Death rates from Covid-19 coronavirus by country

The crude overall death rate or case fatality rate in other countries will be exaggerated as they have only tested people with more severe illness and not all contacts. In Italy so far the case fatality rate is 5.8% Rough estimates are in Spain 2.8% , 2.1% and in the UK 1.7%.

These are not true mortality rates, which can only be worked out at a later stage.

While in Singapore, Scandinavia and Germany they are more in line with normal flu.

These figures are rough estimates, during an evolving epidemic, because of the time lag between diagnosis and outcome. Also milder cases are never tested.

The overall mortality rate for Hubei Province in China where the epidemic started, but has now tailed off to a handful of new cases a day, stands at about 4.5%. Is is thought that once control measures are lifted it could re surge again until about 80% of the population becomes infected. The other 20% being naturally immune. There is no evidence yet that warm weather will control this virus. It could go on all summer in the Northern Hemisphere.

It took Hubei province about 10 weeks of lock down to control the epidemic.

Sources for statistics WHO and European Centre of Disease Control

There are two reasons for low mortality in highly efficient countries . Testing more asymptomatic contacts reveals more people who have very mild illness and better contact tracing and isolation and care once diagnosed will result in less contagion and fewer deaths.

Countries with higher mortality do fewer tests and pick up less severe carrier of the virus, and need more radical population restrictions to control the epidemic.

Better prepared countries do not have to take lock down measure as they quickly identify contacts and isolate them before they can spread the virus into the community.

The UK has been criticised for its strategy which is that they think about 80% of the population will get the virus anyway so they should let it spread naturally and develop a population immunity.

The Spanish government will not reveal the mortality figures broken down by age in Spain.

They have told journalist to ask the individulal Autonomous Comunities.

But looking at Italian figures it is very much confined to the over 60’s

Age in years 0 to 19 zero deaths in sufferers of Covid-19 coronavirus.

20 to 39 0.1% one in a thousand chance of dying if you get the virus.

40 to 49 0.1% chance of dying if you get the virus. This is same risk as normal flu.

Then the rates start to creep up from age 50.

50 to 59 0.6%, 60 to 69 2.7%, 70 to 79 6.9%, 80 to 89 16.9%, 90 years + 19%

The overall death rate for all ages combined is 5.8% Source Italian Health Institute

They have laboratories capable of testing large numbers of people rapidly.

They have not had to implement widespread population control like the rest of China, Italy and now Spain.

They have told journalist to ask the individulal Autonomous Comunities.

But looking at Italian figures it is very much confined to the over 60’s

Age in years 0 to 19 zero deaths in sufferers of Covid-19 coronavirus.

20 to 39 one in a thousand chance of dying if you get the virus.

40 to 49 0.6% chance of dying if you get the virus.

50 to 59 2.7%, 60 to 69 2.7%, 70 to 79 6.9%, 80 to 89 16.9%, 90 years + 19%

The overall death rate for all ages combined is 5.8% Source Italian Health Institute

Spanish Government Lock-down Whole Country

Trips away from your usual resident are being severely limited from Monday 16th March.

You are only allowed to leave your normal place of residence to :

1 Go to work

2 Visit the shops that are open or pharmacy or bank.

3 Visit an elderly or disabled person or collect child.

4 Return to your normal place of residence.

Any unjustified movement can be sanctioned with a fine.

There is no mention of going to hospital or GP for non Coronavirus matters. I suppose you should ring up to confirm before going.

I read hairdressers, tobacconists, news kiosks and IT shops will remain open. Presumably to keep morale up “a packet of fags for hubby and a hairdo for the misses”. And so people can keep informed and work from home on their working computer etc.

Vulnerable people are advise to stay indoors as much as possible.

Avoid kisses and hugs etc.

Vulnerable people are:Over 60’s, People who suffer from : High Blood Pressure, Diabetes, Heart or Lung Disease, Cancer or Immunodeficiency. Pregnant women

If you can, it would be better to get a fit person to go out and run the errands .

Advice for Vulnerable people

Stay at home. Avoid public transport. if you do go out avoid crowded places where it is not possible to keep a distance of 1 metre between you and other people.

If you are worried that you may be infected with coronavirus Covid-19 you can complete an autotest on the Sanitat website. It is only available in Spanish and Valenciano though.

http://www.san.gva.es/web_estatica/coronavirus/coronavirus_es.html

Medical facilities, to decide according to their situation, whether to cancel non urgent operations, out patient clinics, and diagnostic tests.

They can co-opt private hospitals into the public system . They can take over other building to use as medical facilities.

The government can commandeer public and private businesses to control production .

They will ensure food supply is mainlined.

The right to use the armed forces if needed is an available option.

State of emergency “alarma” to be declared from 14th March 2020 through out Spain

There are three grades of State of Emergency in Spain 1 state of alarm, 2 extraordinary state and 3 state of siege.
The first and less severe state of emergency is being declared from tomorrow.
To find out information about the situation in Spain we suggest you read EL Pais in English.
https://english.elpais.com/politics/2020-03-13/spanish-government-declares-state-of-alarm-in-bid-to-combat-coronavirus-spread.html

“The Spanish government announced on Friday that it was implementing a state of alarm for 15 days in a bid to control the spread of the coronavirus pandemic in the country. Speaking during a press conference at around 3.30pm, Prime Minister Pedro Sánchez informed the Spanish public that the Cabinet would meet tomorrow to put the measure into effect, allowing the government to temporarily restrict the movement of citizens. Fundamental rights, however, will not 

be affected.“We are only in the first phase of combatting the virus,” Sánchez said on Friday. “We have some very tough weeks ahead of us. We cannot rule out reaching 10,000 [infections] by next week.”

The Socialist Party leader went on to explain that the state of alarm “would allow for the maximum mobilization of resources against the virus, but victory will depend on each one of us. Heroism also consists of washing your hands and staying at home. We are going to stop the virus with responsibility, and with unity.

“We will overcome this emergency by relying on advice from science and with support from all or the resources of the state,” he continued. “But it is also undeniable that we will manage it sooner, and with the least human, economic and social damage possible if we do it together.”Heroism also consists of washing your hands and staying at home”   from El Pais in EnglishToday the Sanitat stated that there were 119 cases of Covid 1- coronavirus in Valencia Region, 30 of those in Alicante province.
They state routine surgery, non urgent outpatient appointments and diagnostic tests may be cancelled. They may have to commandeer  public and private building to use as medical facilities. ( there has been talk about using the Benidorm hotels but the numbers at present don’t make that seem likely.)
 Most councils have shut public buildings ,schools ,sport centres etc and banned mass event Benidorm is suspending the outdoor markets.

It would seem that the government could use drastic powers to restrict movement of people and shut businesses.

An area of 7,000 residents in Catalonia west of Sitges has been put in lockdown because of a growing spike of cases jumping from 20 to 52 in one day.


All bars and restaurants will be closed throughout Valencia region but home delivery is not affected.

REMEMBER:  FEVER COUGH SHORTNESS OF BREATH .    FIRST CALL SANITAT STAY AT HOME CALL 900 500333 English speaking advisers available.
Wash your hand well when you come back home. Covid-19 Coronavirus doesn’t usually cause runny nose and sore throat so if you have these symptoms you probably have a cold.

CORONAVIRUS COVID-19. ADVICE OF HELP BENIDORM

FEVER    COUGH       SHORTNESS OF BREATH

FIRST  CALL  SANITIAT. STAY AT HOME. CALL 900 300 555

DO NOT GO TO DOCTORS OR HOSPITAL BUT STAY AT HOME AND CALL THE NUMBER

Sore throat and runny nose only occur in about 5% of Covid-19 cases.

If you have returned from a high-risk zone (eg Italy) or been in contact with someone who has been confirmed to have the virus also call the number. 

Cover your nose and mouth if you cough. Wash your hands frequently.

Keep your distance from people and avoid unnecessary gatherings,

This is based on advice from Sanitat Valencia Health Service and W.H.O by Dr  Kevin Jackson of Help International Benidorm.

Our numbers are    President 607 387 040     Welfare 607 386 964

UPDATE COVID-19 CORONAVIRUS 3rd March

CORONAVIRUS

TABLE OF CUMULATIVE NUMBER OF CASES AND DEATHS FROM COVID-19

sources

SANITAT DE VALENCIA, WHO AND EUROPEAN CENTRE FOR DISEASE CONTROL

MARCH 2nd 3rd

  • ALICANTE 0 0
  • VALENCIA 15 19
  • SPAIN 83 151
  • UK 36 51
  • GERMANY 130 212
  • FRANCE 129 196
  • ITALY 1689 2502
  • DEATHS
  • ITALY 52
  • CHINA 80174 80304
  • DEATHS
  • CHINA 2946

The health department of Valencia has published a poster in Valencia which I have translated

Continue reading “UPDATE COVID-19 CORONAVIRUS 3rd March”

COVID-19 BACKGROUND INFORMATION

The course of this disease is changing every day so this information is up to 1st March 2020

FAQS

WHERE CAN I GET RELIABLE UP TO DATE INFORMATION ?

There is a lot of misinformation in the media, go to a reliable source .The GOV.UK Public Health has advice for travellers and people living in and outside the UK. They recommend people returning from certain towns in Lombardy and Po regions of Italy ,as well as parts of China, Iran and South Korea to self isolate at home for 14 days even if they feel well.

This differs from the information given by Sanitat of Generalitat Valenciana who recommend you carry on as normal, observing hygiene measures such as frequent hand washing, using a hanky if you cough or sneeze and watch out for symptoms.

Also the World Health Organisation have a very good site. https://www.who.int/

Also the European Centre For Disease Control https://www.ecdc.europa.eu/en

Pangolin endangered animal in China thought to be source of Covid-19 epidemic. They are illegally caught for food

WHAT IS COVID-19 ? IS IT A NEW VIRUS OR IS IT LIKE OTHER ILLNESSES IN THE PAST ?

Covid-19 is an new infection caused by a corona-virus similar to that which caused the SARS epidemic from November 2003 to June 2004.It was transmitted from animals to people starting in the city of Wuhan in Hubei province. The World Health Authority WHO was notified about it on 31st Dec 2019.

These coronaviruses can cause infections from mild colds to the serious SARS and MERS respiratory infections. This is the sixth type of coronavirus discovered. The latest theory is that it mutated to be able to infect humans form a very similar virus found in Pangolins which are illegally caught and eaten in the area of China where the epidemic started.

WHAT ARE THE SYMPTOMS? HOW WOULD I KNOW IF I HAVE BEEN INFECTED?

Covid-19 starts as any cold or flu with fever, dry cough and generally feeling unwell. Some people may have very mild symptoms or no symptoms at all. 14% of people, especially the elderly or people with chronic disease may go on to get serious lung disease. The infection is spread by fine droplets infected people emit when they cough or sneeze.

The incubation period is from 2 to 10 days. Testing with a thermometer is not an accurate way of telling if someone is infected as the temperature may be normal when someone is infected.But if the temperature is raised it is an indication of infection though it is unlikely to be Covid-19 unless you have returned form a high risk area or have had close contact with someone from a high risk area.

It is thought that infected people can spread the virus from very early on in the illness when they have only very mild symptoms and may just think they have a normal cold or flu.

You need close contact with an infected person to catch the disease as the droplets do not travel great distances in the air. Close contact is defined as either direct face to face contact for any length of time or more than 15 minutes of contact at a distance of less than 1 metre. There is only 1 case of local contact so far occurring in Valencia and that was contact between friends not a casual contact. Touching contaminated surfaces is another way the virus spreads so hand washing is very important.

AM I AT RISK ?

Most cases as of 1st March 2020 in Spain have occurred in people returning from Italy, so at present if you have not travelled to the high risk areas listed below your risk of getting it is very low. HIGH RISK COUNTRIES AS OF 1st March 2020
NORTH ITALY ,CHINA ,SOUTH KOREA ,IRAN , JAPAN and SINGAPORE

If you have been to these high risk countries and have symptoms of Fever Couch or Shortness of breath or are worried you should call 900 300 555 or if they don’t speak English 112. You should not go to the doctor or hospital, a medical team will visit you at home.

HOW IS IT SPREAD ? HOW CAN I PREVENT MYSELF GETTING IT ?

The Covid-19 virus is produced on the membranes of the mouth and nose early on in the infection and is spread out by sneezing and coughing. This produces fine droplets load with the virus. In cold dry weather the droplets stay in the air longer, while in hot humid air the droplets tend to fall to the floor. That is one reason that colds and flu occur more often in winter and in cold climates. You should always cover your nose and mouth and use hankies if you cough or sneeze. And dispose of hankies in sealed bins.

The virus is also passed on by touching contaminated surfaces and then touching your nose and mouth so you should always wash your hands or use alcohol based gels after coming home, before eating and food preparation and after using the bathroom.

If going to the hospital you should used the hand cleaner provided. In Villa Hospital they have installed one at the main entrance so you should use it on entering and leaving the hospital. The virus does not live long outside the body so you are unlikely to get it from handling objects such as packages from China.

Shops in Valencia area running out of hand gels and face masks,but you can get 96% alcohol from chemists and supermarkets.Masks are not thought to be effective except as used by trained health professionals who will use FFP 2 or 3 masks.These have a valve on them for breathing. Cheap masks are useless. Also you have to take them off correctly by the straps behind the ears being careful not to touch the mask ,which may be contaminated.

IS THERE A BLOOD TEST FOR COVID 19 ?

A blood test was developed within weeks of isolating the virus. It took six months to develop one for SARS. It is a PCR test and is thought to be very accurate (sensitive) and can detect the virus at very low concentrations early in the disease,

IS THERE ANY TREATMENT SHOULD I GET IT ? IS THERE A VACCINE YET ?

A vaccine has been developed in the USA just 42 days after sequencing the Covid-19 genome and has been sent to China for trial. But 17 years after the SARS epidemic no vaccine has proved successful against SARS despite many attempts to develop one.

Antivirals medicines used for other infections such as HIV and Ebola are being trialled in China. There has been a case in the press of a 62 year old man from Seville who was very ill and was treated successfully with drugs used against HIV.

Otherwise treatment is similar to other cases of pneumonia but with stricter isolation.

A study of 1000 patients in China demonstrated that 14% were very ill, 5% were admitted to an intensive care unit, 2.5% needed a ventilator and about 1.5% died. Some people with very severe disease have been treated by heart lung machines ie extra-corporeal circulation. Some had multi organ failure which if not fatal can take weeks and months to recover from

Cases in England will be treated in four Airborne High Consequence Infectious Diseases Treatment Centres, or Airborne HCIDs. Two in London and two in the north of England. They probably just have a few beds each. I imagine that it is similar in Spain.

That is why the Chinese had to build two x 1 thousand bed hospitals in less than a fortnight in the city of Wuhan which is the epicentre of the disease. At the beginning of Feb 2020 they were treating almost 4,000 patients in temporary hospitals in gyms and exhibition centres. These would not have had the high security facilities needed to isolate patients and keep staff safe.

You have to admire the dedication of the nurses and doctors who have to look after Covid-19 patients, wearing very hot and uncomfortable protective clothing and putting themselves at risk of acquiring the infection. Some staff have died themselves from the disease.

Medical workers in protective suits attend to novel coronavirus patients at the intensive care unit (ICU) of a designated hospital in Wuhan, Hubei province, China February 6, 2020. Picture taken February 6, 2020.

HOW DEADLY IS IT ?

Mortality is thought to be 2% of confirmed cases in the new Covid-19. However the case fatality rate of Covid-19 from Chinese data, appears higher in people with chronic diseases,heart, lung,diabetes and cancer etc. where it averages about 8%. People over 60 have increased mortality from Covid-19,estimated to be about 14% in people over 80. However many people with mild disease who are never tested,are not included so the death rate could be lower.

COMPARISON WITH OTHER SIMILAR RESPIRATORY DISEASES

SARS had a mortality rate of 10%., Normal seasonal flu has a mortality of 0.1% or 1 in a thousand people die who get flu. Avian/bird flu generally have higher mortality 10-20% but usually they do not pass on from human to human.

IS IT WORSE THAN SEASONAL FLU THAT KILLS THOUSANDS EVERY YEAR ?

Some people think that influenza or flu is more deadly than Covid-19.

Between 5% and 20% of people each year in non-tropical countries get Influenza. Flu has a case fatality rate of just 0.05% to 0.1% , compared to Covid-19’s 2%. Flu has been estimated to by the Centre For Disease Control USA to kill about half a million people a year worldwide.

Reproductive Number or R is the number of people on average 1 person with the virus goes on to infect. The higher the number R the worse the epidemic will be.

The R for normal seasonal flu is 1.27, lower than the 1.95 R WHO attributes to Covid-19. So Covid-19 has twenty to forty times higher mortality than influenza and the higher in R in Covid-19 means the rate of increase in cases is much faster.

However influenza constantly circulates the earth following the seasons in non tropical countries. While Covid-19 is still largely confined to several provinces in China north of Hong Kong. The epicentre is the city of Wuhan. 93% of cases and deaths have occurred in China. The number of deaths per day in China peaked in late January and then started to fall to about 300 a day but has risen to over 500 on 1st March for reasons unknown.

However Covid-19 spread from just one centre in China and it is still possible to keep the infection controlled by testing people with symptoms, and isolating them if the have the virus. Tracing their contacts and making them self isolate for 14 days is an important tool in preventing spread of the virus. This is only possible in countries with a well organised public health system. Developed countries will have a plan in place for dealing with pandemics.

WHAT ABOUT THE SPANISH FLU. THAT WAS WORSE WASN’T IT ?

So called Spanish Flu from 1917 to 1920 was the worst pandemic in history. It was probably an H1N1 bird flu virus that mutated to infect humans. Again it originated in China not Spain and killed about 50 million people worldwide. It had 2 waves the second more deadly than the first and it killed mostly people young adults. The overall R was 1.8, its mortality was between 10% and 20%. So it was between 5 and 10 times more deadly than Covid-19 though it spread as easily with R of 1.8 .

HOW DOES COVID-19 COMPARE TO LAST GLOBAL PANEDMIC IN 2009

Developed countries have plans to deal with influenza pandemics.

The last one was the swine flu pandemic in 2009. It affected about 1 billion people worldwide about 14% of the world’s population, more than got the Spanish flu. But only about 300,0000 people died from it so it was a much less lethal virus with a mortality rate of 0.008%. The pandemic influenza plans can be adapted for Covid-19

IS IT WORSE THAN SARS ?

There were 8000 cases of SARS in 2003/4 with 765 deaths and no death after 2004. While to date there are about 86,000 confirmed cases of Covid-19 with 2906 recorded deaths and the epidemic has not yet peaked. SARS was more difficult to contract as the virus was emitted from the lungs at a later stage of the illness when the person had pneumonia.

That is probably why SARS did not spread as much as flu and Covid-19 and the epidemic ended fairly quickly. The R was 1.7 in Hong Kong, whereas in Toronto where it also spread R was 0.86 because of better healthcare and public health. With an R less than 1 the epidemic will die out.

WILL COVID-19 CAUSE A GLOBAL PANDEMIC ?

It appears that Covid-19 prefers cold weather so the arrival of spring should help to reduce numbers in the northern hemisphere. Australia has 24 confirmed cases and is entering autumn. Tropical countries have seen very little local transmission except for Singapore,Malaysia,Thailand, Iran and UAE. While the USA has had a few cases of local transmission as have the big four EU countries, Italy has 888 confirmed cases while it’s neighbours France and Germany have only 57 each. The epidemic got out of control in Italy because surveillance was started late.The UK has just 20 cases with 4 local transmission. There does seem to be a shift of the infection to northern Europe. South America, Canada,and Africa have seen no local transmission. The USA has had 62 cases mostly imported, but with local spread occurring in Washington State. While the Cruise Liner Diamond Princess has had 705 cases of infection.

WHAT CAN BE DONE TO PREVENT SPREAD ON A MASSIVE SCALE ?

There is a WHO plan called FFX (First Few Ten) to trace and isolate all initial cases and their contacts when the virus arrives in a new country. This was based on a UK plan carried out in the 2009 Swine Flu epidemic known as The First Few Hundred. The idea is that if you can stop the spread of the virus in the first few hundred cases and the infection will die out or at least slow down until the warmer weather reduces its contagiousness.

This requires isolating people returning from very high risk areas and anyone with symptoms. If they test positive then all their contacts have to be traced asked to self isolate for 14 days and submit to testing. If someone self isolates in their home they must avoid all contact with everyone including family members.

If this fails and Covid-19 spreads widely in the community then more drastic lockdown measures have to be introduced as in China and now in parts of Northern Italy. This requires limiting travel,closing schools and institutions and banning mass gatherings and events etc.

What is the R Reproductive number and why is it so important ? Maths for Geeks

When trying to assess how serious an epidemic is likely to be, you need to know how lethal the virus is or case fatality rate to use the correct jargon. But also you need to know how easily it is passed on from one person to another. As well as the incubation time, from contracting the infection to shedding the virus and becoming contagious to others.

The number of people one person infects on average is known as the Reproductive Number or R. If R is 1 ,then one person on average infects one other person. However it will not generate an epidemic as 1×1 x1 x1x1 =1. So if the incubation time is one week then one person a week will be infected every week, and five people in 5 weeks. It is called a linear function.

However if R is 2 there will be an epidemic. ie one person on average infects 2 people, these 2 people each infect another two people, 2x2x2x2x2=32. Adding up all the people from the five generations of transmission gives 62 people infected by one person. So small changes in R have a big impact. It is exponential growth in new cases. Each week the number of new cases is not the same but it doubles every week.

Giving a practical example related to Covid-19. If say 10 people come to a new country with the virus and they spread it on average to only 9 people then the R is 0.9. So after 5 generations of local spread, you have 9+8.1+ 7.29+6.6+5.9= 37 people infected after 5 weeks, but the numbers of new people infected each week will gradually reduce to zero and the infection will be contained.

If on the other hand these 10 people infected 11 people on average the R would be 1.1 and the generations of local spread would be 11 +12.1+13.31+14.64+16.1= about 67 people The numbers increase slowly at each generation of local transmission and there would be an epidemic. If the incubation period is 1 week, after 5 weeks those initial 10 people would have caused 67 infections in the new country.

Now what happens after 5 generations with an R of 2 . ( The WHO estimates R between 1.4 and 2.5). So 10 people infected with the virus coming to a country would generate the following infections:20+40+80+160+320=620 people infected after 5 weeks and 1,860 after 6 weeks. This is comparable with what has happened in Italy (1128 cases to date). They reported just 9 cases a week ago. But this was due to a lack of detection and reporting than a true picture of the epidemic in Northern Italy.

CONCLUSION

WHO produce daily situation reports on their website so you can roughly estimate R values yourself once the virus is transmitted mostly by local spread rather than being imported.

Local spread has not yet been recorded in the vast majority of the world area outside China, and is only significant in Northern Italy,Iran, Japan, South Corea and Singapoure.

There have been isolated cases of local spread in Spain, UK ,France,Germany, Netherlands,Norway and Croatia. But this could change rapidly.There are reports of local spread in Washington State in the USA.

This is why public health measures to reduce the spread by even a little can be so effective in controlling infection. People can play their part by using hankies when they cough and sneeze and frequently washing their hands. If R can be reduced to less than one the epidemic would eventually end.

Hopefully Covid-19 will be a winter epidemic that will start to die out by late spring as did the SARS epidemic from Nov. 2003 to June 2004.

This article was written by Kevin Jackson communications coordinator of Help International Benidorm and a retired GP having worked in the UK and Spain

It was based on personal reading of the literature any errors are down to me personally and not Help Benidorm International

The information in this post is based on reliable sources, among them;

World Health Organisation

Sanitat Generalitat Valenciana

Public Health England

Centre for Disease Control Atlanta USA.

British Medical Journal

JAMA journal of the American Medical Association

New England Journal of Medicine

Science

and other medical journals.

This post was written by Kevin Jackson a retired GP.

He and not Help International Benidorm is responsible for any errors it may contain.

UK Passport renew must now be done online or with smartphone.

It is quite easy for people handy with a smartphone. First take a good selfie with plain white background and then type into your browser Renew UK Passport bring up a link to the https://www.gov.uk. site.Make sure it is the genuine www. gov.uk site. It costs 105 euros or free if you are over 90.

UK Passport Renewal at Round Town Travel Avda Dr Severo Ochoa 2, Benidorm
You can get your passport renewed here for 160 euros or 30 euros if you are over 90. They send off your old passport and you will get a new one in the post together with your old passport in separate envelopes delivered by courier. Passport renewal con now only be done online or with smartphone so those not tech savy this is a good option.
Telephone 966 811123. If you do not live in Benidorm ask in a British owned business such as Estate agent etc to see if they will do it for you.