Just hours after I wondered about the data coming out of Africa with regard to the COVID-19 pandemic, I ran across this article in NewScientist (14 March 2020) which may provide some answers:
African countries are both vulnerable and potentially more resilient to the coronavirus. On the one hand, the population is much younger than in Europe and China. The median population age in the UK is 40.2 and in China it is 37, but this figure is 17.9 in Nigeria, Africa’s most populous country. “If you look at the statistics from China, the people that have worse prognosis are the older people, not necessarily the young,” says Stephen.
They also suggest at least some of the African nations are vigilant about incoming visitors.
I had also noted Russia’s small reported numbers. Its median age? 39.6, comparable to the UK & China. CNN has a report today on Russia’s small reported numbers, and it feels properly confusing, as Russia often can be:
“The director-general of WHO said ‘test, test, test,'” Dr. Melita Vujnovic, the World Health Organization’s representative in Russia, told CNN Thursday. “Well, Russia started that literally at the end of January.”
Vujnovic said Russia also took a broader set of measures in addition to testing.
“Testing and identification of cases, tracing contacts, isolation, these are all measures that WHO proposes and recommends, and they were in place all the time,” she said. “And the social distancing is the second component that really also started relatively early.”
Rospotrebnadzor, Russia’s state consumer watchdog, said Saturday that it had run more than 156,000 coronavirus tests in total. By comparison, according to CDC figures, the United States only picked up the pace in testing at the beginning of March, while Russia says it has been testing en masse since early February, including in airports, focusing on travelers from Iran, China, and South Korea. …
Anastasia Vasilyeva, a doctor for Russian opposition figure Alexey Navalny and leader of the Alliance of Doctors union, made headlines with a series of videos in which she claims the authorities are covering up real coronavirus numbers by using pneumonia and acute respiratory infection as a diagnosis.
“You see they said the first coronavirus patient that died, that the cause of death was thrombosis,” Vasilyeva told CNN. “That’s obvious, nobody dies from coronavirus itself, they die from the complications, so it’s very easy to manipulate this.”
Moscow health officials denied the accusation and said they were testing pneumonia patients for coronavirus. The WHO’s Dr. Vujnovic also was skeptical about Vasilyeva’s claim.
“If there was a hidden, unrecognized burden somewhere it would be seen in these [pneumonia] reports,” she said. “So I do not believe this is happening, which does not say that you might not see an increase of cases in the next period, because we have seen that in many countries.”
I have no idea what to make of this. Cover up? So competent they make us look like a clown herd?
Finally, a reader sends this link to a site named Stat, with which I’m unfamiliar. The article bemoans the general uncertainty of knowledge concerning COVID-19, but I have to wonder if they think the professionals at the CDC are dunces. Then I ran across this paragraph:
The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
Perhaps the writer, John Ioannidis, is a victim of bad editing, or perhaps he doesn’t understand how to analyze the situation. Here’s the error as I see it: He’s taking age as a fundamental factor in determining risk.
It’s not.
Age is a proxy for making general statements about underlying health conditions. In general, the aged have less effective immune systems than do the young. But a proxy is always a step away from the fundamentals, and so when using a proxy, one must always view it with some slight suspicion, applying caveats of both qualitative and quantitative measures.
The health professionals have been at pains to emphasize that any sort of underlying health condition may put those who’ve contracted the virus at risk for a severe episode. These constitute the fundamental factors of the risk.
Taking Ioannidis’ paragraph as an example, once you realize age is a proxy, then you find a set of questions that need to be answered:
- Are elderly cruise line passengers more or less likely to be as healthy as the median elderly person in the population? If it’s more healthy, then adjust the derived rates for severe and terminal episodes up; if it’s less healthy, then adjust the derived rates down. By derived, I mean the absolute rate for elderly persons, regardless of context.
- How does the level of care delivered on a cruise ship compare to that at an average 1st world hospital? I’ve never taken a cruise, so I am clueless.
- How did caring for infected cruise line passengers impact other non-infected hospitalized passengers?
- How did the stress of being at sea, with limited resources, impact the recovery of infect passengers? In particular, the psychological stress of having home countries turn your ship away – a dreaded plague ship, as it were – must take a toll on patients of a certain range of temperaments.
- Etc.
Some folks may view the cruise liner situation as an excellent isolated experiment, but I have my doubts that at least Ioannidis’ article understands the nuances of the situation, based on the toss-off nature of that paragraph. And I do get that precision to 15 decimal places is useless, but it would help to at least say, within a magnitude, how COVID-19 compares to the seasonal flu.
