The CODE Update – 15 April

Priscilla Robinson

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Firstly, I think there needs to be some perspective on all of the ‘surges’ of the past week. The first and third countries on the general epidemiology sheet (USA & Brazil) have between them had nearly one third of all of the world’s cases, and this has been the case for many months now. Which is really an inditement of their (mis)management as they only have 7% of the world’s population. India on the other hand, home to almost one in five people in the world, has seen nearly one tenth of all COVID cases; but although their actual numbers are high, they are in general doing much better than the US and Brazil, despite a current upswing. Another way of looking at it: nearly one in 10 Americans, one in about 16 Brazilians, and one in 100 Indians have had COVID19. Those are big differences. There are no doubt some explanations for some of these (lack of testing, lack of diagnosis etc etc) but not really enough to explain all of this gap. The US is of course doing much better these days; new case numbers have fallen enormously, and well over half of the population has now had at least one vaccination.

Some countries are having major surges, though just not the ones in the news – Poland, Iran, and Argentina, for example, not to mention the poor Ukraine – what did they ever do to deserve their multiple plights?

The Snapshot shows that cases are in general down in Africa and about the same as last week in Europe, and up everywhere else. So although individual countries are doing well with supressing cases with vaccine rollouts, it is not yet showing on an international scale. It is of course possible that cases are being identified and notified better – but it will be good when the number of new cases starts to fall.

Speaking of vaccinations, at last new cases are dropping in Israel. It is about time as they have vaccinated so many people! It is still striking that the overall population attack rate in Israel is about double that of occupied Palestine, which has still have not received much in the way of vaccines despite promises.

Internationally the COVID case fatality rate continues to creep down, and I trust that will continue. I cannot find an explanation for the one country with a high rate, Mexico (over 9%), so just have to assume that they do not identify all that many of their cases, and also possibly the criteria for notifying cause of death differs from other countries. Both the South East Asia and Western Pacific regions have much lower rates overall; many countries have reported less than five deaths for many months. That is not to say that the WHO COVAX programme is not terribly important – please do whatever you can to support this critical initiative, for all countries which need support to get and administer the vaccines.

I suppose I should mention vaccines again. The news has been full of ‘it’s safe, but look someone just had a dangerous clot, it’s safe, but look someone just died’ headlines. So maybe it would be useful to mention the ‘precautionary principle’ (PP) so you can add it to your list of riveting dinner party topics. Principle 15 of the Rio Declaration on Environment and Development in 1992 states “where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation.” The key words here are IRRIVERSABLE DAMAGE and THREAT, and although the original Principle is about the environment, it is now used in many other settings with various caveats. In particular, the requirement to act is tied to the idea that lack of evidence of cause and effect is not a reason to delay action. Actions may be revised or reversed if new evidence comes to light, and actions need to be taken where alternative strategies are available. So with vaccines, there are alternatives to the AstraZeneca/Vaxzevria vaccine which is associated with a very rare kind of blood clot (cerebral venous sinus thrombosis), although to muddy the water a bit more there are some reports of problems after these vaccines too (Pfizer, Johnson & Johnson and Novavax) so it is not quite as simple as just switching vaccines. There are regular updates and technical reports about the cerebral venous sinus clots (a total of 62 now reported, plus 24 other unusual clots) and capillary leakage at (and look for the most recent report).

Of course, there are side effects with any medicines including vaccines, some much less common than others, and that is what ‘Phase 4 post-marketing surveillance’ is all about. Unfortunately, application of the PP can make it look as if nobody knows what they are doing and just dithering when in fact they are all doing the right thing. And remember, association is not proof of cause – here is a nice example of that!



(ref:, 12/04/2021)


And now, for dancing fans who like non-classical music, here is some clever editing. If you are not a dancing fan just don’t click the link!

See you next week!


About Dr Priscilla Robinson and The CODE 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 makes weight-bearing gym exercise and strength training a bit redundant.

The CODE Update is a new regular feature on the Intouch blog 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 a way of explaining it to Priscilla’s friends and family who happen to live all over the world, and who were being bombarded with information and misinformation in their own countries. The CODE Update provides links to practical materials and papers written for people who are not versed in the language of outbreaks and epidemic curves. It is sent out every week, and includes a short commentary to provide context to the numbers included in the spreadsheets.

Note: Whilst 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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