COVID-19 pandemic: Global infections up by millions a week

SINGAPORE — One hundred hours. That’s all it took for global coronavirus infections to rise by a million in the five days leading up to last Saturday a week ago.

Just four days later, on Wednesday, total case numbers hit 15 million after surging by another million as a pandemic that has crippled the global economy and put millions of people out of work spread at an unprecedented rate. And by yesterday evening, the tally was just shy of 16 million.

And there is no sign of it slowing. With multiple countries recording record rates of infection in the past two weeks, the grim statistics disprove policymakers’ hopes that strict lockdowns would rein in the disease.

The reported numbers may only be the tip of the iceberg. “The actual number of infections remains uncertain but likely underestimated. Similarly, the precise figure of fatalities directly or indirectly attributable to Covid-19 remains uncertain,” Professor Leo Yee Sin, executive director of the National Center for Infectious Diseases (NCID), tells The Sunday Times.

Buttressing this point, Prof Leo cites a report in the Journal of the American Medical Association this month that put estimated deaths worldwide at close to 20 per cent higher during the period between March and April, about two-thirds of which were attributable to Covid-19.

The promise of a miracle vaccine after the virus first emerged in Wuhan, China, has been tempered by the World Health Organization (WHO), which is under fire for its initial response to the outbreak. The WHO says a perfect vaccine that will be available to everyone immediately remains out of sight for now, even as pharmaceutical giants around the world race to come up with a cure that would potentially be worth billions of dollars.

The WHO’s perceived missteps prompted the United States to withdraw funding for the global body after President Donald Trump accused it of kowtowing to the Chinese government. The action by a country that has traditionally been the biggest contributor of funds to the WHO has jeopardized coordinated global efforts to tackle a disease that has killed over 643,000 people in seven months.

Policy missteps

President Trump’s anger may be gauged from the fact that the US has emerged as the worst-affected country in the health crisis, with over 4.2 million cases and over 148,000 deaths as of 5pm yesterday. But Mr Trump’s own handling of the situation has also drawn criticism, with the American billionaire – who faces an election in November – consistently downplaying the threat posed by Covid-19.

Mr Trump had long disparaged the use of face masks to prevent contagion and even went against the advice of his administration’s own health experts to claim that the virus does not pose a grave risk to life. He has also alleged that calls to lock down the US and take stricter measures to avert more deaths are a conspiracy to sabotage his re-election effort.

He is not the only politician who has done so, however. Brazil’s President Jair Bolsonaro, a self-confessed Trump fan, has also disparaged health experts’ warnings of the need for tough measures.

Mr Bolsonaro’s strategy has resulted in Brazil becoming the second worst-affected country in the world, with over 2.3 million infections and 85,385 deaths as of yesterday evening. Although he, too, has been infected by the coronavirus, he has scoffed at the danger.

The Brazilian President’s concerns about the economic fallout of lockdowns are shared by Indian Prime Minister Narendra Modi. Despite one of the strictest lockdowns in the world, India has not managed to avert a health catastrophe.

The country has seen over 1.3 million infections since Covid-19 reached its shores. The Indian government has nevertheless touted its relatively low death rate in comparison to Western countries, with just 31,425 fatalities, to justify a reopening of the economy.

But experts have stated that the low mortality rate in India may not be attributable to government efforts. They said the country’s young population, and the low incidence of lifestyle diseases such as obesity and diabetes, were the main factors that led to fewer deaths from a virus that has been found to pose a greater threat to the old and infirm.

Concerns have also been raised about Covid-19 reporting in India, a country with a healthcare infrastructure that is ill-equipped to tend to a billion-plus population.

WHO spokesman Tarik Jasarevic tells The Sunday Times: “If governments do not clearly communicate with their citizens and roll out a comprehensive strategy focused on suppressing transmission and saving lives, if populations do not follow the basic public health principles of physical distancing, hand-washing, wearing masks, coughing etiquette and staying at home when sick; if the basics aren’t followed, there is only one way this pandemic is going to go, it’s going to get worse and worse and worse.”

Spiraling death toll

Global coronavirus data clearly illustrates the success of some countries in battling the deadly virus in comparison to others that have seen rising numbers of infections and soaring death tolls.

In the initial weeks after the pandemic came to the world’s attention, the mortality rate from the disease – the percentage of people who would die out of the total number of infected – was pegged at 2 percent. Subsequently, the WHO provided its own estimate of a 3.4 percent mortality rate.

However, given that the world has witnessed 15.9 million cases and over 643,000 deaths, the real mortality rate worldwide is over 4 percent. The divergence is attributable to the higher mortality in some countries in comparison to others.

The WHO has said of the mortality rate: “It is a ‘snapshot’ of the current situation. This ratio can vary considerably during an outbreak. Such numbers are always evolving, and we will not have a clear CFR (case fatality ratio) until the outbreak is over.”

Adding to the concerns about the rampant spread of the virus, increased testing for Covid-19 across the world has also resulted in more positive cases being detected. The WHO tells The Sunday Times that while test positivity rates can be an indicator for the intensity of disease transmission, they must be considered alongside other criteria such as health system capacity.

Glimmer of hope

Despite the veritable mountain of bad news, there remains hope in the midst of the global crisis. One ray of hope is research findings that show the number of Covid-19 patients who have died in hospital has fallen by 60 per cent since the start of March to 42 per cent at end-May. This rate was applicable across Asia, Europe and North America.

NCID’s Prof Leo says the intensive care unit is the last of the chain of care activities.

“To reduce mortality, we need to look at the entire chain of care delivery with emphasis on early care,” she says, highlighting efforts for early intervention and increased testing.

In that regard, the experience of Singapore is playing a valuable role in nations’ understanding of the coronavirus and how to combat it. The country has had 49,888 infections so far, with the death toll at 27. The government’s aggressive strategy of detecting infections early, isolating infected residents and contact tracing has enabled the country to see a mortality rate much below the global average.

Strict policies governing the wearing of face masks and social distancing have also resulted in a significant decline in the number of infections in Singapore, though the virus has proved resilient and cases continue to emerge.

Prof Leo cites local research supporting the evidence-based management of Covid-19 in Singapore and notes that it is among the few countries in the world to partner the United States’ National Institutes of Health in adaptive Covid-19 treatment trial studies using remdesivir, an immune-modulator.

Mr Jasarevic of the WHO points out that there will be no shortcuts out of this pandemic.

“We all hope there will be an effective vaccine, but we need to focus on using the tools we have now to suppress transmission and save lives,” he says.

“We need to reach a sustainable situation where we have adequate control of this virus without shutting down our lives entirely or lurching from lockdown to lockdown, which has a hugely detrimental impact on society and economy.”

Surge in infections across the world

Even economies that were initially hailed for their handling of the coronavirus situation have witnessed a surge in cases.

Singapore, for example, saw a spurt in cases among its foreign worker population in April but community cases are now viewed as being low enough to permit a partial return to normalcy.

Hong Kong, which also enjoyed initial success against the virus, is suddenly seeing a spurt in cases. It has had more than 1,000 cases since early July, accounting for over 40 per cent of its total cases since the virus first hit the Chinese territory in late January.The development has alarmed health officials, who face a shortage of isolation beds and testing capacity.

Indonesia, too, has witnessed an unabated rise in cases, which led it to surpass China – the epicenter of the original outbreak – in terms of the total number of infections. Indonesia had 97,286 cases, against 83,784 in China, as of 5pm yesterday.

In Japan, the nationwide death toll is nearing 1,000, with cases emerging on a daily basis, many of them in the capital Tokyo. The number of confirmed cases in Japan rose by a record 1,000 on Friday to touch 27,956.

In Australia, officials have enforced a six-week partial lockdown and made face masks mandatory for residents in Melbourne, the capital of Victoria state, after a fresh outbreak that saw a record number of new cases detected in a single day last week.

In the West, Barcelona in Spain has instructed millions of people to stay at home following a spike in infections. Spain recorded 922 new cases last Friday, prompting officials to issue warnings against going out.

s Health Ministry reporting 7,573 new cases and 737 fatalities on Friday, taking the country-wide total to 378,285 cases and 42,645 deaths.