The corona virus represents a human tragedy, causing deaths, suffering and loss of livelihood. Draconian measures are clearly needed, and governments, companies and us as individuals should clearly err in the direction of caution.

There is still a lot to learn on the impact of the virus; how it spreads, the sufferings it causes, the mortality and its broader impact on society. Here qualified institutions as the World Health Organization, WHO, have a big role to play in providing data and analysis. Here we should expect more in the days to come.

Given my curiosity and appetite for analysis I, however, in all humbleness did an effort to structure some of the scattered data that´s available in the public domain.  I am sure others may do it better, but for whatever its worth, below is what I found.


1. There is no consistency as to when tests are conducted

Some countries appear to have very low hurdles as to when a test is to be conducted, some only test those who are considered most vulnerable while yet others only test those that have very clear symptoms. 

The ratio between number of tests and number of persons categorized as infected vary (based on available data) from 1,2:1 in the Netherlands, 5:1 in Italy to 150:1 in Hong Kong, i.e. one country only tests those who clearly are ill while another tests 150 for each person diagnosed.

Stockholm in Sweden first tested all that requested a test, while it now rations the number of tests. 

Reports in media indicate that the suffering of individuals can vary widely, from very modest to the most severe sufferings imaginable. Business Insider reported March 6th that the “majority of coronavirus cases — around 80% — are considered mild. But the cases reported first are often those with the most severe symptoms, since those people go to the hospital. Milder cases, on the other hand, could go uncounted or get reported later on.”

One would therefore expect that the ones tested and identified as infected suffer more severely in the countries with the most restrictive practices. If so, this would make all comparisons between number of infections and mortality filled with error. This is accentuated if there are differences as to whether tests primarily are conducted for those individuals that are most exposed. 

As an example, the Stockholm rules now only allow for testing for those considered to be in the high-risk (vulnerability) group. 

To date, to my knowledge, no summary has been made public on the link between testing practices and measured infection and mortality rate. I would assume that WHO sits on data/systems that could allow for such adjustments.


2. The learnings from China and South Korea aren´t leveraged

China was first hit by the virus. One would thus expect that the outmost would have been done to learn from China, especially since they apparently have succeeded in their effort to contain the virus.

Corona testing and mortality

Based on a report today from a Norwegian in Shanghai, the main restriction is that ones temperature is measured at every location prior to entry (metro, office, shops, apartment blocks). None with fever is allowed to enter.  Such a moderately intrusive measure can clearly also be implemented in the West.

South Korea was among the first countries hit. It has also conducted the highest number of tests (ex-China), beyond 210 000. Hence, one may assume that the South Korea testing procedures were relatively best able to identify and diagnose a fuller range of the corona infected, from the lighter to the most severe cases.


3. Mortality rates vary widely

Given the above difference one would expect the ratio of infection to tests to vary widely, as it does. This is shown along the x-axis of Chart 1.

The y-axis shows the mortality rate. This also varies enormously, most notably between South Korea´s and Italy´s.  Some have explained Italy´s high rate by its elderly population, with a median age of 45,5 years, the fifth highest in the world (after #1 Monaco, Japan, Germany and Saint Pierre). 

South Korea though follows quite closely with 41,8 years, right behind the EU-average of 42,9.  Its thus way more likely that the difference is due to the testing and diagnostic practices, with Italy conducting relatively fewer tests and only identifying the ones infected when the infections are the most severe and at a (too) late stage.  The Italian mortality rate may thus say as much about Italy as it says about the corona virus.

The US, similarly, appears to have (too) few tests only identifying the most severe cases at a (too) late stage. Hence, also here the high measured mortality rate appears to have its (sad) reasons.  

 
4. China retains its corona containment measures

Schools in Shanghai are still closed. Tuition is provided via TV and online platforms.

The last days have seen 20 new registered cases in the Shanghai region.  Interestingly the new ones in the last two weeks are due to travelers from Italy etc. These are discovered at the airport. All passengers are tested and quarantined for two weeks. This applies to everyone who enters Shanghai. 

There are apparently virtually no new cases internally in China. Everyone who becomes ill is treated in hospitals, regardless of the severity. 

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By now large parts of the Western societies have been shut down. To err on the side of caution this is appropriate. However, hopefully information can be compiled that can allow us to make the measures more targeted, most importantly making them more effective in combating the virus. ‘

Additional benefits can be achieved by reducing the societal costs of the measures. Forceful containment, early identification, treatment and care appears to be the main lessons as learned from China and South Korea, and with this society can fully restart within a few months.