Taking stock of the pandemic

On March 11, 2020, the World Health Organization declared Covid-19 to be a global pandemic. In the two years since then, we have passed one grim milestone after another. As of yesterday, there have been 483 million cases worldwide or 6.1% of the total population of 7.9 billion. There have been a total of 6.2 million deaths.

When one looks at the per capita death rates, apart from Peru (which has the highest rate), Brazil, and Chile, the rest of the top 20 countries for cases are in Europe or the US. In fact, the highest ranking country outside Europe and the Americas is at #35 with Tunisia. A similar pattern holds for infection rates.

With just 4.2% of the global population, the US has had 82 million cases and over one million deaths, about 16% of each total. One question of local interest is why the rates in the US are four times the per capita rate for the world, when it had plentiful and early access to vaccines. One obvious factor is Covid skepticism and vaccine resistance in the US. The percentage of people who needlessly got sick and died due to those factors needs to be taken into account.

Other factors may be that there has been undercounting of cases and deaths in other countries. It may be that lack of testing led to under-diagnoses or that deaths in other countries were mistakenly or even deliberately ascribed to other causes either because of stigma associated with the disease and the desire to avoid the social isolation required, or because governments wanted to underplay the severity of the disease. Another is that the US and Europe have older populations who are more adversely affected.

Another factor is that although China has 18% of the global population, the number of cases and deaths is relatively minuscule. The same is true, to a lesser degree, for India which has 17% of the global population. This will skew the distribution.

But all these explanations are just guesswork at this point and require considerable evidence to substantiate such a big difference of a factor of four for the per capita rates in the US.

It is going to be difficult to figure out what the exact numbers are. The most reliable figure is likely to be the counting of excess deaths during the pandemic period. By comparing the total number of deaths in each country with a baseline obtained from historical trends before the pandemic, one could reasonably postulate that the excess deaths were to covid.

All this is assuming of course that the pandemic has largely run its course. While I am hoping that that is the case, the arrival of the BA.2 version of the virus, the rise in cases in some countries, and the plateauing of the decrease in the US are worrying signs.

It looks like I will need to keep wearing my mask for some time to come.


  1. moarscienceplz says

    Mano, I think you meant March 11, 2020, not 2019.

    [I have corrected it. Thanks! -- Mano]

  2. moarscienceplz says

    I suspect the 6.2 million deaths figure will turn out to be a massive undercount. The 1918 influenza is believed to have killed 50 million people when there were only 2 billion people on the planet. Plus, the 1918 flu had the curious feature that it mostly spared older people. It is suspected that this may be due to an earlier flu pandemic giving some immunity to the people who were old enough to have lived through it. So, in 1918 we had about one fourth of the planetary population we have today with maybe a third of them already having some immunity, and STILL 50 million died. Granted, comparing the two diseases is comparing apples and oranges, and we in the rich countries did get very good Covid vaccines within one year while nobody got vaccines in 1918, but still if something near the 6.2 million number turns out to be correct, then the people of Earth were very, very lucky.

  3. garnetstar says

    I would like to see the effect of the more-ill US population considered. The US has a much larger proportion than many countries of underlying chronic conditions such as obesity and diabetes, and less access to health care. These factors were already being counted as reasons as to why the US death rate from COVID was so much higher tha Europe’s.

    The illusion of being a wealthy nation aside, a great deal of the US population lives with borderline malnutrition and no health care, and it’s showing. A failed society.

  4. flex says

    We know there is under-reporting from looking at the excess deaths numbers. This is the difference between the expected number of people who die in a year, against how many actually did. These suggest that the actual death toll is probably 50% -- 70% higher than 6.2 million, at a conservative estimate. We’ve probably passed the 10 million mark now, but that’s a speculative number.

    A couple other factors which may explain why some (certainly not all), of the disparity between the US and the rest of the world. One of them could be the higher relative age of the population (older people died at a higher percentage in this epidemic), and looking at the average age of population doesn’t really say much about how a population is distributed. (I try to teach the young engineers I work with that an average (or mean) doesn’t usually tell you enough, a normal and bi-modal distribution can have the same mean, you have to test for normality before applying populations statistics.)

    Another factor could be the disorganized and inefficient (by design) nature of the US healthcare system. An inefficient health care system cannot provide a consistent quality of care, either across regions or across time.

  5. Holms says

    I think undercounting is inevitable. Many impoverished nations, and impoverished regions in wealthy nations, may lack the infrastructure to provide an accurate count of cases and deaths confirmed to be covid; some governments may also be willing to meddle with the statistics to bolster their image in some way.

    The most reliable figure is likely to be the counting of excess deaths during the pandemic period.
    -- Mano

    We know there is under-reporting from looking at the excess deaths numbers. This is the difference between the expected number of people who die in a year, against how many actually did.

    I would also love to see the figures for excess hospitalisations.

  6. says

    Another factor in the U.S. was a president who, when confronted with the American deaths per capita statistics, said, “you can’t do that. You can’t do that.”

  7. flex says

    As far as getting out of the pandemic, I’ve seen some data recently which suggests that about 50% of the reported cases are now from patients entering hospitals for other reasons, like a broken limb, and testing positive for Covid-19.

    That doesn’t mean that the pandemic is over, but it means that we need to adjust our thinking again. For a long time there were not enough tests, so we were undertesting the population which may have had, and died of, Covid-19. Then we seemed to reach a plateau where tests were available, and most of the people going to a hospital were actually ill with Covid-19, so there was certainly some under-reporting, the level of under-reported was probably very low.

    As the pandemic recedes, we should expect to get to the stage where fewer and fewer people are going to the hospital for Covid-19, but everyone is being tested anyway (and probably will be for some years). As Covid-19, and it’s variants, become endemic the number of people testing positive will not directly correlate to deaths because more people without any symptoms will test positive for Covid-19. Is this over-reporting? If we only look at positive test statistics and don’t recognize that many of the positive test results are no longer an indication of a serious illness, maybe it is.

    We have added a new cause of death to the mortality statistics. It will probably never go away entirely. The people who have lived through it will continue to shake their heads about the futility of it all when someone dies of Covid-19 thirty years from now. But, for the children born now, it will just be another cause of death, probably less common then pneumonia. Mind you, there is some hope that better and broader medical interventions could start wiping out some coronaviruses. I really am looking forward to what we have learned from these past couple years, medically. I recognize that as a species we haven’t learned anything politically.

  8. ShowMetheData says

    There’s a lot of to account for -- for the poorer nations
    You can better compare the circumstances more closely between Canada and the U.S

    Canada 37,500 deaths with 35M population
    U.S. -- 975,000 deaths with 330M pop.

    37,500 x 9.4 = 350,000
    Doing the math -- if the U.S. had vaxxed and masked like Canada, there’d be 600,000 fewer American deaths

    The U.S. response has been failure -- of its society

  9. flex says


    While I think your reasoning is sound, it misses an important point. Epidemics, particularly those involving human-to-human air-borne transmission, are also very dependent on the density of a population. Population congestion causes nasal congestion, as it were.

    So, while we can say that had the U.S. vaxxed and masked like Canada there would be fewer U.S. deaths, a direct multiplication exaggerates the level.

    Epidemiologists will be combing through this treasure trove of data, and arguing about what factors were important which which factors were not, and what each nation could have done differently, for decades.

  10. Alan G. Humphrey says

    @ flex in #10,
    The total density of populations between the countries may be different, but density in cities is not much different. If you compare the urbanization of Canada (81.8) and USA (81.6), both from 2015 in Wikipedia, then the comparison that ShowMetheData made is reasonable.

  11. KG says

    The Economist estimates the true death toll of Covid-19 so far (excess deaths globally) at 20.3 million, with a 95% confidence interval of 14.1 million to 24.6 million. Looking at country comparisons in excess death rates per 100,000 it finds the USA is not quite such an outlier, but it still does worse than any comparably rich (and old, in demographic terms) country. There’s a lot more detail at that link, and here. It turns out the USA did not do significantly worse than western Europe until 2021:

    In 2020, the U.S. had done a bit worse than average among its OECD peers. In 2021, when pandemic outcomes were often determined by the relative uptake of American-made vaccines, the U.S. did much, much worse than that. In country after country in Europe, the pandemic killed a fraction as many last year as it had the year before. In the U.S., it killed more…
    How did this happen? The answer is screamingly obvious, if also, in its way, confusing: The U.S. drove an unprecedented vaccine-innovation campaign in 2020, which empowered much of the world to turn the page on the pandemic’s deadliest phases, then, in 2021, utterly failed to take advantage of its power itself. But what is perhaps even more striking is that American vaccination coverage isn’t just bad, by the standards of its peers, but getting worse. About two-thirds of Americans have received two shots of vaccine, a level that is in line with Israel and not far off from the U.K., though below many other wealthy countries. (And even in the U.K., vaccination was more effectively directed toward the old.) But over the last six months, the country has had an opportunity to make up that gap with boosters and has simply not taken it. Only 29 percent of Americans have had a booster shot of vaccine, which puts us behind Slovenia, Slovakia, and Poland and means that less than half of those people happy to be vaccinated a year ago have chosen to get a third shot through Delta and Omicron. Booster campaigns seem like an obvious opportunity for easy public-health gains, yet remarkably few Americans seem to think it’s worth the trouble. Why? For everything we think we know about the pandemic and how people have responded to it, that one remains a maddening mystery.
    The obvious answer, given my priors, is that this is a lag effect of the politicization of the vaccine. Even though Trump himself deserves significant credit for launching Operation Warp Speed, he and his minions undermined public confidence in the vaccine and underplayed the virus itself. But, of course, that doesn’t explain why we’re roughly in line with other developed countries in being “fully vaccinated” (under the original definition) but wildly lagging in getting boosted.

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