Welcome to another MedCram COVID-19 update.
Overall in the United States, the daily new cases have come down recently, but have kind of stayed
steady. If we look at the seven day moving average, there's been a plateau. Daily new
deaths in the United States are on the slight decrease trend. And while in the United States
there is heterogeneity in terms of areas that are increasing and areas that are decreasing
it seems as though, by and large, in Europe there's a different story emerging, and we touched on this
last week and we found that week over week it seems as though cases of infections are
rising in Europe. For instance, this is a graph of cases in France, but if you look at the number of
daily deaths in France, there seems to be hardly a blip at all. Now, notwithstanding, deaths are not the
be-all and end-all of bad things in infections. I mean, you have hospitalizations, you have morbidity ,
simply talk to any person who has what we call "long haul or symptoms" and they'll tell you that
this is no picnic, but nevertheless, what is the reason for this discrepancy in cases versus
deaths? And I think a interesting deep dive into the numbers reveals what it is that's going on,
and to be able to do this, there is a great website called the European Center
for Disease Prevention and Control, which is basically the European version of the CDC,
and of course we'll give you the link in the description below. The amount of data on this
site is just tremendous, and it's broken down by country and it's also graphed, so it makes analysis
fairly quick, so what they have here on the left hand side is every country in Europe ,
this page happens to be for Austria, but we can look at every single other country,
and what they have here is a graph looking at the cases per 100,000 and the deaths per million
population, and you can see here, this starts off in February and goes all the way to October, and
we can see here in red is the cases per hundred thousand and in blue it's the deaths per one million,
and you can compare the first wave with the second wave. Clearly here, the number of cases
was higher in proportion to the number of deaths, and as we go out here towards the second wave
that the number of cases seem to be flipped to the number of deaths, so definitely more
cases as there are per deaths. Well down below superimposed tells you exactly what sort of
policy measures were put in place. You can see here that for instance this very dark red or
reddish-pink bar is the stay-at-home order, which was enforced. Prior to that was the stay-at-home
recommendation. This green one here was the closure of educational institutions of higher education.
This would have been high school here in the more cyan, and this blue would have been the closure of
primary schools. If we go on down here, this lighter green is the closure of educational institutions,
such as daycare, and here we have the closure of public places. This green here is mass gathering
cancellations, this black one is protective mask use in public and protective mask use in public
transportation for the general population, and then finally here is teleworking recommendations
and workplace closures. And you can see these same graphs for every single country because, of course,
different countries impose different restrictions and recommendations at different times.
One of the things that I find interesting is that the second wave always seems to come up in
every country right after the stay-at-home order enforcement ends, which I think is interesting.
The other thing that I see on a regular basis in almost every country is this graph here, which you
could superimpose on this graph, and it simply takes the number of cases and breaks it down by
age with the older being the darker and the younger being the lighter, and you can see
clearly here in this first stage that it was the elderly that seemed to be the infected the most,
and most likely that is the result for the higher death rate here in blue, whereas the second wave
and this seems to go for just about every single country in Europe has a much higher proportion of
younger people, and it's these younger people, presumably, which are out there in the public
and maybe spreading the virus, whereas you can see here for almost a very, very large portion
of this second wave that it was the elderly people that have not gotten it predominantly as they did
in the first wave, may be explaining why the death rate has not gone up tremendously in this second
wave. The other thing that is very important is the weekly testing rate. Clearly, the weekly testing
rate early on in the pandemic was very low. This is a linear scale here, as you can see, and you can
see here that it's maybe two or even three times as high here towards the end of this graph, which
is the current, and then you can also see here something called the weekly test -- positivity, in
other words, what proportion of people being tested are turning positive -- and you can see that those
are slowly going up. All this to say, this case notification rate per 100,000 is probably
grossly underestimated, which may be the reason why we're seeing a proportionally smaller amount of
mortality here, because even though this second wave is going up it's probably in reality smaller
at least at this point compared to what we had back in April. So these are just the statistics for
Austria; let's look at some other countries. Here is Belgium and, again, first wave, lots of elderly
people, testing going way up, and as we can see here, after the mandatory stay-at-home order, things
continue to go down, but then eventually start to come back up again. Here is the country of Czechia.
Clearly can see here that they are having a pretty large second wave. Most of it made up of
very young people, and we're just starting to see an elevation in the mortality rate
here, and that is because elderly people are being involved, and for those of you who want to review
that, you can see here that this is a breakdown on ages in rows, and you can see what the mortality
rate from different countries, such as Italy, China, and Spain that had high mortality rates
during this pandemic, so clearly there is a maldistribution of deaths per age group. So
this is the data from France. Again, once the stay-at-home order is stopped, we see that
for some period of time, there is minimal if any increase in cases and then it starts to go up.
Testing has increased dramatically. Unfortunately we do not have data here on what's going on with
the age group population, but once again seems to fit the pattern. Here is the Germany data. Once
again, there was no mandatory stay-at-home order, yet it seems as though they were able to get their
cases down. What they did have was a recommendation for stay at home, and it seems as though that got
the population down, we have not seen any really increase in death rates here towards current,
and it may be because, for some particular reason, a lot of the people that made up that first wave are
not being seen here, in terms of cases, we're just not seeing cases among the elderly here in Germany.
We're seeing more of them along with the young, and we're seeing a lot more testing, so we're
able to pick them up sooner, and I think that's the explanation for the lack of deaths at this point.
Here is the Netherlands. Once again, large increase here in the cases. The people that made up the
cases early on, the elderly, totally flipped around. Now it's the younger group that is making up the
second wave. Testing has gone way up, so we're probably detecting this much faster, but also the
weekly test positivity is going up, which might signal that this is headed for higher numbers.
These are the numbers in Poland. They never really had a big wave, and they're getting a second bigger
wave. Although testing has gone up, they're probably detecting it earlier. Interestingly the elderly
made up most of the first wave, and they're not too far behind. We're starting to see a very similar
pattern here with the elderly also coming in here and the younger not so much in terms of cases.
As a result of that we are seeing that the death rates are not really coming down. They are not
insignificant, they're still elevated similar to what they were at the beginning, so that lends
credence to this idea that the age distribution in the wave is going to determine the mortality.
Here's the data for Spain. Once again, huge increase here, then decrease, and it seems as
though after the mandatory stay-at-home order, we have a reduction, and then an increase once again.
Here again, we see that the elderly make up the majority of the first wave,
but not the second wave. As a result of that, we're not seeing much of an increase in mortality.
We're seeing much more testing than we were seeing back here, and so
this was probably underestimated and was probably much higher than we're seeing right now.
So what about the data for Sweden? Here, Sweden always had this general recommendation to stay at home, but they never enforced it, and interestingly here, we see in red the 14-day
case per 100,000 that seem to come down, and here we have the 14-day death notification that was
high initially, but has come down and has stayed down, and it seems to mirror that of the population
of elderly in these patients who have COVID-19, and what's interesting about Sweden is there
really hasn't been a second wave, and these numbers have stayed down pretty consistently despite the
fact that testing has gone up pretty significantly, and in fact their weekly test positivity has
come down and actually stayed down, so Sweden is actually an outlier in terms of the rest of Europe.
Here we have Great Britain, again data showing that case notifications are going up, deaths
are not interestingly. Here we're not seeing much of an increase in any age distribution.
Testing has gone up pretty dramatically and weekly test positivity has stayed pretty low even up to
October, and I think basically the data from Hungary tells the story. Notice that cases
of infection are basically marrying the younger population, whereas deaths are marrying the cases
of the older population, and one can envision that we're seeing the young people getting out. They're
being educated in populations, they're going out to restaurants, they're in public, or is the
elderly or not and one can envision that as this is being spread around in the younger populations,
it may only be a matter of time before it gets home. It certainly is possible that its
isolation from the elderly population is only time limited, and that is seen in almost every
graph here in most of the countries of Europe that the elderly population cases are going up, and when
that happens, as we can see in the first wave, at that point the deaths predictably should go up.
I'd like to hear your theories about this and I encourage you to take a look at this
site and review the data and see if there's other conclusions that you can come up with.
And what we're going to talk about next time on our next update is some really
interesting data coming out showing why at least a portion of the people who died from COVID-19
died from COVID-19. And it appears as though there are some genetic abnormalities in subpopulations
that cripple their own immune system's response against COVID-19, and if we understand exactly
what portion of the immune system is crippled and causes increased deaths then we can flip it around
potentially and understand what part of the immune system is critical in having a good
immune response against COVID-19. Watch for that update coming up, and thanks for joining us.