The Pandemic can be assessed a bit like games of football, with deaths being the score. (Or, given that there are many ‘teams’ competing together, a better analogy may be a Marathon race. Nevertheless, I will use the language of the football metaphor.)

The winning country would be that with the fewest number of deaths attributable to Covid19. While this football metaphor is indeed useful, our perceptions of ‘who did best’ are strongly coloured by the pandemic’s first year, when media attention was greatest, when public health measures were most ‘in our faces’, and when the pandemic response was at its most bureaucratic.

As a result, the half-time scores are the scores that most seeped into public consciousness. Then, deaths which were classed as ‘covid-deaths’ were implicitly seen as more tragic, more requiring of daily tallying, than other deaths.

The two Tables below look at this Pandemic ‘World Cup’ through the simple demographic criteria of increases in deaths, all deaths. We may note four ‘ordinary-time’ phases of the pandemic. Together, they add up to a period of four years.

First, the warm-up, from May 2019 to February 2020. The warm-up, going back to 2019, is important to include because countries with unusually low numbers of deaths due to respiratory illnesses in 2019 would typically have higher death tallies in the next respiratory epidemic, whatever virus that might be.

Second is the first half of the Pandemic proper, which I would date as March 2020 to March 2021. Third is the second half, from April 2021 to April 2022, which includes the waves associated with the Greek-alphabet variants (especially Alpha, Delta and Omicron).

Following ‘ordinary-time’, there was ‘extra-time’ which I define as May 2022 to April 2023. We may note that the WHO declared the Pandemic to be over at around the end of April this year. So, we may formally categorise the period from May 2023 as ‘post-pandemic’.

Table 1 below indicates the score at the end of ordinary-time. It shows the percentage increase in deaths for a number of countries for the three years from May 2019 to April 2022, compared to the three years from May 2015 to April 2018. In the right-hand column is a counterfactual which is a best estimate of what the increase in deaths would have been in the pandemic period had there been no pandemic. (The counterfactual is calculated by comparing deaths in the 24 months ending April 2019 with deaths in the 24 months ending April 2017. I have used April years because, in both hemispheres, the period in late April and early May is generally free from epidemic respiratory deaths. This method minimises the impact to this calculation of the severe influenza global epidemic which lasted from late 2016 to early 2018.)

Table 2 indicates the ‘extra-time score’, comparing the year-to-April 2023 with the year-to-April 2019. It uses the same ‘trend’ counterfactual as Table 1. Whereas Table 1 is sorted to place the ordinary-time ‘winners’ at the top, Table 2 is sorted to place the ‘extra-time losers’ at the top. (We note that, for Table 2, some countries are laggards in publishing their mortality data; and also that the most recently published numbers are subject to upwards revision. The countries which are problematic in this regard have their data marked with asterisks, the number of asterisks indicating the degree of estimation required.)

In the pandemic proper, the two countries with easily the least increases in deaths were Norway and Sweden. The others in the ‘Top Eight’ (the ‘quarterfinalists’, to use the football metaphor) were the other Nordic countries, Australia and New Zealand, and Taiwan.

Based on the media coverage in New Zealand and the world news channels that New Zealanders mainly follow, the only surprise in that Top Eight would be Sweden, which pursued a very different policy response, especially in the ‘first-half’ of the Pandemic. In the 2020 New Zealand election campaign, political parties generally agreed that Taiwan was the exemplar for other countries to follow.

We may note that only New Zealand and Taiwan had counterfactuals showing higher projected increases in deaths than what actually happened. Thus, these two may be declared the ‘ordinary-time’ winners. The problem is that the Pandemic World Cup had ‘extra-time’. (It must also be noted, however, when we take the ‘non-death costs’ of the pandemic and its associated health policies, Sweden’s non-death costs were easily the lowest. So, on this basis, it could be argued that Sweden was the true ordinary-time winner, despite having been way behind at ‘half-time’.)

Extra-Time

When we look at Table 2 we see clearly that the East Asian countries performed very poorly. Most of these were deemed to be success stories in ordinary time. Taiwan is very prominent here. So is South Korea which has a conservative estimate in this table for its ‘extra-time’ increase in deaths. Macao is very important here, because it is the best proxy we have for China. Taiwan has had a recent resurgence in deaths in May 2023, and Macao has had a resurgence of Covid19 cases in recent weeks. So, these countries’ pandemic problems are far from over. (There are also signs that New Zealand’s seasonal death tally is picking up early this year.) The Macao situation, combined with other reports that all is not well in China right now, suggest that China may be presently going through a significant third wave of Covid19. This will add to global supply-chain problems.

New Zealand and Australia are in the top (ie worst) half of Table 2. So are two of the Nordic countries, Iceland and Finland, the Nordic countries which imposed more restrictive health mandates than their neighbours. So is Ireland near the worst, more restrictive in its public health mandates than the United Kingdom countries. Norway, top of Table 1, is in the middle of the Table 2 pack. Of the Nordic countries, only Sweden – easily the least restrictive in Europe, especially in the first-half of the Pandemic – performed well.

Quirky Counterfactuals

Creating consistent counterfactuals for each country is difficult because there are quirky demographics at play. First, we note that there are three main reasons why death increases might trend high for a given country. The first is a general increase in the population of a country: more people, more deaths. Second is the aging of a country, represented by increases in the median age of living persons. Third is a deterioration of general health, especially of those middle-age cohorts whose deaths ‘come under the radar’, given that deaths are dominated in most countries by people aged over 75.

It is likely that the high counterfactual for New Zealand is due to a mix of these. We know that New Zealand has some of the same issues of underclass deprivation as the United States, which include obesity, diabetes, and substance abuse. And we know that the United States has a lower life expectancy than other ‘western’ countries; a life expectancy now known to be falling.

The other two main quirks to look out for are birth rates in the troubled second quarter of the twentieth century. The Great Depression and World War Two were the main events that impacted on birth rates. There was also warfare in the 1950s in Korea and Malaysia. Sweden is an interesting case, comparable with Switzerland, neutral in World War Two, so having a lesser demographic impact from the War. Also, Sweden came out of the Great Depression early, meaning it will have had comparatively high birth numbers in the 1930s; Sweden’s peak deaths since 2015 will have been higher than otherwise, on that account.

While New Zealand is possibly the western country with the fastest population growth this century, this is offset by the fact that low birth numbers in the 1930s are translating to lower deaths since 2015. (See my recent ‘Smithometer’ analysis, in Granny Smith.) Aging and population growth are not the whole story of New Zealand’s upper quartile trend of increasing deaths. (Unlike, say Portugal, which is known to attract retirees in Europe as Florida does in the United States.)

New Zealand also has the additional factor of having, in June and July 2022, too many vulnerable people who were denied, for unexplained political reasons, a timely second booster Covid19 vaccination. The July 2002 mortality peak, almost entirely experienced by older European-ethnic New Zealanders – the Granny Smiths – came to a prompt end once these people became eligible for second-boosters. This sharp July peak – and drop-off – appears to have been a New Zealand specific phenomenon.

High counterfactual notwithstanding, New Zealand performed very poorly in extra-time, though not as badly as the East Asian countries which imposed the most ‘sterile’ public health policies on their people.

East Europe

I would like to note two other groups of countries. First, it was Eastern Europe which had the highest reported per-capita Covid19 death tolls. These countries do not look as bad in this analysis, though they (except the Baltic states) still look bad in Table 1, especially in light of their often negative counterfactual death trends. The main demographic problem that these countries have been facing is emigration of working-age adults, especially those Eastern European countries in the European Union. Generally, these countries look much better in Table 2, in extra-time.

Most of these countries successfully imposed severe public health restrictions in the first half of 2020, but abandoned those restrictions – or were unable to easily reimpose them – in the later stages of ‘the game’. The result was that these countries’ populations had substantially compromised immunity going into the winter of 2020/21. Their death peaks were much higher than the death peaks in the west earlier in 2020. The second problem was that, on account of their departed youth, their populations were aging as well as falling. Hence the high Covid19 per capita death tolls that savage winter.

In ‘extra time’, East Europe has ‘performed’ best. This would appear to be in part because so many of their most vulnerable people had already died; respiratory viruses had lost much of their human ‘fuel’. Also, these countries had re-established (the hard way) high levels of natural immunity to respiratory illnesses.

Russia continues to supply mortality data, though it excludes deaths in the Ukraine conflict zone; so its not included in the tables. And Ukraine has certainly stopped supplying data, due to governmental priorities as well as a lack of will to publicise its present demographic plight. Kazakhstan is probably the best proxy for assessing the impact of the Pandemic in Russia.

South America

These countries (plus Mexico) are among the worst performers in both Tables. Typically, they exhibit many of the ‘underclass’ socio-economic problems apparent in the United States, United Kingdom, and New Zealand: inequality, poverty, homelessness, obesity, crime, violence. It is likely that they will see ongoing increases in annual mortality on account of these factors; factors exacerbated by both the Pandemic and its associated mandates.

While Latin American populations are much younger than Eastern European populations – due to both higher births and less emigration – there will also have been a significant growth of numbers of people of peak-dying-age (over 75) contributing to ‘trend’ counterfactuals in some cases as high as New Zealand’s.

Another factor in these American countries is the high proportions of people living in or near the tropics at high altitudes. Under normal circumstances, these are unusually healthy environments, in which seasonal respiratory illnesses do not circulate as much as in temperate climes. But, it makes people living in these zones more vulnerable to pandemic respiratory illnesses when they do happen. It’s an old story that goes back to the time of Spanish colonisation in the sixteenth century.

This last factor is only apparent here in Colombia and Ecuador. Other similarly affected countries – Peru and Bolivia – had very high early death tolls, but (presumably due to political crises) have not released ‘extra-time’ data. Venezuela was even less forthcoming with useful data.

Africa including Qatar

Mortality statistics from Africa are rare. Egypt is now the best, and it certainly suffered. South Africa, which in ‘ordinary-time’ had a similar experience to that of East Europe, used to supply good quality data; but no more as its present economic crisis deepens. Signs are that the African continent was less impacted directly by Covid19 than other regions, though its more fragile economic supply-chains have become victims of the Pandemic’s ‘extra-time’ environment.

Qatar is an interesting case, because of its unusual demographics. Qatar’s resident population is heavily weighted towards the younger working-age population. So, while its death rates per capita have been very low, its percentage increases in deaths have not been low. We do need a good comparative analysis of the health impact of Covid19 on working-age populations, though made difficult by demographic data today still focusing on sex and ethnicity rather than age or occupation or labour force status.

South Asia

After China, the biggest Pandemic uncertainties relate to South Asia, with Inda being the largest country. We may also add the very populous country that is Indonesia. This region is a demographic black hole, which experiences high levels of emigration as well as of death. (We may note here – see Hundreds of Pakistanis dead in Mediterranean migrant boat disaster, CNN 19 June 2023 – that the majority of victims of the overcrowded refugee boat which sank last week off the coast of Greece were from Pakistan.) This region has suffered a huge upheaval since 2020, with the Pandemic a significant contributing factor.

Conclusion

There remains a lack of competent demographic analysis of recent and former pandemics, partly due to poor (sometimes politically-motivated) record-keeping, and partly due to the low status of demography among the social sciences. Analyses like mine here – amateur in the sense of being unpaid, but not in the sense of quality – help to fill the gap.

The most striking conclusion is that the ‘extra-time’ of the Pandemic gives a very different picture of the Pandemic’s human cost. The imposition by governments of sterile environments for long periods is not a recipe for good health outcomes, although it may give good headlines in the early phases of a pandemic when the Press is at its most attentive.

*******

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Analysis by Keith Rankin.

The ‘Young Elderly’ are in essence the post-war baby-boomers. An average young elderly person in these charts was born around 1950 to 1952.

The charts look at ‘quarterly excess deaths’, so do not show week-by-week fluctuations in deaths. For example, data for the very end of 2022 covers the whole of the last three months of 2022.

As in my previous recent charts (see my Spiralling Deaths in Germany, Evening Report, 14 March 2023; and Examples of Germany and Denmark, Evening Report, 12 March 2023), I have emphasised Germany, because late-pandemic mortality has been so bad there. And because Germany’s differences with the rest of Europe create a very useful point for epidemiological analysis.

In the first chart (above), of the countries shown only Germany and New Zealand had excess deaths in this age group below ten percent in the first six months of Covid19. The United Kingdom was easily worst then.

The United States had a really bad pandemic, for two years from April 2020 to April 2022. But, subsequently, for nearly two years since April 2021 Germany has been for the most part easily the most deathly of these countries, for the young elderly, with only the USA contesting Germany for this dubious honour. For some of 2022, New Zealand was in second place out of these seven countries.

We note that Belgium, Netherlands and France all had high death rates early in the pandemic, but have subsequently had much lower death rates than Germany for this age group.

The two obvious avenues for investigation are diet (the French surely have a more healthy diet?) and differences in the policy responses to the Covid19 pandemic. My understanding is that, while all countries had similar public health restrictions during the peak weeks of Covid19, Germany was much the slowest of these countries to remove mandated public health measures. Germany’s abundance of caution may have backfired big-time. Yet the only reason given here (on Deutcshe Welle) is: “that diseases other than Covid19 are bouncing back because fewer people are wearing masks amid a general relaxation of pandemic rules in comparison with the past two years”. There is no hint of comparative analysis in this particular DW media report.

The second chart compares Germany with its four nearest Eastern European countries, and with the two Mediterranean countries which were the first to experience substantially elevated pandemic death rates.

For the young elderly ‘boomers’, Spain and Italy show quite the opposite pattern to Germany; they started with high death rates and then moved to generally lower rates. Both had summer mortality peaks in 2022, to some extent due to the summer heat waves but mainly due to the rebounding of tourism with Covid19 still present. Covid19 flourishes in bars and restaurants, and in airport terminals.

The eastern countries had more deaths overall in the middle seasons of the pandemic, despite (or maybe because of) the success of the measures taken in the early months of the pandemic. Also, for these countries, with lower life expectancies than their western neighbours, the young elderly are on average closer to their eventual deathdays. It is important to note that these eastern countries had the fewest pandemic-related deaths after March 2022. Presumably their people most at risk of dying had already died, and the remainder had higher natural immunity to respiratory illnesses than did the older citizenry of Germany. (I am not aware that Polish, Bohemian or Hungarian cuisine is particularly noted for its health benefits, in contrast to the much-touted Mediterranean diets; so a better diet is probably not the reason.)

There is one other country with a similar pandemic death-profile to Germany; its southern geographic and cultural neighbour, Austria. The final chart here shows the smaller countries of western and central Europe, plus New Zealand. (Australia and Sweden do not provide age-group data.)

First we note that Austria and its neighbours Slovenia and Switzerland start out closely synchronised. Switzerland drops off Austria’s high young-elderly mortality path from March 2021, and Slovenia drops off a year later (though has a high summer peak in line with its Italian neighbour). The Scandinavian countries had generally low death rates for the young-elderly age group. (They did however see rising deaths from mid-2021 for the older elderly.)

Any valid epidemiological analysis for Germany’s 2022 tragedy needs to take into account the similar experience of Austria, as well as the generally different experiences of the other European and neo-European countries.

The United States still has a worse overall pandemic record than Germany, for the young elderly. The worry for Germany, though, is that the reasons for its really bad 2022 have not necessarily been resolved; 2023 may be just as bad. Time will tell; so long as an asteroid strike or a nuclear war don’t displace infectious diseases as drivers of excess mortality in Europe.

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

https://www.dw.com/en/winter-illnesses-burden-germanys-intensive-care-units/a-64135331

https://www.dw.com/en/top-german-virologist-says-covid-19-pandemic-is-over/a-64214994

Here we see charts of the same ten western tourist countries of Europe (refer to my Travel Warning: Excess Summer Deaths in Europe, 5 Oct 2022). It is important to note from the outset that ‘reported death’ figures have become increasingly unreliable. And reported cases are now unreliable indicators of the size of a covid outbreak; they do indicate the timing of covid waves, however, albeit with increasing time lags relative to the date of infection. The most reliable data is ‘excess deaths’. (Indeed Michael Baker has recently taken to citing this measure; see NZ Herald 16 October Covid19 Omicron outbreak; Another Wave.)

The Mediterranean tourist countries most popular with English-speaking visitors are shown first. All charts are to the same scale. We start with Greece this time.

Greece is one country that, using reported covid data, did not seem to be impacted much until the very end of 2020. However excess deaths in 2020 do suggest that there was a summer wave of Covid19; in addition, Greece was suffering excess deaths from influenza in the beginning months of the covid pandemic. The chart for Greece is quite dramatic-looking in 2022, with a significant death-wave in July (almost certainly continuing into August). We note that, re cases, July is worse than August; this represents the peak of American tourism into Greece, with intra-European vacations peaking in August.

Moving west to Italy, we see again the substantial covid death wave in July 2022. And we see, more clearly than Greece, the most recent (autumn) wave. This may be the wave of greatest impact, worldwide. Moving on to Spain, we see that the July death wave there is Spain’s highest covid death-wave since March 2020. And, by looking at reported cases, this July wave of excess deaths is clearly attributable to Covid19. (Note that 1,000 daily deaths per 100 million people is the same as 10 daily deaths per million; equivalent to 50 daily deaths in New Zealand. Indeed some of these deaths may be New Zealand tourists in Spain.)

Finally for South Europe, in the far southwest we see that Portugal had a bigger autumn wave of Covid19 (May) than elsewhere, while also catching the July wave early. Its July 2022 peak is as big as (or bigger than) its three 2020 peaks.

Looking at West Europe’s ‘big three’, the UK has had smaller summer peaks than the Mediterranean countries, probably because the ratio of visitors to residents is much lower than in (say) Greece and Italy. But we do see a clear rise in cases in June, meaning that the actual rise in cases will have been in May, when the summer tourism season in Britain gets underway. And excess daily deaths have averaged three in a million since May, equivalent in New Zealand to 2,700 pandemic deaths over a six-month period. We also note that these deaths occur in a context where many of the most vulnerable people had died in earlier covid waves.

France represents the high point of the immunity gradient, where many cases translate to relatively few domestic deaths; but where visitors can expect to be especially vulnerable. We see clear covid death peaks in April (when the French tourist season is well under way) and again in July, the peak month for English-speaking tourists. And, like Italy, we see that the latest wave is well underway.

Germany has seen a bigger covid death wave in the later summer; and we note that reported cases in Germany precede deaths, which is what happens in a country with an efficient reporting system. The latest wave of cases is prominent in Germany; deaths will come this month and next, not unlike 2021.

Now the mountain tourist areas, attractive in summer to people who like to walk (and to travel about by train) rather than to swim and sunbathe. Austria shows a pattern very similar to Germany, with a very marked October wave of cases. Austria, like Germany, was a leader in the autumn wave of 2021. Switzerland shows the same patterns as Austria, though with less amplitude. Norway is the most muted of these destinations. Yet its excess deaths are higher relative to reported cases than most of the other countries shown here. Reliable once for its excellent record-keeping, Norway seems to have lost interest in Covid19. My sense is that their autumn deaths will be much as they were in 2021. For Norwegians, October and November 2021 represented their biggest death-wave of the pandemic.

It is important to note that October is a peak month for air travel from Europe and North America to Aotearoa New Zealand. As I have previously noted (see Covid Waves in Europe, Lesson for New Zealand 26 July, and Covid Demography: New Zealand in context of North and West Europe 19 August), New Zealand can expect a late spring or summer covid wave. New Zealand, which has no regular summer seasonal pattern of high deaths, may well in a few months see its highest peak of excess deaths for the whole of the pandemic. Indeed, as has been announced by New Zealand’s Ministry of Health today (RNZ), Covid19 is waxing once again.

As has been the case in 2022 so far (but not in 2020 and 2021) New Zealand’s covid deaths most likely will be nameless and faceless statistics. Out of sight – as reporters, politicians and public servants take their holidays – and out of mind.

*******

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Covid Excess Deaths: East Asia in context – These charts show excess pandemic mortality so far for a wide range of countries, geographically themed. The charts are structured to emphasise deaths in 2022 and 2021, and to facilitate comparative analysis between regions. (General mortality data is lacking for Africa and South Asia.)

The first chart shows Australasia and East Asia, with Scandinavia providing context. (While Malaysia and Indonesia are missing because of a lack of supplied data, indications are that Malaysia’s excess death profile might be an average of those of Philippines and Thailand. Indonesia is more speculative, though estimates from The Economist and WHO suggest that Indonesia has suffered worse than the United States, maybe worse than Brazil, and certainly – unlike USA and Brazil – with the vast majority of its deaths in the 12 months to June 2022.)

From New Zealand’s point of view, the 2022 ‘performance’ is comparable with Australia and most of Scandinavia; New Zealand was much better in 2021 though. The worst performers in these regions over the last 12 months have been much of East Asia, Finland and Norway. Japan is most like New Zealand, with its worst half-year to date being the most recent one, suggesting that much of Japan’s and New Zealand’s eventual covid stories are yet to be told.

Philippines needs a special mention. It’s a country with a substantial demographic and labour force connection to New Zealand; it’s also comparable in terms of the severity of its top-down anti-covid public health mandates. On Al Jazeera News today, one item indicated that Philippines has been in shutdown for two years, featuring a succession of lockdowns which are just now ending. (See links to Al Jazeera stories at the end of this commentary.) Of most significance was that children there are only now returning to school after a two-year closure; and that the costs of this lost education may prove to be huge.

We should also note that the 2,300 excess deaths per million in the last 18 months in Philippines is in a country with a young population, making Philippines’ experience somewhat different to that of East Europe. (For East Europe, see final chart below; one similarity though is that both Philippines and East Europe are exporters of young labour.)

This next chart, to the same scale as the first one, allows for comparisons to be made with West Europe and North America. Greece is the country here which is most like Philippines in the earlier chart, having a substantial majority of its deaths in 2021 and 2022 following an apparently successful 2020. Greece is also a country that New Zealanders connect with, yet is almost never mentioned by New Zealand’s epidemiologists.

Germany, Austria, and Netherlands are not too flash either, having more than half of their excess deaths in 2021 and 2022. Spain, France and the United Kingdom have done significantly better than these from 2021, having done worse in 2020.

The next chart, on an extended scale, shows the Americas (with South Africa). Canada shows a ‘performance’ comparable with Ireland and Scandinavia. United States looks much like Latin America. Three countries which did pretty well in 2020 did poorly in 2021 and 2022: Uruguay, Paraguay, and Cuba. (Cuba’s actual numbers for 2022 are highly speculative.) In many ways these ‘Latin’ countries are like Philippines, in culture, demography, socioeconomic circumstance, and in economic proximity to the United States. Though only Cuba has been like Philippines epidemiologically, with the majority of its deaths being in late 2021. Both countries actively fought-off the virus for a long time, only ‘surrendering’ to it after a year-and-a-half (or so).

The final chart, on an extra-extended scale, shows the underacknowledged epicentre of the covid pandemic, East Europe. In all countries in East Europe, we see that the first wave of the pandemic (February to July 2020) was fended-off successfully, I understand through government mandates. The crisis came late in 2020 as the perpetuation of these mandates became untenable. East European populations were substantially less able to cope, owing to both economic and immunological weakness, than were West European populations.

On both sides of Europe, covid’s initial hit was during a shoulder season, neither winter nor summer. East Europe has the look of a region with a substantial general-immunity deficit in the autumn of 2020. Most countries in the region now appear to have restored general-immunity, but at great cost. For the most recent period (shown in black), February to July 2022, New Zealand falls between Hungary and Romania. Some countries in this region have lower recent excess mortality rates than New Zealand; this was especially true in July.

East Europe has an unusual demography, dominated by older people, as the region bleeds its younger population to West Europe. East Europe was already in dire straits before Covid19 hit. Indeed, it has been becoming the Dixieland of the European Union. We ignore East Europe’s stresses at our peril; those stresses are the crucible of world wars.

(A note about Russia and Ukraine. Russia’s reported deaths have dropped dramatically since it invaded Ukraine; before this year, Russia’s aggregate mortality data could be trusted. And Ukraine’s last reported aggregate of monthly deaths was in January.)

*******

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Al Jazeera news links:

https://www.aljazeera.com/news/2022/8/22/philippine-schools-reopen-after-one-of-worlds-longest-shutdowns

https://www.aljazeera.com/news/2021/8/21/philippines-eases-lockdown-amid-record-covid-19-infections

The Marshall Islands lost its covid-free status yesterday when tests confirmed six positive cases in the capital, the first known community transmission since the pandemic started in early 2020.

It was not immediately clear the source of the covid-19 spread as Marshall Islands borders have been closed since March 2020 and rules currently require 10 days of government-managed quarantine prior to release.

The six people who tested positive Monday had “no travel history, no contact with anyone who was in quarantine,” said Health Secretary Jack Niedenthal.

The government moved quickly last night to announce a halt to the start of the new school year with all island schools scheduled to open this week.

President David Kabua delivered a brief 90-second statement to the nation via an online live stream in which he announced that the Ministry of Health and Human Services had confirmed six people positive in the capital of Majuro.

The President’s short speech was the first official notice of news that in the fashion of a small island had spread several hours prior to his speech.

“I advise people to remain calm and follow the protocols to prevent covid,” Kabua said.

Wearing facemasks advice
President Kabua advised the country to follow established protocols of wearing facemasks when in public. Kabua wore a facemask while delivering his speech.

Notices on social media went viral in the minutes and hours after people learned of the first-ever covid community spread in this isolated north Pacific nation.

Although there were no rules except for school closure announced by government, within minutes of the official confirmation of the cases, a national basketball tournament game was halted mid-way through the contest Monday night, and some restaurants began shutting their doors.

The Office of the Chief Secretary said that the start of the new school year, which opened yesterday at some public schools and was scheduled to open later this week in private schools, would now be postponed for two months.

While businesses and government offices can continue as usual, hospital services will be modified and masks will be required in public for the next two months, said a statement issued by the government.

The government also announced a halt to travel by plane or ship to remote outer islands in hopes of restricting spread of covid to islands that have only rudimentary medical care services available.

“The most important lesson learned from Palau’s experience with a wave of covid starting in January is to protect the hospital during the initial stages of a covid outbreak,” said Niedenthal.

Protecting patients
“This is to protect both the patients already in hospital from being infected by incoming covid patients and, of equal importance, minimising the exposure of hospital staff so they can remain functional and on the job.”

The Ministry of Health and Human Services moved quickly last night to set up previously planned “test and treat” facilities in designated locations in the community.

Niedenthal said the number one lesson learned from watching other nations respond to their covid waves was the priority of “protecting the hospital”.

The goal, he said, is to have people use community test and treat facilities where health officials will perform tests and determine treatment needed.

The entire Marshall Islands has a population estimated at only 42,000 scattered on dozens of atolls and single islands. The two urban centers of Majuro and Ebeye, however, contain three-quarters of the population and many people live in overcrowded conditions ripe for the spread of covid.

Laboratory tests of people who were positive for covid while in managed quarantine last month showed they were all BA.5 variant. And ministry officials said they were proceeding on the basis that BA.5 is what they are seeing.

One local resident said that he was aware of a church member who was confirmed with covid yesterday.

“That means spreading already since yesterday was a busy day at church,” said the person.

Giff Johnson is editor of the Marshall islands Journal and the RNZ Pacific correspondent in Majuro. This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

Respiratory Virus Hospitalisations in Counties-Manukau, as reported by Stuff

The chart above splits the patients in Middlemore Hospital into the different categories of Severe Acute Respiratory Illness. The vast majority are what in the past we have called ‘common colds’. There is no indication that any of these ‘colds’ are due to human coronaviruses other than the Covid-Omicron. Indeed, as well as ridding us of Covid-Delta and its ancestor variants of the original SARS-Cov2 virus, Covid-Omicron may well have sealed the fate of the human coronaviruses which previously caused about 15% of all ‘colds’.

We do not know what percentage of covid hospitalisations end up becoming deaths. (My guess is that about half of covid deaths occurred in people’s homes, including age-care facilities.)

It is likely that the deaths associated with the 93% of SARI hospitalisations which were not covid are a relatively low number compared to covid deaths, mainly because a large proportion of these other cases will be children. But it is appropriate to remind ourselves that, in normal times, about ten percent of all winter deaths are attributable to ‘common colds’, and that this figure will be higher this year, maybe 20% of all winter deaths.

Recent Changes to the Reporting of Covid19 Deaths

The recent changes have been very confusing to media trying to report these. But I will summarise the three main measures, using data from Tuesday 26 July until today.

• Deaths of people who became Covid19 cases within 28 days of their death: 154
• Deaths of people for whom Covid19 was the principal cause: 90
• Deaths of where Covid19 was the principal or a contributory cause: 130

The last of these has become the favoured measure of the Ministry of Health. It is important to note, however, that because of times required to verify that Covid was the underlying or a contributory cause of death, this last favoured measure is not as up-to-date as the first (previously favoured) measure.

To impute weekly deaths (and allowing for lower weekend reporting) we should scale-up these four-day totals by 50%: giving 231, 135, and 195.

Then, to convert them into weekly deaths per million in the population, we must divide by five. That gives, for each measure:

• 46 per million
• 27 per million
• 39 per million

These last three numbers should be seen in the context of this Worldometer screenshot (22 July 2022) which showed New Zealand last week as the country with the world’s highest Covid19 death rate.

Based on the above calculation, New Zealand’s current comparable rate of Covid19 mortality is 46 per million (up from the 34 per million shown in the screenshot). And even if we use the much more conservative measure above (27 per million), that’s still the same as the number given for Malta, and well above the high numbers for Taiwan and Australia.

And we know that significant numbers of people are also dying from the other SARI viruses. SARI deaths would appear to be being substantially downplayed by the Ministry of Health.

*******

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

West Europe

The first three charts (above) show three of the larger Western European countries: Germany, France, Spain. (Italy shows a similar picture.)

The most important data item is ‘excess deaths’. (In the case of France and Spain, the last few weeks of this data have been ‘topped up’ using estimates from The Economist, published by Our World in Data. Germany’s data is complete to the end of June, though most countries which release their mortality data promptly do subsequently revise their recent numbers, usually upwards.) For the pandemic as a whole, Germany has ‘lost’ 1530 per million of its population, including 197pm in the first half of this year.

In Germany, we clearly see the ‘Omicron death wave’ in March 2022, a common but by no means universal feature of country charts of this type. Reported covid cases clearly correlate with excess deaths in that month. We are also seeing the same June/July wave in Germany – in its summer – as we are seeing (in winter) in New Zealand. And, there is a clear June/July death wave to match Germany’s ‘case wave’. (Germany’s two worst death waves were in December 2020 [original Wuhan variant] and November 2021 [Delta variant].)

France shows many of the same recent patterns as Germany, though with only about half the severity. Two important differences are that the late 2020 wave came a month earlier in France, indicating that this late 2020 resurgence in Europe was probably driven by tourists from North America; covid levels in the summer of 2020 were much higher in the USA than in Europe.

Overall, France ‘lost’ 1740 per million of its population, including 240pm in the first half of this year. Certainly, France has the look of a more immune population than Germany. And it’s starting to show once again in the French Caribbean; throughout the pandemic, French people – relatively well-adapted to covid – have been conspicuous spreaders of covid through France’s extant empire.

As with Germany, deaths in the present wave do not show up markedly, yet, in the official death statistics; they only show up in excess deaths, meaning many people who have died in this wave have not been acknowledged as covid deaths.

Spain, while much more like France than Germany, still conforms with the general 2022 pattern for Western Europe. While case numbers appear lower in Spain than France, deaths are similar. Overall, Spain ‘lost’ 2570 per million of its population, including 286pm in the first half of this year. Spain looks to be well up the immunity gradient, like France; more so than Germany. This means that I would predict that Germany will have more excess deaths per million in the second half of this year than France and Spain.

We should note the importance of this concept of ‘immunity gradient’. New Zealand (like the much of the Western Pacific region) has a low place on the immunity gradient. This gradient means that countries like France and Spain will be among the most dangerous for New Zealand tourists to visit, at least with respect to catching Covid19. (New Zealand sports teams in Europe this year will be particularly vulnerable to covid, though these younger and fitter sportspeople will generally get through the illness quite quickly. So far, while significant numbers of elite sportspeople from New Zealand have caught covid overseas, almost none seem to have had disabling forms of the illness.)

Thanks to its place on the immunity gradient, in Spain “the pandemic has felt like an afterthought as Spaniards reverted to their usual beach holidays and eagerly welcomed tourists.” Deep in a Covid wave, Europe counts cases and carries on (22 July, NZ Herald courtesy of NY Times).

We should also note that the Scandinavian countries other than Sweden have charts that are similar to the Germany chart; except that their tolls in the first half of the pandemic so far were lower than Germany’s.

East Europe

Here I include charts for Czechia and Hungary, noting that other neighbouring countries – especially Poland and Slovakia – show similar patterns. (The Balkan countries and the former Soviet Union countries are more complex, and will not be further mentioned here.)

The first and most important things to note are that Czechia and Hungary successfully suppressed Covid19 until September 2020; they were significantly more successful than even Germany, in this respect. The pattern then shows a particularly severe winter of 2020/21; in two or three waves, though the troughs of these waves were probably overstated.

The key issue here is that countries in these temperate latitudes – and North Europe is the best set of test cases – suffer significant winter seasonal epidemics in three or four winters out of five. The timings of these regular epidemics of excess deaths vary; February tends to be worst. This makes it very hard to determine a winter normal for these countries.

In the winters of 2020/21 and 2021/22, covid has to a large extent displaced influenza and other seasonal cullers. Thus, in the peak influenza months, excess deaths from Covid19 may fall. Rather covid has displaced these other illnesses as the principal seasonal culler. That’s why covid deaths are best understood in the context of the fatal illnesses that covid is displacing. (See these charts on Evening Report.)

Czechia ‘lost’ 4480 per million of its population, including 234pm in the first half of this year. Hungary ‘lost’ 4500 per million of its population, including 292pm in the first half of this year. Overall, both countries have lost nearly one in every 200 of their populations, so far. (One in 200 of the world’s population would be 39 million people.)

So far, these Eastern European countries have incurred double the mortality of the major western countries noted here. But they suffered much less in the first six months of the pandemic, and they have seen significantly fewer deaths in the last couple of months. They also suffered surprisingly little in July-September 2021, the Delta wave that was then washing through the whole world.

These countries appear to have suffered a calamitous shift down the immunity gradient during 2020, and then paid the full price. Thus, by mid-2021, they shifted up the immunity gradient; or at least the ‘natural immunity gradient’. With waning vaccination immunity, and lower rates of vaccination, these eastern countries suffered in the late months of 2021 (October and November).

From the abovementioned New York Times article: “Other parts of Europe were even more hands-off [this year]. In the Czech Republic, where there are no restrictions at all, including in hospitals, the virus is running rampant, and officials openly predict an increasing spike in cases.” While Czechia is a place to watch, I suspect that any uptick in covid there will be less than the present covid spike in Germany. Either way, like France and Spain, Czechia and Hungary are presumably dangerous countries for New Zealanders to visit at present.

New Zealand and Sweden

These two countries are widely regarded as the developed capitalist countries which represent the opposite ends of the 2020 ‘stringency spectrum’. Sweden’s public health scientists emphasised the importance of population natural immunity as the key to good public health outcomes. New Zealand was the poster-child for interventionist mandates with the aim of creating maximum distance between the coronavirus and the people. New Zealand and Australia took more cues than Europe from those East Asian countries which were at the frontline of the successful suppression of the more lethal (though less transmissible) SARS1 coronavirus.

Sweden ‘lost’ 1210 per million of its population, including 128pm in the first half of this year. New Zealand ‘lost’ minus 220 per million of its population, though plus 272pm in the first half of this year.

Looking backwards, New Zealand has ‘done best’, though its excess deaths this year are comparable to all the other countries mentioned here (except Sweden which has done the best of the developed capitalist countries this year).

What matters, clearly, is the next phase of the pandemic. New Zealand is clearly, at present, well down the immunity gradient. New Zealand remains very vulnerable to international visitors bringing new strains of respiratory (and maybe some non-respiratory) pathogens.

The charts suggest that Spain, France, Czechia, Hungary and Sweden will have comparatively low excess mortality in the coming year and a half. My sense is that Germany will have higher ongoing mortality rates than these neighbours and near-neighbours.

My concern is for New Zealand, ‘going forward’, and with those other western Pacific countries that have taken bigger covid tolls in 2022 than in the previous two years combined. A particular point to note is that the next wave – the coming summer wave (or late spring) wave – will have a higher excess death toll than the present wave.

We see that, in many countries, Covid19 remains much more than a ‘winter’ illness. New Zealand at present is still seeing (at least in the early winter) rising covid-deaths offset by lower than normal non-covid winter deaths. When New Zealand gets to the late-spring or summer, there will be no such offset. Rather, in November or December, New Zealand could suffer a covid death spike similar to those this year faced by South Korea and Taiwan.

In terms of published data, New Zealand had the most covid deaths in the world last week. For some reason this known fact did not make the headlines. (This week New Zealand has been overtaken by Martinique and Anguilla, pointing to a new Caribbean covid wave. Just now is the peak of European and North American tourism into the Caribbean holiday destinations.) Further, while published cases and deaths have held steady in New Zealand over the last week, hospitalisations are rising again in the most recent data. It is possible that New Zealand will suffer over 800pm excess deaths in the second half of 2022; that’s another 4,000 people.

Below is the screenshot from Worldometer from Friday 22 July, showing New Zealand in its place at the top of the table for reported Covid19 deaths. The table is sorted by deaths per million people in each country’s population.

Context of the Immunity Gradient

Johan Anderberg, in The Herd, cites Hungary and Poland – and Spain and France – as being among “countries that had shutdown playgrounds, forced children to wear facemasks, closed schools, fined citizens for hanging out on the beach, and surveilled parks with drones” (p.298). And he includes Germany, Czechia and Hungary “among countries that hadn’t been affected in the spring and thus lacked immunity” as having problematic experiences at the end on 2020 (p.292). Hungary, “where Viktor Orbán had invoked the threat of the virus to strengthen his power”, gets a special mention for the initial strength of its anti-covid response (p.260).

Re the matter of children, on RNZ today I heard a news report about this story: Likely cause of mystery child hepatitis outbreak found. This story provides significant counter-evidence against requiring younger children to isolate and wear facemasks. Presumably, adenoviruses have been in short supply in New Zealand too, especially given the prolonged closures of New Zealand’s international borders.

It’s more important than ever that the blindspots in New Zealand’s official covid narrative are exposed. Many countries desperately need a scientific scrutiny of facts, and not just a lazy presumption that a few overexposed experts are presenting all the known facts to the New Zealand public; all the facts about New Zealanders’ – and other peoples of the Western Pacific – changing vulnerability to Covid19 and other infectious diseases.

Instead, the latest reporting of Covid19 [RNZ] is substantially downplaying deaths, with no daily death total given in the press release, and no further mentions of people dying ‘with covid’. If the reporting had been done the same as last week, there would have been a record high daily death total of 40. Even under the new tighter definition, the latest daily covid death toll is 29, also close to the daily record.

*******

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

A Papua New Guinean doctor, who is alleged to be covid-19 positive, has been arrested and charged in Solomon Islands for illegally crossing the border.

The doctor, from Bougainville and employed at Nonga Provincial Hospital in East New Britain province, was arrested and charged in the Solomon Islands capital, Honiara, for illegally crossing, authorities from both countries have said.

Solomon Island Prime Minister Manasseh Sogavare made reference to the case in a statement he had made, saying the doctor was now being quarantined.

Sogavare had, in his covid-19 update address to Solomon Islands on January 18, said: “…according to our contact tracing information, the index case that brought in the infection to Pelau is a medical doctor from Papua New Guinea who hails from Tasman Island and has traditional ties with the people of Pelau.

“This doctor with nine other people, including members of his family crossed the border illegally from Tasman to come to Paleu on 9th January 2022 and it is quite disturbing that such a highly qualified person a medical doctor, blatantly disregarded our laws, breached our covid-19 regulations, and crossed our border illegally.”

“He has now started a community transmission of covid-19 to his relatives and people in Pelau.

“It is extremely disappointing that the relatives of this doctor in Pelau completely disregarded the instructions from the government to not allow any person from the other side of the border to land at or stay in any of their villages and homes.

“By allowing the doctor to enter the village they have provided the platform to start the community transmission of covid-19 in Pelau.

In this regard the relatives of this doctor have also breached the covid-19 by allowing this doctor and his family to land and stay in Pelau and started the community transmission of covid-19.”

Confirmed by Bougainville
Autonomous Bougainville Government Health Secretary Dr Clement Totavun has confirmed that the doctor, from Tasman Island, works at Nonga Hospital, and travelled to Bougainville during Christmas, got on a ship to Tasman and then on to Pelau in Solomon Islands.

“I have been advised by my covid-19 team that this is true.

“The doctor from Tasman who works at Nonga General Hospital, Rabaul, came here during Christmas and got on the ship to Tasman and on to Pelau,” Dr Totavun said.

“He was arrested by Solomon Island police for crossing the border, which is currently closed, and is currently in Honiara. Doctors at Honiara Hospital have contacted our CEO Buka Hospital and confirmed.

“I have alerted our surveillance team to check out Tasman in the coming week as the virus might be spreading there,” Dr Totavun said.

Buka Hospital chief executive officer Dr Tommy Wotsia told the Post-Courier he was advised of the reports.

Traditional border crossing banned
Traditional border crossing between Bougainville and Solomon Islands has been banned since November last year following claims that Bougainvilleans had been smuggling arms into that country to arm and train Malaita islanders seeking to overthrow the Sogavare government.

Bougainville Police Commissioner Francis Tokura said he confirmed with Solomon Islands police about the incident but could not elaborate further.

Nonga Hospital chief executive officer Dr Ako Yap and his deputy Dr Patrick Kiromat also confirmed the doctor was working with them and had been on holiday since December.

They said they had not been officially notified of the incident involving the doctor in Honiara but said he was due to return to work soon.

Gorethy Kenneth is a senior journalist on the PNG Post-Courier. Republished with permission.

Article by AsiaPacificReport.nz