped high peaks, instead having a more sustained daily case load.

Here, the countries again seem to divide into two groups. Tunisia, Libya and Morocco tend to follow the multi-wave pattern of the rest of the Middle East, with total cases in the range 2 to 5% of the population. The others have low total cases, all below 0.7% of the population.

Sub-Saharan Africa

As case numbers here are generally low, I’ll show only the total cases per million graphs.

The Seychelles is the high outlier here, with 19.7% of its population having become cases. Cape Verde, Botswana, Namibia, South Africa and Eswatini are all in the 3% to 6% range. The multi-wave pattern is in evidence, too. The other countries are all around or below 1%.

Rest of Asia

Case counts are low here, with the Philippines leading the way at about 1.6% of the population. Taiwan had almost zero cases before May 2021, and China – if we can believe their figures – has had all but zero cases per million ever since the end of the first wave in about May 2020. The multi-wave pattern is apparent in Hong Kong, South Korea and Japan, at least. And it looks as if Japan, and possibly the Philippines too, have received the delta variant.

In north-east Asia, the multi-wave pattern is with us again, and Georgia is leading the pack with more than 12% of the population having become cases. Cases in Uzbekistan and Tajikistan are minimal; 0.44% and 0.17% of the population respectively. The remainder are in the 2% to 6% range.

The timing of the recent rise in cases in Georgia suggests that it may be due to the delta variant, and it could very well be contributing in Azerbaijan, and maybe Kazakhstan, too.

The Maldivian islanders seem to be having a European style epidemic, with more than 14% of the population having become cases. None of the others have gone much above 2%, and Bhutan is the low outlier with only 0.33%.

In South-East Asia, cases are low, not more than 1.5%; except for Malaysia, where about 4.5% of the population have become cases.

Australasia and Oceania

The only country here with a significant case count yet is Fiji, with almost 5% of the population having become cases since June 2021. Again, showing that once the virus does get in, it is difficult to contain it, even if you have previously been successful against it.

Top and Bottom 20

Here are the lists of the top and bottom 20 countries in cases per million.

The top 20 all have more than 10% of their populations having been diagnosed as cases. But many of these countries have small populations; and the virus seems to spread more easily in small countries than in larger ones. Serbia, Andorra, Montenegro, San Marino, the Maldives and Luxembourg all have populations of less than a million. Bahrain and Cyprus have less than two million, and Slovenia and Lithuania not far above that number. Czechia, Sweden, Israel and Serbia are all near the 10 million mark. Only the Netherlands, the USA and Argentina among these top 20 have populations significantly over 10 million.

The bottom 20, on the other hand, are a mixed bag. There are remote island countries. There are countries in Africa, where the virus seems to spread relatively slowly; and many of them have relatively little interaction with their neighbours. There are countries which closed their borders hard and early, like Taiwan and New Zealand. There’s Yemen, which is a war zone. And then, there’s China.

So, which countries will I follow up this time round? Czechia is a must; as are Bahrain, the Netherlands, the USA and Uruguay. And from the bottom 20, Taiwan and China are the obvious choices; similar ethnicities, but very different politics.

The current “hot spots”

But before I do individual country follow-ups, I’ll show the top 20 countries in order of current level of daily cases per million (weekly averaged):

They look to be well spread out around the world! It’s worth noting that Israel, the Seychelles and the UK were among the countries I looked into in detail in the vaccinations paper. Thus showing, that having a high level of vaccinations isn’t the automatic panacea that some seem to think.

The bottom 20 are also worth showing, if only for the enormous difference in the scales of the two graphs, and the position occupied by China:

Some examples


The most significant things on these two graphs, I think, are on the right-hand side. Cases have been pretty much flat-lining since the middle of June, at just a few hundred new cases per day – orders of magnitude below the values of over 12,000 at the peaks. And there’s the sudden drop-off in the R-rate and weekly case growth at the end of June, following an equally sudden rise, which may have been due to the delta variant getting loose.

This looks much like what happened in Belgium at almost exactly the same time. The difference is that the Czechs, unlike the Belgians, chose to tighten lockdown from 35% to 37%. On July 23rd they closed schools in some regions, and tightened their national face mask mandate to “Required when with others.” This has had no visible effect, as the drop in R-rate and weekly case growth had already happened by the time the lockdown came into force; and the cases have continued to flatline up to the date of writing (August 26th).


In Bahrain, the cases have been less heavily concentrated in large peaks than in most other countries; which may help to explain the high total cases per million. Lockdowns seem to have been constantly and tightly micro-managed. While the current stringency is only 54%, the measures are quite harsh, including mandatory closure of all schools and some workplaces, and face coverings required everywhere outside the home.

The right-hand end of the cases graph looks very much like Czechia’s. The current trend in the R-rate looks interesting; if that continues to go down, the Bahrainis could be in good shape. But it isn’t clear from these figures whether or not they have had the delta variant yet.

The Netherlands

As in Belgium, there was a big spike in cases, starting at the end of June; probably the delta variant making its mark. This coincided with a major unlock, which was partially reversed on July 10th by closing some workplaces. There was then a spectacular drop in new cases. But given the example of Czechia, I wonder if the Dutch might be close enough to herd immunity that this drop might have happened without the closures? New cases are now (August 26th) going up, but barely so. We’ll have to see when the R-rate next peaks.


In the USA, the weekly case growth spiked hugely at the end of June, like Czechia, the Netherlands and Belgium. Very likely, this was the delta variant. It’s not entirely obvious on the cases graph, but the week-on-week rate of increase of new cases has dropped significantly since then, though it is still above zero. Other things being equal, the next few weeks should see a flattening out of the new cases curve, hopefully followed by another fall.

Lockdowns in the USA are not easy to track, as almost all the measures are at the individual state level, and large states even have their own regional lockdowns. Moreover, the national stringency tends to overstate the stringency levels in individual states. But the general lockdown trend since June and before has been slowly downward.


I recounted earlier the Uruguayan story, of initial success (due to relative isolation?) followed by two big peaks. Things seem to be better again now. Cases are still (just) going downwards. The R-rate is still below 1, but going up. The Uruguayans are unlocking, but the lockdown stringency is still above 50%. The borders are closed, there is a medium restriction on gatherings, and face coverings are required in some places; but the rest of the mandatory measures are gone. It will be interesting to see what happens when they re-open the borders.


The Taiwanese story looks at first sight similar to Uruguay’s. Almost no cases at all, helped by early closure of the borders; until a sudden surge in the middle of May 2021. But unlike Uruguay, this surge only caused 0.7% of the population to become cases.

Lockdowns were generally low, until the surge. The borders are now closed again, some schools and workplaces are closed, and face coverings are required when with others. The Taiwanese don’t seem to be bothering too much with vaccinations: 39% of the population have had one jab, while only 3% have had two. And there’s no evidence from what I see that the delta variant has found Taiwan yet. It looks to me as if the epidemic in Taiwan still has some way to run.


China. Ah, China. Do I believe that epidemic profile? I’m inclined not to, even though there is a certain resemblance to Taiwan’s profile. I’m dubious about the enormous claimed number of vaccinations, too. And I’m not sure whether, as suggested by events in the Seychelles – if not also, according to reports, Bahrain, Chile, Indonesia and Mongolia – the Chinese vaccines might not be as good as they claim them to be.

But the Chinese lockdown figures have been generally high, which I suppose might be believable. As in the USA, the national lockdown figure tends to overstate the lockdown levels in individual provinces. But even provincial stringencies have not often been below 50%. The Chinese have micro-managed lockdowns in a way that makes the Bahrainis look like amateurs; in August 2021 alone, there have been 70 different changes in lockdown measures in 26 provinces (out of 27!) And over the course of the whole epidemic, there have been 1,060 such changes.

To keep on managing these lockdowns, and to keep them going for such a long period, when none of the outbreaks (since the initial one) have looked at all serious by the standards of other countries, gives me furiously to think. What is their actual strategy for dealing with the thing in the long term? And what might the Chinese know about this virus that we don’t?

To sum up

I’ve learned a lot from this exercise.

First, initial success in keeping cases down is, to use a phrase from the finance industry, “no guarantee of future performance.” Even absent new variants, if there is a pool of susceptible people anywhere, the virus will eventually find them. And even if you manage to stop it the first time, it will try again. The Uruguayans, among others, have found that out the hard way.

Second, the cases per million to date are generally highest in Europe, next highest in South America, a little lower in North and Central America and the Middle East, and lowest in Asia and Africa. Small countries, particularly islands, may get a lot more cases per million than their locations suggest. But there are also a lot of countries, in which the penetration of the virus into the population in percentage terms is low or even very low.

Third, the delta variant seems to be present in most of Europe, in the USA and perhaps in the West Indies. Also in Japan, and perhaps in the Philippines and a few other countries, particularly in the Middle East.

Fourth, three European countries I have looked at in the first two papers (Belgium, Netherlands, Czechia) appear to be approaching a kind of equilibrium, in which new cases remain low while the level of lockdown is far lower than would have allowed this earlier in the epidemic. How far this equilibrium is from full herd immunity, and how far the herd immunity target might go up if a new variant gets loose, remain to be seen.

Fifth, the Chinese are not to be trusted. Not their data, nor their vaccines; and, very probably, not their intentions.


Opher Goodwin said...

Interesting Neil. You are doubtful bout China but what do you really base that on?

Neil said...

Opher, I suppose you could say it's the "smell test." If the case counts given are accurate, then why have they needed to lock down so hard for so long? You would have expected an approach far more like New Zealand's. But then, they're communists, and communists don't care a damn about people.

Alternatively, there may be some fudging of the numbers going on.