Analysis of population based Data

Worldwide incidence of COVID-19 from Dec 31 to July 31

It is widely broadcast that the US has the highest number of cases of COVID-19 in the world at this time. Of course that is published, documented cases. Many cases are never identified and documented by public health and some countries are less forthright in publishing actual data than others. Furthermore, the USA is a huge country with nearly four million inhabitants. How does it compare to other countries on a per capita basis? Also, if we adjust for undercounting and under reporting, where do we stand?

After the list of countries is an analysis by BBC regarding international fatality rates.

There is a data set from the WHO that shows the daily total of each country that has reported, sometimes separating territories, such as counting Puerto Rico as not part of the United States for statistical purposes. The data includes cases per million. This is based on a nation’s listed number of inhabitants on Jan 1, 2020. Some countries such as Iceland and New Zealand (both isolated islands) have very exact numbers of inhabitants, in addition to citizens. Others, such as the US count citizens and those there on a visa, but do not count undocumented workers and their families, so the denominator could be off by about 4 Million. What percentage of a population has been tested is also variable.  In the US there are epidemiologists that estimate that our total number of cases could be double, or even quadruple.  Most asymptomatic individuals are never tested until recently (an exception is Klamath County, Oregon which secured a very large number of tests early); many individuals in New York at the peak were very symptomatic, but could not get tested and therefore were not counted.

A wealthy dictatorship can obtain a lot of testing material and force its entire population to be tested. China did a very tight, draconian lockdown and tested very widely, especially in Hubei Provence, so they have fairly accurate numbers, although they rarely tested anyone under the age of 10, and we now know that many children are asymptomatic carriers. There is also question as to whether China is reporting all of their known cases, or are they trying to show that they have gotten the virus under better control than reality? The recent surge in cases would indicate that Beijing is not trying to hide information, but the same cannot be said for each individual provincial committees of the National People’s Congress, and strangely all cases seem to be imported and not domestically acquired.

Going through all 15,000 lines of data has given me a lot of insight as to where the disease is spreading and at what time it was exponential within each country, when it was gotten under control (or not) and any second waves. More information could be analyzed on data in August, but there is a lot of information in just the first seven months. We know that the virus was spreading in a small part of Wuhan during 2019 and may have leaped to humans as early as October. (Wuhan is a huge, modern metropolis of 11 million and only a small section was affected, although the entire Province was tightly locked down). Yet no organized data set predates Dec 31, 2019, so we start there and get the first cases outside China often not documented by a country until several cases are present.  Even Germany, with its very robust public health system and the primary developer of PCR testing for SARS-CoV-2, (even in China) was caught off guard and had a dozen cases in 9 cities all over the country before they realized they had any. Weeks later, they discovered that there had been a case in Munich a couple of weeks earlier.

The diseases started in central China and quickly the surrounding countries closed borders and started quarantining expats coming home. As a result, Vietnam has had very few cases and little spread within the country. Vietnam is of course a very strict dictatorship and wealthy enough to have ready access to testing. Vietnam and Thailand could be hiding numbers, as both are corrupt, but there are enough foreign medical individuals in those countries that any surge in deaths would be reported. So we can probably trust Vietnam and to some extent Thailand and even its neighbors. Myanmar, Cambodia and Laos have also had few cases. Partially this could be because of early lockdown and border control, but also in poor countries people live in open houses with fans, so essentially outdoors, these countries are rural and all public transportation was halted, traditionally no one shakes hands and even under normal conditions, people keep a respectful distance. Even before the pandemic, most people in these countries were wearing masks. This is probably a factor for low numbers in Hong Kong, Taiwan and relatively Singapore. South Korea had the most well-funded and aggressive public health department, even using police detectives, but East Asian countries have really not been hit hard, even China.  China is a huge country and has over a billion inhabitants. It kept the virus mostly to a localized area, so even though they have a large number of cases, when divided by a billion, the per capita case load is low.

I reviewed 231 countries and territories. I was surprised at how current my knowledge of geography was, as there were only three I had not heard of and only another 5 that I had to look up to determine the neighbors. About 80% I knew enough about that I needed little research to understand the level of development, type of government and healthcare capacity (I have friends in many, and forty I have visited). I still used CIA and other data sources to come up with a likelihood that the data is accurate, or way off base.

The pandemic started in China, but spread from there first to Thailand, Japan and South Korea; but it was  Italy, specifically the industrial center of Milan, where companies had ties to China, including Wuhan that had the first large outbreak. Retrospectively, it seems to have spread simultaneously to Iran, and into Afghanistan, but it is a rural country with limited travel, so it did not spread far in Afghanistan, as opposed to Teheran. From Italy it spread directly to its neighbors, Austria and France and from there rapidly to Spain. It did not spread to Greece and COVID is only now beginning to be a serious problem there. From one Austrian ski resort, it spread to Germany, Iceland and the Scandinavian countries. Unbeknownst to Germany, it had already started to spread in Munich from a visitor to Wuhan. As a result, Bavaria had much more COVID than the rest of Germany, made worse by locking down a week later than the rest of the country.

South Korea and the US had their first cases simultaneously, but it was a week later before the US had confirmed its first case. A few cases came to the US in Washington State and Silicon Valley, directly from Wuhan. Very shortly later it spread rapidly in New York and then the Northeast US, as cases were imported from Europe.

There are 30,000 Chinese in Djibouti, so this was one of the earliest countries in Africa to report cases and likely from there it spread through the Middle East, which has been the hardest hit of all parts of the world. South Africa has ties to China and Europe and it has spread very rapidly there and gradually is spreading across Africa.

Chile and Ecuador have ties to China, as do other countries in South America. They also have strong ties to New York City. Through these pathways, the virus has spread essentially unmitigated throughout the Americas, except Canada, which has shut its borders.

Spread in Eastern Europe has been more sporadic. It is suspected that Russia is the hardest hit, but data is considered suspect. Sweden elected initially not to lockdown, much to its regret. The UK did not lockdown soon enough or tight enough, so spread there has been much worse than most of the rest of Northern Europe, but its numbers are a little lower overall, as Scotland is included as part of the UK and Scotland has been much tighter in controlling the spread and the Scots have been generally more cooperative with restrictions than the English. Also the population of the UK is much larger than Belgium or Luxembourg.  Countries with a small population need only a few cases to have a large number of “cases per million inhabitants.”

Some countries are very small (Andorra and Monaco)  and a few cases can give a drastic per capita number, even if there have been no new cases in weeks (Vatican City, also listed in some sources as The Holy See). Other countries can tightly isolate (New Zealand and now Iceland and the Faroe Islands and the Antarctic Continent). Some countries have leaders that are highly respected by the populace, so cooperation is high: Germany, Taiwan, New Zealand, Iceland, Finland, Norway, and to some extent Canada (cooperation with public health, even if they have concerns with the Prime Minister). Some countries have authoritarian leaders who have pushed the economy in preference to public health: Brazil, Hungary, Venezuela, Zimbabwe, and to some extent Poland, and early on Austria, and of course the US).

One country stands out: Slovakia. The government is not trusted and is known for corruption. Compared to its neighbors, Slovakia is poor and many work outside the country and commute on weekends. Yet, before the first case was documented, the public health department warned of the danger and the population, especially young people took it seriously. They have had amazingly few cases. Since they are not an island and only closed their borders for a brief time, have limited testing, and other resources, Slovakia has done remarkably well.

I focus on total cases as of July 31.  Some countries had sudden early surges (Italy, Iceland) and subsequently got the spread under control (or nearly stopped in Iceland and the Isle of Man). Other countries did not institute control measures early (Sweden, UK, Belgium), had a surge of cases early on and few since. Other countries have only recently started seeing cases (most of Africa), but there are signs that COVID is now spreading exponentially. There are also countries that locked down early, stemmed the spread, but are now experiencing a second wave (Australia and the Maldives – some would say South Korea, but even their “second wave” is very small and limited to mostly members of a single church). So the ranking list I have made is not based on the risk of contagion or current spread of the virus in August 2020, but the total number of cases reported between Dec 31, 2019 and July 31, 2020.

The US makes the news as we document 1500 new cases per day and could be having over 300O. However, things are spreading much worse in Latin America and if the US can get the new cases under control (possible a vaccine, although that is unlikely) through better testing and contact tracing, the disease will still be raging through most of the Western Hemisphere and how will that not spread to the US, or significantly impact the US economy?

Currently in Africa the documented incidence is low in most countries, both because little testing is done, but the African continent is huge and it will take time to spread across thousands of kilometers. By March, the Middle East had seen huge numbers of cases and this spread across the top of Africa from Egypt to Morocco fairly quickly. South Africa was also hit hard, as were some islands with strong ties to Europe. The disease is going to spread completely across Africa and many countries are going to be devastated, however, at this time there is not the huge amount of travel across Africa like there is in Europe and Asia. Seeing what is going on in the rest of the world has made the public health leaders in many African countries especially cautious. So it is spreading slowly into the Sahel and the equatorial Africa.  Many of these countries have very limited resources (Niger, Malawi), or very corrupt governments (Nigeria and Zimbabwe), or severe lack of clean water for much of the population (much of Uganda and Kenya). None, except Botswana, have a robust public health system and few can afford wide spread testing.

COVID-19 does not have the high death rate that the 1918 H1N1 pandemic flu had, but then we have better medical care, even in developing countries, and this virus is killing few under five, as opposed to pandemic flu, so Africa and much of the Middle East will not have huge fatalities. However, the virus spreads rapidly among those of working age and often leaves people unable to work for weeks or months. Therefore the economic consequences of what is happening in Latin America and will soon happen in Africa, will be horrendous and affect these economies for many years; which will in turn have a negative impact on the economies of the developed world.

1918-1919 pandemic flu may have killed 50 million worldwide. The world population then was 1.8 billion and it is estimated that one third of the world’s population was infected; the fatality rate was about 3%. Less sophisticated health care, so COVID is worse in total, but less devastating in that those hardest hit in 1918 were 20-40 year olds and those hardest hit now are over 60. Of note, the second wave hit much harder than the first and drove the economy of most countries into a downward spiral when an worldwide economic downturn was already occurring.  Loss of so many workers during peak economic years was hard to recover from to some extent in the US and Western Europe, but severely added to Germany’s economic depression. In most Western countries there was a shortage of workers, but an abundance of capital, so the stock market began to rise, yet for a few years the poor got poorer. India suffered a huge population loss in 1919, but as a result, unemployment fell and workers were somewhat better off.

According to Tony Blair, “Covid-19 is the toughest practical challenge for government I have ever seen. To a greater or lesser degree every country in the world is grappling with the virus. For developed countries the need is to understand that eradication is not possible, only containment. Lockdown is a necessary step, but only mass testing of the population will isolate the asymptomatic cases (carriers).”

“It is clear what must be done, but the challenge of developed countries pales into insignificance beside the dilemma facing developing countries, and if the developing world fails, the consequence will reverberate around the world. If low and middle-income countries cannot deal with the crisis, we cannot control the disease globally.” (Quoted in Financial Times, Aug 10, 2020). Food shortages and recurrence of HIV, Malaria, TB, Ebola and malnutrition will occur. The international community must assist to shield the most vulnerable people in those countries that cannot lockdown, test and trace.

 

Below is a list of countries in order of reported per capita cases. The number following each country or territory is the cases per million. This can be confusing, as Vatican City actually only has 12 cases total, but few permanent residents. This also throws other small countries who have now gained control high on the list: Andorra, Luxembourg and Belgium. Likewise, countries like India that probably have a huge number of cases, but also a huge population end up way down the list: 103, but there poverty and limited testing means that the actual case load is horrific and recent hospital overloads in Delhi are indicating that the actual case load is many fold, or even a quantum level higher, but still, there are nearly a billion inhabitants. Following the number per million inhabitants is my best estimation of what the true number should be.

When you look at the first six countries, four are Middle East petroleum powerhouses. They have absolute dictatorships and a lot of wealth. They have been hit hard early, but have tested very widely.  The fact that these four countries are among the world’s worst for COVID-19, would indicate that they are not trying to hide their numbers, but these are probably accurate. Nearby in Iran, it has been estimated, that they are reporting only at most 1/3 of cases.

Chile is number 4, but has limited testing ability.  Add to that that about 40% of cases are asymptomatic; its numbers cannot be compared to the small wealthy countries that can test widely. Therefore it should rank #2, or maybe it is #1. It will be soon, as Qatar has few new cases and is very tightly controlled, whereas Santiago has large demonstrations in the streets and it is winter there, so people are forced closer together in buildings with limited air circulation. There is also a lot of poverty, although maybe not much more than parts of New York City. The US has not tested as highly as any other developed country, but still probably is way ahead of Panama. So even if we need to double or triple the numbers in the US, it is still below Chile, Panama and probably Qatar. Likely Peru has more cases per capita than the US, and the same is likely true of Brazil, with their huge favelas. The case load in the US is growing exponentially and in Qatar barely at all. So the US will soon pass Qatar, but as of July 31, I would rank the top five countries as Qatar, Chile, Peru, Brazil and the US as #5. Armenia might be ahead of the USA and possibly South Africa.

Israel is better able to test than its neighbors and the poorer Palestinian areas are counted separately. The Middle East has been hard hit, but new cases in Israel are lower now. Its position as #15 will likely drop and in reality, things are worse in neighboring Palestine, (especially Gaza)  Jordan and Lebanon. One can only imagine what is happening, or soon to happen in Syria and Yemen.

Singapore is unusual among Southeast Asian countries, but seems to have stemmed the surge, as has Sweden, the highest ranking European Country of any size, now that they have abandoned their unsuccessful attempt at herd immunity. Among the top twenty are tiny countries like the Vatican, San Marino, Andorra and Luxembourg, all of which have limited new cases Among 21-30 are not surprisingly Belarus, Russia and Kyrgyzstan. The numbers are likely quite higher in these dictatorships and these three are probably in the top 20, likely above Israel and Sweden, but probably not South Africa.

Iceland was caught by surprise when many of Icelanders chose to go to the same Austrian ski resort that a week later spread cases all over Europe. They have a small population, so only a few infections resulted in a high per capita number, but like New Zealand, a cooperative citizenry and strong public health. Similar is the case in Ireland.  The high ranking of Macedonia makes one wonder what is really happening in Greece. Puerto Rico has so far been better off than the rest of the US.

Looking at the next fifty shows that the disease is really spreading fastest in Latin America, although Italy is still ranked very high. There are many small countries and territories that are listed here, including the US Virgin Islands, but we see more of the Latin American countries. Switzerland is doing well, but is squeezed between Italy and France, both of which were hit hard early on. A few African countries appear starting at 44. Some are popular European vacation spots, but Gabon must be able to test better than its neighbors and might be more representative of central Africa.

The war torn regions of the world (parts of Africa, Middle East and in actuality the Northern Triangle of Central America and Venezuela) are going to soon be the epicenter of COVID-19. International Cooperation will do more to contain the spread of COVID than the current competition between many countries. The cooperation between Israel and the UAE is an example of how the pandemic may have some positive effects to lessen world tensions.

Once we get to those countries with less than 2000 cases per million inhabitants we are seeing some highly developed countries that have aggressively limited the spread of the virus, as well as countries that cannot test widely (India), or may have not yet been hit (Western Sahara, Ghana and Guinea-Bissau). Tajikistan should probably be in the first 100.

Note that the “World” is listed at 83. This median is of course not based on accurate data at all, as few countries are submitting accurate data.

At 139, Slovakia is nearly as good at keeping the case load low (and fatality rate) as well publicized South Korea (152) and New Zealand (157). It is not surprising that Japan (159) and some Caribbean Islands have done well. Japan has excellent public health, few cases and a large population (so large denominator and small numerator, like China). The islands, including Greenland can easily isolate.

At the bottom of the list are some very isolated places that have still kept the virus at bay and have no cases. Both parts of Samoa are in this category, which is a major achievement for a large and usually mobile population. All research stations on Antarctica have been protected and cruise ships prohibited. North Korea claims no entry by infected individuals and this could well be true. China acts as a protector for this most isolated dictatorship and China has kept the virus from spreading to the province adjacent to North Korea. Turkmenistan is an absolute dictatorship with no free press and little opportunity to investigate its claim. Its borders are not as tightly sealed as North Korea and its neighbors all have plenty of cases. Tehran is not that far from Ashgabat and its border with Uzbekistan is rather porous.

 

Country                      cases per million              adjustment factors

1. Qatar                                     38340                    likely accurate
2. Bahrain                                 23951                    probably accurate
3. San Marino                          21097                    probably accurate
4. Chile                                      18494                    at least double
5. Kuwait                                  15578                    likely accurate
6. Oman                                    15501                    likely accurate
7. Vatican City                         14833                    very precise
8. Panama                                14663                    probably double or triple
9. United States                      13579                    at least double
10. Armenia                               12617                    double or triple
11. Peru                                      12358                    probably 5 X
12. Brazil                                     12279                    probably 10 X
13. Andorra                               11932                    quite accurate
14. Singapore                            8855                      accurate
15. Israel                                     8131                      perhaps 50% higher
16. South Africa                       7931                      likely 5-10 X
17. Sweden                                7931                      accurate
18. Saudi Arabia                       7876                      likely accurate
19. Luxembourg                       7223                      accurate
20. Belarus                                 7160                      likely triple or more
21. Maldives                              6880                      likely 50% higher or more
22. Bolivia                                   6445                      at least = Peru
23. Dominican Republic          6261                      probably at least double
24. United Arab Emirates        6120                      accurate
25. Spain                                     6001                      probably 20-30% higher
26. Moldova                               5936                      likely 2-3 X
27. Belgium                                5859                      very accurate
28. Puerto Rico                         5792                      probably similar to rest of USA  
29. Russia                                   5718                      accuracy doubtful
30. Gibraltar                              5550                      precise
31. Kyrgyzstan                          5488                      double or triple
32. Iceland                                 5485                      accurate
33. Ireland                                  5251                      probably 20% higher
34. Djibouti                                5142                      could be double
35. Macedonia                          5099                      probably 20% higher
36. Colombia                             5053                      likely 10-25 X higher
37. Portugal                               4989                      accurate
38. Montenegro                        4893                      likely 40-50% higher
39. Kazakhstan                          4744                      2-5 X higher
40. Ecuador                                4664                      probably 5 X
41. Faeroe Islands                     4502                      precise
42. United Kingdom                4441                       probably 20% higher
43. Cape Verde                         4268                       possibly only 10-25% higher
44. Kosovo                                 4193                       likely 20-50% higher
45. Honduras                            4182                       probably 2-3X, maybe 10 X
46. Italy                                      4088                       probably 20-30% higher               
47. Switzerland                         4011                       precise
48. Sao Tome and Principe    3961                       unknown, probably 2-5X
49. Argentina                            3960                       at least double
50. Isle of Man                          3951                       accurate
51. Guernsey                             3758                       accurate
52. Falkland Islands                 3732                       accurate
53. Serbia                                  3705                       probably 20-100% higher
54. US Virgin Islands               3687                       possibly 20-30% higher
55. Iran                                       3590                       at least 3-4 X, maybe 10+
56. Bosnia /Herzegovina        3488                       probably 20-100% higher
57. Costa Rica                           3394                       likely 3-6 X
58. Jersey                                   3314                       accurate
59. Gabon                                  3303                       recently spreading, likely 2-5 X
60. Netherlands                        3149                       accurate
61. Mexico                                 3123                       probably 5-20 X
62. Cayman Islands                  3088                       precise
63. Azerbaijan                           3079                       at least 3-4 X, maybe 5+               
64. Canada                                3068                       likely 20-30% higher
65. Monaco                               3057                       accurate
66. Iraq                                       3015                       at least 3-4 X, maybe 10+
67. Sint Maarten                       2985                       possibly 20-30% higher
68. France                                  2858                       possibly 20-30% higher
69. Palestine                              2834                       probably 20-60% higher               
70. Suriname                             2813                       probably 20-100% higher
71. Turkey                                  2726                       probably 30-100% higher
72. Guatemala                          2725                       probably 10-20 X
73. Montserrat                          2600                       possibly 20-30% higher
74. Romania                              2578                       probably 20-100% higher
75. Turks & Caicos Islands      2557                       probably 20-100% higher
76. Bermuda                             2505                       possibly 20-30% higher
77. El Salvador                          2502                       probably 10-20 X
78. Germany                             2481                       accurate
79. Denmark                             2370                       accurate
80. Liechtenstein                     2334                       accurate
81. Austria                                2333                       accurate
82. Swaziland                           2221                       likely 3-8 X
83. World                                  2219                        unlikely
84. Equatorial Guinea             2189                       likely 3-6 X
85. Guam                                   2109                       accurate
86. Malta                                   1844                       accurate
87. Albania                                1806                       likely 20-100% higher
88. Norway                                1692                       accurate
89. Bulgaria                               1644                       likely 20-70% higher
90. Estonia                                 1546                       accurate
91. Ukraine                                1545                       doubtful (2-6X)
92. Czech Republic                  1526                       possibly 20-50% higher
93. Bangladesh                         1426                       5-20 X
94. Mauritania                           1348                       unknown, likely 3-6 X
95. Finland                                 1340                       accurate
96. Bahamas                              1292                       likely 20-100% higher
97. Western Sahara                  1282                       5-20 X
98. Pakistan                               1260                       5-20 X
99. Cyprus                                  1207                       likely 50-100% higher
100. Croatia                                 1199                       likely 20-70% higher
101. Poland                                 1190                       likely 50-200% higher
102.  India                                    1188                       at least 5-40 X
103. Seychelles                           1159                       2-20 X or more
104. Ghana                                  1131                       2-20 X or more
105. Aruba                                   1124                       likely 50-200% higher
106. Guinea-Bissau                    1007                       likely 50-500% higher
107. Slovenia                               1004                       maybe 20-70% higher
108. Central African Republic     953                      2-20 X or more
109. Antigua and Barbuda          929                      likely 50-200% higher
110. Egypt                                      908                      at least 3-4 X, maybe 10+
111. Easter Island                         865                       tightly locked down, accurate
112. ­­­­Namibia                                 808                       likely 4-8 X
113. Tajikistan                               772                       possibly 2-6 X
114. Lithuania                               757                       could be 20% higher
115. Philippines                            749                       easily 3-8 X higher
116. Northern Mariana Islands  730                       likely 50-200% higher
117. Uzbekistan                            704                       possibly 2-6 X
118. Nepal                                      671                      likely 50-200% higher
119. Algeria                                    667                      likely 50-400% higher
120. Haiti                                         650                      likely 4-8 X
121. Cameroon                              650                       possibly 2-6 X
122. Latvia                                      649                       could be 20% higher
123. Australia                                 639                       could be 20-30% higher
124. Morocco                                 630                       likely 50-300% higher
125. Venezuela                              628                       suspect 50-100 X
126. Paraguay                               623                        suspect 10-20 X
127. Lebanon                                 616                       suspect 5-15 X
128. Cote d'Ivoire                          606                       unknown, limited in the area, but limited capacity 2-6X
129. Senegal                                  604                       unknown, limited in the area, but limited capacity 2-6X
130. Congo                                    580                       unknown, limited in the area, but limited capacity 2-6X
131. Hong Kong                           579                       could be 10-30% higher, or actually lower due to denominator
132. Nicaragua                             554                       suspect 50-100 X
133. Guinea                                   547                      unknown, limited in area, but limited capacity 2-6X
134. ­­­Guyana                                  470                      small, isolated, poor likely 50-300% higher
135. Saint Vincent and the Grenadines  469       small, isolated, could be 20-50% higher
136. Hungary                               464                       autocratic, but closed borders, 2-15X
137. Comoros                              435                       isolated island, maybe double
138. Greece                                  422                       cases spiking, suspect 3-10 X
139. Bonaire Sint Eustatius and Saba  420           could be 20-30% higher
140. Slovakia                                415                        hard to believe, but early lockdown and trust in public health
141. Libya                                     411                        likely 50-500% higher
142. Barbados                             383                       could be 20-100% higher
143. Indonesia                            382                        could be 20-200% higher, but good public health
144. Kenya                                   370                       unknown, limited in area, but limited capacity 2-20X
145. Uruguay                              346                        limited testing, suspect 10-15 X
146. Botswana                            342                       could be 20-200% higher, but good public health
147. Madagascar                       336                        isolated, could be 20-400% higher
148. Brunei                                  322                       tight lockdown, but are they testing much? could be 20-200%+
149. Saint Kitts and Nevis        320                        could be 20-50% higher
150. Georgia                               290                       likely 3-10 X
151. Jamaica                               289                      isolated, poor, maybe correct, or 2-5X
152. Lesotho                               282                       isolated, poor, probably 2-5X
153. South Korea                       278                       precise
154. Malaysia                              275                       could be 20-200% higher
155. Mauritius                            270                       tight lockdown of small island, probably accurate
156. British Virgin Islands        265                       precise
157. Sudan                                  261                       country in disarray, likely 3-10 X
158. New Zealand                     251                       precise
159. Dominica                            250                       isolated and lockdown, but disrupted by hurricane
160. Japan                                  248                       large population, but excellent cooperation, maybe 10% +
161. Zambia                               247                       isolated, poor, probably 2-5X
162. Greenland                          247                       likely correct (14 cases)
163. Liberia                                233                       isolated, poor, probably 2-5X, but little in the area
164. Cuba                                   228                       very isolated now, probably close, maybe 10-20%
165. Sierra Leone                      226                       isolated, poor, probably 2-5X, but little in the area
166. French Polynesia             221                        tight lockdown of small islands, maybe 10-20%
167. Grenada                            213                        small island, probably accurate World Bank support
168. Malawi                               208                        isolated, poor, limited resources, chaos, maybe 2-5X
169. Zimbabwe                         208                        total chaos, hospitals closing, probably 10-40 X, friend runs ICU in main hospital
170. South Sudan                     207                        war torn, minimal services, probably 10-20 X
171. Nigeria                               207                        crowded, no social structures, probably 10-50 X
172. Anguilla                              200                       isolated island, 3 cases, precise
173. Somalia                              200                        war torn, minimal services, probably 10-20 X
174. Curacao                              177                      isolated island, probably accurate
175. Rwanda                              154                       unknown, limited in area, but limited capacity 2-20X
176. Benin                                  146                       unknown, limited in area, but limited capacity 2-20X
177. Saint Lucia                        136                       isolated island
178. Gambia                              135                       unknown, limited in area, but limited capacity 2-20X
179. Bhutan                               131                      isolated, but likely 50-200% higher
180. Sri Lanka                            130                     isolated, but limited resources,  2-20X
181. Ethiopia                             127                      unknown, limited in area, but limited capacity 2-20X
182. Mali                                    124                      unknown, limited in area, but limited capacity 2-20X
183. Tunisia                               124                      surrounded by high areas, government chaos 2-20X
184. Belize                                 121                      surrounded by high areas, but better government 50-500%
185. Jordan                               119                      limited data, surrounded by high areas, suspect 2-10 X
186. Trinidad and Tobago      117                      able to isolate, but limited resources, 2-10 X
187. Togo                                  112                      unknown, limited in area, but limited capacity 2-20X
188. Democratic Republic of Congo  100        limited in area, but limited capacity 2-20X
189. Mongolia                           89                      isolated, but likely 50-200% higher
190. Eritrea                                79                      surrounded by high areas, limited resources, 2-50 X
191. New Caledonia                 77                     isolated island, probably 10-20% higher
192. China                                  61                     draconian lockdown, huge population, might be correct
193. Yemen                                58                     war torn, minimal services, probably 10-50 X
194. Chad                                   57                     unknown, limited in area, but limited capacity 2-20X
195. Burkina Faso                     53                     unknown, limited in area, but limited capacity 2-20X
196. Burundi                              53                     unknown, limited in area, but limited capacity 2-20X
197. Eswatini                             53                     unknown, limited in area, but limited capacity 2-20X
198. Cabo Verde                       53                     isolated island, probably 10-20% higher
199. Reunion                             53                     isolated island, probably 10-20% higher
200. Mayotte                             53                     isolated island, probably 10-20% higher
201. Thailand                            47                     Strong lockdown, autocracy, maybe 10-100% higher
202. Niger                                  47                     unknown, limited in area, but limited capacity 2-20X, friend says diverse spread
203. Syria                                   42                     war torn, minimal services, probably 10-500 X
204. Angola                               33                     unknown, limited in area, but limited capacity 2-20X
205. Burundi                              33                    unknown, limited in area, but limited capacity 2-20X
206. Fiji                                       30                    isolated islands, probably 10-200% higher
207. Uganda                              25                    surrounded by high areas, limited resources 2-30 X
208. Taiwan                               20                     Strong lockdown, excellent cooperation, probably accurate
209. Timor                                 18                     isolated island, probably 10-20% higher
210. Cambodia                         14                     Strong lockdown, limited resources, maybe 2-5X
211. Tanzania                           8.5                     surrounded by high areas, limited resources 2-50 X
212. Papua New Guinea         7.0                    isolated, but likely 50-200% higher
213. Mozambique                    6.5                   unknown, limited in area, but limited capacity 2-20X
214. Myanmar                          6.5                   Strong lockdown, autocracy, maybe 10-500% higher
215. Timor-Leste                     6.5                    isolated, but likely 50-200% higher
216. Vietnam                            5.3                   Strong lockdown, autocracy, maybe 10-100% higher
217. Laos                                   2.7                  Strong lockdown, limited resources, maybe 2-5X
218. Vanuatu                               0                   Tightly closed island
219. North Korea                                              probably
220. Turkmenistan                                           ?
221. Solomon Islands                                      Tightly closed islands
222. Samoa                                                        *
223. Kiribati                                                        Tightly closed island
224. Federated States of Micronesia            Tightly closed islands
225. Tonga                                                         Tightly closed island
226. Marshall Islands                                       Tightly closed islands
227. Palau                                                          Tightly closed island
228. Tuvalu                                                        Tightly closed island
229. Nauru                                                        Tightly closed island
230. American Samoa                                     *
231. Antarctica (continent, not actually a country) very controlled entry, all cruises shut down

*both parts of this island agreed to block all travel early.

 

 

       President Trump claims the country has one of the lowest death rates from the virus in the world.

     He's also said excess deaths are significantly lower than elsewhere - that's the number of extra deaths above what would be expected.

But others say the US has been hit worse than other countries, pointing out it has the most recorded Covid deaths of any country in the world.

"More than 170,000 Americans have died - by far the worst performance of any nation on earth," Democratic presidential contender Joe Biden has said.

We've looked at three different ways you can measure the rate of Covid-19 deaths, two of which show that while the US is not the worst affected, it's among those most badly hit.

1. The number of excess deaths

First, there is no international standard for how you measure deaths, or their causes. And making comparisons is tricky as countries record deaths in different ways.

But experts say one of the most telling measures is how many extra deaths a country experiences above the number who would have been expected to die.

 

This "excess" death data captures some potentially unrecorded coronavirus deaths, and other deaths that might be the result of strain on healthcare systems and other indirect effects of the epidemic.

It can therefore provide a more complete picture of how a country has been affected overall.

Most developed countries publish excess death data, but they do it less frequently than the daily coronavirus death totals they provide.

The US experienced almost 200,000 excess deaths from the start of the outbreak up to 11 July, according to the latest data available.

That's an 18% increase on previous years.

Although the time periods are different, looking at the latest data from the world's leading industrialised nations, we can see the US has a lower proportion of excess deaths so far than Italy and the UK.

The UK has been one of the hardest hit countries, with around 26% more deaths than expected in a typical year up to the start of August.

So on this measure with the data available so far, the US is not the hardest-hit country, but this figure could change.

While weekly deaths in the UK and Italy have gone back to expected levels, the US could move up the rankings if it continues to see above-expected numbers of deaths each week.

2. The case fatality rate

Another measure is the case fatality rate. This is the ratio of deaths to confirmed cases - of those who tested positive for coronavirus, how many have died?

President Trump has said: "Our case fatality rate has continued to decline, and is lower than the European Union, and almost everywhere else in the world."

The US rate is relatively low compared with most major European countries, including the UK, although it isn't the lowest in the world.

Percentage of coronavirus cases which lead to deaths

  

But different countries are testing to find coronavirus cases in different ways, meaning this is a hard comparison to make.

A low case fatality rate could mean that widespread testing identifies lots of mild cases who were unlikely to die in the first place.

3. Death rates per capita

The US has recorded the most deaths from coronavirus in the world, but it has a larger population than many other countries.

When you look at deaths per capita - as a proportion of each country's population - the US is no longer top of the list, but remains in the top 10 worst-hit countries.

10 countries with most coronavirus deaths per

 capita (go to link to see graph)

The US has recorded more than 52 coronavirus deaths per 100,000 people - there are a number of countries that have recorded more.

The US continues to regularly report more than 1,000 new coronavirus deaths a day, which is one of the highest daily death rates per capita in the world, according to the UK-based Our World in Data website which compiles global figures for coronavirus.

However, there are important differences in how countries count coronavirus deaths, making exact comparisons difficult.

https://www.bbc.com/news/world-us-canada-53780196

(copy and paste link)