The CODE Update – 17 March

Priscilla Robinson

View this week’s spreadsheet

This week there are some interesting – and slightly concerning – changes in patterns.

Overall this week, the snapshot shows that whilst cases are up about 10% overall, fatalities are down compared with last week. Cases are currently rising in half of the WHO regions (Europe, South East Asia, West Pacific). Whilst a number of African countries have a very high fatality rate, it is also a concern that the overall fatality rates – the proportion of cases who die – is also rising slightly in some places, especially in Europe – which is not a pattern that is usually seen as an outbreak evolves – usually fatality rates drop (i.e. survival rates increase). This is happening even in countries which have made good progress with vaccination programmes. Maybe this is a result of more conservative diagnosis, or maybe there is a drop in detection of +ve people – or maybe both – it is hard to know.

Locally to us in Australia, PNG has had a big spike in both cases and fatalities, which is not good news at all because they had done such a good job to date; in Queensland where some of their testing is carried out a +ve rate of 50% is being reported. No doubt at some point we will hear about the geographical origins of this problem. Cambodia has seen a similar surge (but without a similar press anxiety, including its first reported fatality); Timor-Leste has almost doubled its reported cases in a single week.

In any case, country by country, numbers are much bouncier than they used to be and sometimes the rise in cases does not make much sense when compared to previous days. So, we will all just have to remember all of the rules about data quality, and remember that overall countries consistently report in whatever ways they do, and it will be different to other countries – but the overall patterns are still helpful. Despite the vaccination programmes! I do hope that made sense to you all…

Really, I also need to say something about the hoo-hah about the Oxford AstraZeneca vaccine reports of coagulation problems (blood clots etc.) after having the vaccine and policy decisions by some governments to ‘pause’ their use of it.

The WHO website includes this information about the vaccine:

“Most common:

  • Pain or tenderness at the injection site
  • Headache
  • Tiredness
  • Muscle or joint aches
  • Fever
  • Chills
  • Nausea

Other, less common side effects are also possible.”

For those of you who have not had to study such things, when any new medicine (including a vaccine) is developed there are a set of clinical trials which they have to be subjected to – you cannot just develop a drug and put it out there (well you can if it is not called a drug and is claimed as a food supplement etc and it is located in the general wellness industry, but that is a whole other debate and not for this blog; apologies for the digression). Phases 1 to 3 are to make sure that it does not kill its recipients, that it does what it is meant to do, and to identify the dose and regime needed. Phase 1-3 trials are conducted in ‘healthy volunteers’ – that is, young, fit, not pregnant and not likely to be (and usually male, but that is also another debate for another time!), so that trial results are not muddied by interactions with other drugs and diseases. The last phase, phase 4, is designed to see what happens when it gets into the general population, a lot of whom are neither fit nor young, and who are on various medications for many reasons … so monitoring is very important, looking for unexpected problems. If any are detected the programmes/use of drugs is paused – using the ‘precautionary principle’ – it is stopped just in case there is a problem, while an analysis of lots of different data from many sources are analysed and tested.

Now, although it isn’t really known how many people have blood clots each year, the usual number is somewhere between 300 – 650 people in 100,000 every year (somewhere in the region of 60-150 a month). Oxford AstraZeneca spokespeople say that there have now been about 17,000,000 vaccine doses given since early March (or 170 X 100,000), with about 15 reports of major thrombosis and 22 other clot problems – so 37 in all, in half a month, which is the equivalent of about 900 in a year (i.e. 37 X 2 (for a whole month) X 12), or about 900/170 – less than 5.5 for every 100,000 people in a year – in other words, somewhere between ‘about the same’ and ‘a lot lower’ than would be expected in a general population (of course I can see that these are their own data so some people are likely to say ‘they would say that wouldn’t they’). This is obviously a crude way of looking at these numbers, but other reports I have seen come to much the same conclusion. Of course, blood clots occur after walking on the beach, eating breakfast, and phoning a friend, but just because these things are associated in time it doesn’t mean that the one thing caused the other! So, given the potential risks associated with not having the vaccine, unless more robust data are provided to show that there is a true causal association, I cannot see why any vaccination programmes need to be halted – clearly the risk from disease remains high where the virus continues to circulate.

The WHO website has a wealth of information on COVID in general including vaccines for anyone who is interested, from the different types of vaccines to ongoing distribution and surveillance:

Lastly, just to remind you that there are other communicable disease problems in this world of ours:



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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