The Code COVID-19 International Update – 18 November 2021

close up photo of the coronavirus

Dr Priscilla Robinson

The Code COVID19 International Update is a weekly snapshot of the COVID-19 pandemic, assessing efforts by nations around the world to test, track and fight the virus. It’s compiled by Dr Priscilla Robinson, an Adjunct Associate Professor of Public Health at LaTrobe University, and an editor for the Australian and New Zealand Journal of Public Health.

View the latest spreadsheet here

Reporting from  Gippsland where we have only had power out unexpectedly for one day this week which seems almost normal now. I remain perplexed though at the complete lack of public health information, and wonder why the message is always ‘visit the website for more information’ when there is no internet service and little telephone coverage, and very little information when you land on the right website anyway. I don’t know how many times this needs to be mentioned really, but for people relying on a functioning power supply for medical reasons, not to mention employment responsibilities, there is accumulated anger building. Just saying.

Now to COVID:

Many high income countries with respectable vaccination rates are currently reporting surges. The USA for example has between 50,000-100,000. cases every day. Tiny Cayman Islands in the Caribbean has suddenly reported an almost 33% increase in a week (this might be a reporting consolidation of course). Austria has reported around 10,000 for a few days in a row.  In our part of the world Thailand is now 25th on the global case number league-table and is reporting close to 10,000 cases most days, and is up to almost a 3% overall population rate. Vietnam is also having a surge, and Singapore has been dealing with a rise in numbers for a while now. Notable increases include previous poster-children New Zealand (over 15% increase last week), Singapore, Australia, Israel, plus Fiji is having another moment.

This summary table shows the countries amongst whom at least 10% of their population have tested COVID-19 positive, and the countries with fatality rates over the global average. The Global attack rate over the course of the pandemic is currently 3,797.63 per 100,000 people (i.e. nearly 4%, so this table only shows some of the really badly affected countries). However, as the COVID-19 fatality rate is now down to 2.01, these are all of the countries on this list which have higher than average rates. It all makes for interesting reading, not least because in general the press completely misses the point about the difference between cases and attack rates. It is also important to remember that these are notified cases, and there are many ways countries are dealing with their cases – some do not have the resources to undertake contact tracing for example.

Geography Total cases Pop cumulative AR/100,000 Geography Deaths Cumulative CFR
Seychelles                 22,704            23,085.61 Chile        388,001 22.44
Czech Republic (Czechia)            1,907,629            17,813.36 Yemen            1,926 19.38
Maldives                 89,999            16,649.71 Philippines        457,009 16.21
Israel            1,337,887            15,457.01 Peru        200,635 9.06
UK            9,600,373            14,141.90 Mexico        291,147 7.57
USA          46,780,515            14,132.97 Syrian Arab Republic            2,672 5.76
Netherlands            2,314,304            13,506.40 Afghanistan            7,294 4.66
Belgium            1,512,474            13,050.24 China            5,697 4.48
Argentina            5,305,742            11,739.46 The Gambia               341 3.41
Sweden            1,182,471            11,708.49 Indonesia        143,685 3.38
Mongolia               373,513            11,162.98 Hungary          32,336 3.35
Costa Rica               564,159            10,950.52 South Africa          89,489 3.06
Portugal            1,108,462            10,908.22 Romania          53,264 3.05
France            7,064,362            10,822.71 Russian Federation        257,837 2.82
Spain            5,056,954            10,815.91 Brazil        611,283 2.78
Austria               969,407            10,690.61 Namibia            3,564 2.76
Switzerland               905,161            10,458.70 Italy        132,819 2.74
Brazil          21,957,967            10,330.27 Colombia        127,809 2.54
Liechtenstein                   3,945            10,311.84 Poland          79,161 2.45
Ireland               498,448            10,094.56 Ukraine          77,985 2.40
Hungary               966,167            10,001.37 Cambodia            2,872 2.40
Viet Nam          23,183 2.24
Pakistan          28,612 2.24
Argentina        116,232 2.19
Iran        128,272 2.12
Greece          16,838 2.01


The fatality rates also reflect different way of counting causes of death, and it is worth remembering that a few months ago Chile added a large batch of deaths attributed to COVID. However, with a population attack rate just under 10% it is not clear whether this is an over-attribution of deaths or an undercounting of cases, or both. Or even a reflection of available health care. And for the record, China where it all perhaps began, has an attack rate of only 8.84% (i.e. under 1%), with a fatality rate of 4.48

Here is where we are at worldwide with vaccine roll-outs. The press has finally noticed that the COVIX programme is not working as intended. I think it is something of a travesty that more people are on their third dose in some countries, where in others almost nobody has had any at all.


CONTINENT % of population who have had at least one dose. % of population who are partially vaccinated % fully vaccinated   Booster doses /100 people
Africa 9.53 3.13 6.40 0.02
Asia 60.09 14.76 45.33 1.66
Europe 61.02 4.72 56.30 4.78
European Union 69.62 3.42 66.20 4.35
North America 62.60 9.17 53.43 5.38
Oceania 57.85 5.78 52.07 0.60
South America 70.53 15.45 55.08 4.86
Income Group
Low Income Countries 4.46 2.14 2.32 None
Lower Middle Income Countries 40.78 17.05 23.73 0.11
Upper Middle Income Countries 72.92 9.31 63.61 3.33
High income 72.69 6.35 66.34 6.56
WORLD 52.11 11.34 40.77 2.12


Now to papers.

Grange Z and colleagues. Characteristics and risk of COVID-19-relagted death in fully vaccinated people in Scotland.

This paper summarises the characteristics of fully-vaccinated people who tested +ve for covid and died.

The take-home messages are: that 0.007% of fully vaccinated people died of COVID (which is 4.2/10,000 vaccinated people compared with almost 65/10,000 unvaccinated people, so the risk is more than 15 times higher for unvaccinated people). In general, of these vaccinated people who died, they were older, slightly more likely to be men, with a range of chronic health problems, and the more the number of conditions, the greater likelihood of dying. Interestingly, it was not COVID-19-related symptoms that were the cause of them seeking medical care.

For people who like reading about mathematical models, this paper by Sonabend R and colleagues show that the relaxation of control measures must be balanced against vaccination rates. Apart from having some interesting diagrams and a good time-line description of the outbreak/s in England and Wales, it is a very constructive  piece of research, and the take-home messages apply to everyone, not just the UK.

Non-pharmaceutical interventions, vaccination, and the SARS-CoV-2 delta variant in England: a mathematical modelling.

And now, just because I can because this is my blog, here is an imaginative climate action on YouTube: many German musicians got together in 17 cities and performed absolutely terrific flash mob concerts to highlight the 17 SDG goals, as a message to COP26. Here’s a news item about the concerts.

Follow the arrows on the screen, there are 17 concerts, and they are well well worth the effort of finding them. Thanks to Saskia for the heads-up.

There are some really interesting arrangements and takes on and there is a very wide variety of music here. Enjoy!

See you next week


About Dr Priscilla Robinson and The CODE COVID 19 International Update

Dr Robinson is a public health epidemiologist with particular interests in international health and communicable diseases, and public health competencies. She has worked in health departments in England and Australia, has managed public health teaching programmes, and taught and researched many aspects of public health epidemiology and policy in many countries. She is an adjunct Associate Professor at LaTrobe University, and to stop herself being bored is an editor of PHAA’s journal ANZJPH, and holds board positions (almost all unpaid) on various NGOs, journals, and at her local hospital. Otherwise, 10 acres of untamed bushland on a hill in South Gippsland, VIC, makes weight-bearing gym exercise and strength training a bit redundant.

The CODE Update is a regular Intouch feature to keep readers informed of COVID-19 developments around the world.

The CODE Update originally began at the start of the SARS CoV-2 pandemic as Priscilla’s way of explaining to her friends and family around the world what was happening, and counter their experiences of information overload and misinformation. The update provides links to practical materials and papers written for people who are not versed in the language of outbreaks and epidemic curves. Published weekly, it includes a short commentary to provide context to the numbers included in the spreadsheets.

Note: While every attempt is made to transcribe all data faithfully, every now and again mistakes are made and not noticed until the next Update. Also, on occasion, numbers are revised after posting at the source databases.

We hope you will find these updates to be a helpful tool, and the links to current information useful.

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