The CODE Update – 25 February

Priscilla Robinson

View this week’s spreadsheet 

This week in COVID-land the general downward progression continues in both cases and fatalities, although there are a few blips here and there, with a couple of countries reporting fairly large increases, for which the reason is unclear – possibly an adjustment of numbers, as these are quite unusual. The global fatality rate has risen very slightly over the last two weeks, again the reason is not clear as the newly circulating strains are not being reported as more likely to kill people, and so far, do not seem to be widespread. The global rate is 2.2% of notified cases, and in the UK the rate is lower than that at 2.04. However, although the rate in Brazil is only 0.83, in Mexico it is a whopping 8.7 (very much an outsider compared with its neighbours, and with the rest of the world – the usual reasons for this would be that there is a huge underreporting of fairly benign cases, or maybe the definition for a COVID death includes presumptive but not confirmed cases).  In South Africa the rate is 3.27, and in Italy 3.41 (it was way higher than this a year ago though at a whopping 12.25 – see the last sheet which is a copy of the very first one about a year ago).

It seems to me, having had a really good search, that there is still very little on the epidemiology of COVID disease, apart from case numbers, fatalities and some information on age and attributed sex of these people. Whilst we know a little about clusters, we know very little about crowding and associated socio-economic factors. We know some things about aging and co-existing disease, but nothing about other risk factors such as diet, alcohol, smoking and chronic disease status. We know a little about geography and less about secure employment and housing, and access to greenery and leisure pursuits (other than some sports) such as the arts. We know far too much about the negative effects of lockdowns and working from home, but nothing at all about people who have thrived and found the whole pandemic to be a largely peaceful and happy time. So, if anyone has a student looking for a project…

This is an interesting report from a respected Australian scientist who was on the WHO Wuhan COVID-19 investigation team. Worth reading, a thoughtful account of their investigation. A few years ago, I was part of a team in Wuhan working on a project focused on reducing respiratory infections, including the installation of handbasins at child height in schools, handwashing routines, not sneezing and coughing over other people, staying home when unwell etc. Much of it used a child-to-child model, and the reflections by the scientist in the article about his colleagues in Wuhan are very much like mine.

Now then – the international chloroquine stocks which various wealthy countries stockpiled in a fit of panic, sometimes paid for by medically-unqualified entrepreneurs, a year ago are … where? Please can we send them to countries that really need them for their intended and effective use, for malaria? Worldwide, deaths from malaria approach half a million annually, but will probably be higher for various reasons associated with COVID-19. Although deaths from COVID are about five times higher than that, 2020 will likely have been a one-off (especially in developed countries). Malaria remains a major threat in transitional countries, despite progress in treatment, hazard reduction, etc. Maybe the very new mRNA vaccine technologies might hold some possibilities for reduction/elimination strategies? Come to think of it, the 2020 deaths from malaria are about the same as the notified deaths from COVID in the USA. But one has had a lot more funding than the other.

Next, let’s think about flu, because the best ways to prevent flu are the same as for COVID, except that we have good information about what flu infection rates were like before COVID prevention measures were introduced worldwide. Australia and New Zealand had very little flu last winter, so here are a couple of comparisons for those of you living above the equator – social distancing and flu vaccine etc really do work! In Australia in 2020, 37 people died of flu, compared with 705 in 2019, and a five-year average of 378, and flu notifications were very small compared with previous years. Check these websites for good information:

Flu vaccine coverage in the OECD including the UK (seems to be up compared with ‘usual’):

and for Canada (coverage seems to be similar in most groups as during the last few years)

Flu in the northern hemisphere is definitely low:

UK (but you have to go a long way through the very comprehensive report to find last year’s numbers, around P30)

Canada (also very low compared with normal – “To date this season, 59 influenza detections have been reported … … which is significantly lower than the past six seasons where an average of 29,890 influenza detections were reported for the season to date.”)

In terms of government responses to COVID-19, this seems to be a useful website: Oxford Covid-19 Government Response Tracker; and at this site; plus this site.

Here in Melbourne, we have had some extraordinary coverage about a group of doctors (international, with local support) who seem to agree with various alternative views and theories about COVID-19 treatments. (Here is their site if you want to see for yourselves). Last weekend they headed a demonstration against various preventive measures including, apparently, vaccines. This group have had media coverage before, mainly in the USA a few months ago. However, although they do between themselves hold an impressive set of qualifications, there is not much in the way of public health, even though they self-describe as public health scientists, by which they mean infectious disease microbiologists. A reading of their materials truly suggests that they have not been trained in EPI101, or understand how to do a solid review of scientific evidence, or read any Cochrane etc protocols – or they would not, for example, be promoting chloroquine as a COVID-19 treatment. This is a problem because they do have popular clout – but beware, just because a paper is published, and apparently peer-reviewed, it does not make it scientifically valid. Their website is full of unreferenced and patently incorrect statements (e.g., ‘there is no evidence that lockdowns have ever prevented spread’). I have added the website above so that you can read about them for yourself. Take note of the evidence published by people whose job it is to be able to analyse and understand these things. Just saying, that this underlines how public health interventions are much more nuanced than just reading a paper and saying ‘that’s the answer’. This Guardian article has a good analysis of this problem.

The first doses of COVID vaccines are being administered at last here in Australia. They will, rightly, be given first to front-line workers and people living in aged care. The first dose went to a very sprightly 84-year-old person and the second to the Prime Minister. One of these people was in a high-risk group, but I am not so sure about the other; but it was apparently supposed to send a safety message to the general population. Myself, I prefer clinical trials! So lastly, here is a message from First Dog on the Moon. Notes for overseas readers, Craig Kelly is a strange politician who has been promoting various (mainly conspiracy) theories about COVID-19, and Pete Evans is an Australian ‘celebrity chef’ who for some reason believes himself to be qualified to provide advice about things he clearly has never studied (at least in the scientific sense).

Until next week, remember the mask-wearing, physical distancing, elbow-fist-bumping rules and stay safe.


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.


Image credit: Science Photo Library

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