UPDATED May 9, 2020. The coronavirus, or COVID19, has swept around the world. However, not all countries have had the same experiences. Outcomes have varied by the number of cases, the rate of increase, and how countries have responded.
In this post, I present coronavirus growth curves for 15 countries and their per capita values, graph their new cases per day, daily coronavirus deaths, and describe how each country approached controlling the virus. You can see the differences in outcomes and when the effects of coronavirus mitigation efforts started taking effect. I also include the per capita values for these countries in a table near the end.
At this time, there is plenty of good news with evidence that many of the 15 countries have slowed the growth rate of new cases. However, several other countries have reason to worry. And, we have one new cautionary tale about a country that had the virus contained but is now seeing a spike in new cases.
About the Graph of Cumulative Coronavirus Cases
The graph below represents the cumulative growth of confirmed coronavirus COVID19 cases starting at around the 20th case for each of the following countries: Sweden, Brazil, Australia, South Africa, the United Kingdom, Spain, Germany, India, Taiwan, Singapore, South Korea, Japan, Italy, and the United States. For China, I had to start with the 548th case given the data available. To facilitate the comparison between countries, I’ve lined up the countries so their 20th case occurs at the origin on the X-axis. Of course, their 20th cases didn’t happen on the same day but, by lining them up, we can compare growth rates between countries. The X-axis numbers represent the number of days since the 20th case, except for China. These data are current on April 30, 2020.
On the graph, you can really see the flattening of the curves for Spain, Italy, and Germany. Compare the steeper middle portion of each country’s curve to their flatter portion towards the end.
For some of the harder to see curves, I’ve included individual country curves in the sections below. Data are provided by Johns Hopkins University and are available here.
For more information about these countries, read my post about Mortality Rates by Country.
Coronavirus Confirmed Cases and Deaths Per Capita by Countries
Below are the per capita rates for confirmed cases and deaths in the 15 countries I cover in this post on April 30, 2020. Keep in mind that these are confirmed cases, as are all the numbers in this post. The true infection rate will be higher. These per capita values are based on the April 30th data. Countries that have an upward slope in the cumulative cases graph will have increasing per capita values over time. These numbers give a sense of the relative impact COVID-19 has had on these countries in terms of cases and deaths while factoring in their population sizes.
The table is sorted by Deaths per 100,000 people from worst to best. Coronavirus deaths are a more concrete measure of the virus’ spread than the number of confirmed cases. Each country’s testing rate can influence the number of confirmed cases.
|Country||Cases per 100,000||Deaths per 100,000|
The time series plot below tracks the number of coronavirus deaths per 100,000 people for the seven countries listed in the legend. Note that the other eight countries all had less than one coronavirus death per 100,000 people. The last point in the graph for each country equals the value in the table above, which is updated to April 30, 2020.
Now, let’s move on to determining whether these countries have coronavirus under control! There is good news because the data show that lockdowns can be successful!
Western Countries and the Coronavirus
On March 27th, Italy become the country with the 2nd highest number of confirmed coronavirus cases (86,498). Notably, Italy has started to slow the rate of new cases of COVID19. The news media has reported that Italians didn’t take the warning seriously early on. However, since then, Italy has implemented a nationwide lockdown. The little blip in Italy’s curve around day 19 is when they started the strict quarantine. Currently, all stores are closed except grocery stores and pharmacies. The situation has overwhelmed the medical resources, which has required Italian doctors to perform triage where they determine which severely ill patients should, and should not, get care based on the resources available.
Italy’s graphs show that Italy has successfully flattened the curve. They’ve slowed down the daily rate of new cases and deaths.
On Italy’s cumulative cases graph, the lockdown began on March 9th. Notice how the daily cases graph starts with each successive day seeing a larger increase in new cases. It took 11 days for the Italy lockdown to start producing visible results. That trend of more cases each day reached a peak on March 21st with 6,557 new cases. Since that date, the number of daily new cases has a steady decline. Similarly, the number of daily coronavirus deaths has peaked on March 27th with 919 deaths. Since then, both daily new cases and deaths have further decreased.
The difference between Italy’s peaks for new daily cases and daily deaths is six days. That lag for reduced numbers of deaths is normal because it takes awhile for the lower number of new cases to reduce the number of deaths per day. In about a month after Italy’s peak deaths, daily deaths have decreased by 69%, from 919 to 285.
Notice how the ramping up for both curves to the peak is much steeper than the slower tapering off after the peak. You’ll see this pattern for other countries. As of April 4th, Italian hospitals have reported experiencing fewer numbers of COVID19 patients. It’s great to see that their lockdown is successful! Of course, there is a ways to go before they’re experiencing very low daily rates of new cases and deaths.
On March 26th, the United States became the country with the most confirmed cases of coronavirus. The United States had a slow response to the virus and has had severe shortages of testing. While testing capacity increases, most people can’t be tested currently unless they pass through a screening process. There is no surveillance testing to test for coronavirus spread in asymptomatic people.
On the large cumulative graph, the United States appears to have an even worse trajectory than other countries. However, the United States has started restricting businesses, closing schools, and promoting social distancing a bit earlier than Italy relatively. On the other hand, the United States has had a notable shortage of testing kits, which is undoubtedly causing a substantial underreporting of confirmed cases. Additionally, lockdowns don’t cover the entire country. There’s a patchwork of different restrictions by state and city.
Finally, there is some good news for the United States! According according to the daily cases graph below, the United States appears to have reached a peak in new coronavirus cases on April 21 with 37,140. Although, overall, it looks like a broad plateau that has persisted for 28 days from April 2 – 30. During that time frame, there are typically between 20,000 and 30,000 new cases each day. The peak day for deaths was April 15 with 4,892. The number of daily deaths since has declined since then and settled in to approximately 2,000 per day. However, there are a few notable upward blips. Unfortunately, there hasn’t been a sustained decline in daily new cases or deaths like we’ve seen in other countries.
UPDATED May 9, 2020. An interesting trend to assess is the number of deaths in New York State versus the rest of the United States. Lyle, thanks for the idea! In the graphs below, you can see how up to April 14, 2020, New York had at least 50% of the COVID19 deaths in the United States. However, New York has gotten the spread of the virus relatively controlled compared to the other 49 states. Since April 14, the rest of U.S. has seen the number of daily coronavirus deaths grow more rapidly than NY.
Spain’s slow response to the coronavirus is similar to Italy’s. Spain has been criticized as having a particularly slow response to the virus. Additionally, a soccer game (futball for non-Americans), between an Italian and Spanish team might have increased the spread much as Mardi Gras is being blamed for an explosive increase of cases in Louisiana, USA.
Like Italy, Spain’s lockdown has slowed the rate of new cases. Spain saw an increasing number of new cases daily until reaching the peak of 9,630 new cases on March 25. After that date, the rate of new coronavirus cases has declined. Spain’s peak day for coronavirus deaths was on April 2 with 961, and it has decrease since then. The lag between Spain’s peaks for daily new cases and daily deaths is eight days. Both graphs show a continuing decline in daily new cases and deaths.
On April 13, Spain lifted some of its lockdown restrictions and allowed construction and factory workers to return to work. However, schools, restaurants, and other services are still closed and Spaniards are asked to stay home. Since that date, there seems be a slight uptick in both new cases and deaths. We’ll track these developments to determine whether these increases mark the beginning of new trends.
In about a month after Spain reached it’s peak for deaths, daily deaths have decreased by 72%, from 961 to 268. In the charts below, you’ll recognize the steep ramping up to the peak followed by a slower tapering off.
Germany has had a very proactive response to the virus and has aggressively tested for it. You can see Germany’s curve already flattening out. Germany reached a maximum number of new daily cases on March 27 with 6,933 cases. Since that date, the rate of new coronavirus cases have slowed down but then accelerated again. Germany seems to have a double peak for daily confirmed cases. However, since April 2, the new cases have consistent downward trend. The daily coronavirus deaths seems to be declining outside one large spike.
Until recently, Prime Minister Boris Johnson hasn’t taken the coronavirus seriously. The official policy of the United Kingdom was to rely on herd immunity kicking in after a sufficient number of cases. However, the government began taking the crisis more seriously, the UK imposed a lockdown starting on March 24th, and Boris Johnson tested positive for COVID19 on March 27. For UK’s curve on the cumulative graph, that lockdown began on day 27, which indicates that it took 27 days for the UK to go from 20 to 8077 cases. I’ve added the UK to the chart so we can track the effectiveness of its lockdown on the number of confirmed cases. Despite the late start, the UK’s curve isn’t as steep as other European countries on the chart. Does its geographic separation help?
Lancet, the respected medical journal, has described the United Kingdom’s response to the pandemic as a “national scandal.”
Currently, the United Kingdom seems to be at a plateau of around 5,200 new cases per day with an unusual exception of 8,733 cases on April 10. Additionally, the UK’s rate of daily coronavirus deaths seems to be declining very slowly.
I’m including Sweden in the set of countries I’m tracking because they’re trying an unconventional approach. Unlike the rest of Europe, Sweden is not doing a lockdown. Restaurants, schools, parks, playgrounds, and so on, are all open. Descriptions of Sweden’s approach varies based on who you ask. Some describe it as allowing herd immunity to kick in. In this view, the goal is to build up the country’s immunity to coronavirus by letting enough people become infected. Eventually, this process allows herd immunity to control the spread of the disease. In the view of the Swedish government, it is giving the people the responsibility and information to handle it themselves. In this view, the government plays an encouraging role where they provides recommendations but not mandatory requirements.
However it’s described, Sweden is seeing a growth in its number of cases. Unlike Italy, Spain, Germany, and the United Kingdom that are getting coronavirus under control, Sweden is seeing upward trends in cumulative cases, daily new cases, and daily deaths.
Southern Hemisphere Countries and Coronavirus
The number of cases in the Southern Hemisphere has started to increase. Scientists have not confirmed that the coronavirus is seasonal. Seasonal viruses tend to spread more effectively in colder temperatures. Cases might have started growing because autumn has started in the Southern Hemisphere, and temperatures are cooling. Consequently, I’ve added Australia, South Africa, and Brazil to the graph so we can track developments in those locations.
Of the Southern Hemisphere countries that I’m tracking, I have the great concern for Brazil. On the cumulative cases graph, Brazil is following nearly the same curve as the United Kingdom to this point. However, in Brazil’s new confirmed cases per day graph, you can see a large increase on the last two days. Is that the start of exponential growth? Will each day see larger and larger numbers of new cases? Time will tell.
Australia serves as a good model for how the graphs appear for a country that has controlled the spread of coronavirus. Australia’s chart of cumulative cases displays the familiar steep, exponential growth in cases followed by a leveling out. The daily cases show a rise to the peak on March 28th of 497 cases followed by a consistent decline. Deaths remain in the single digits throughout.
Brazil’s graphs for daily cases and daily deaths both show an upward trend. Sadly, in the last several days, Brazil has experience a dramatic increase in the number of daily coronavirus deaths. They’ve doubled from 200 to 400 per day.
Asian Countries and the Coronavirus
Taiwan, Singapore, and Japan are all squished at the bottom of the large cumulative cases chart at the beginning of this post and they are hard to distinguish. These countries have tiny numbers of COVID19 cases because they haven’t experienced the exponential growth that occurred in other countries. South Korea had a period of sharp increase, but that has quickly leveled out. What did these countries do?
Previous experience with SARS, a coronavirus oubtreak in 2003, has taught these Asian countries how to act quickly and effectively. These countries enacted early travel restrictions, large-scale testing, contact tracing for confirmed cases, and aggressive quarantine rules. Additionally, the MERS coronavirus outbreak in 2015 exposed the problems that a lack of test kits will cause.
These policies contained the virus in Taiwan and Singapore and slowed the infection rate in South Korea. Western countries, and elsewhere, haven’t had this experience with SARS and MERS, which has hampered the effectiveness of their responses.
South Korea is a great model for a country where coronavirus got a foothold but then they fought back successfully. They reacted quickly and used massive testing, 5X times more than the U.S. on a per capita basis, performed aggressive contact tracing, and quickly quarantined cases. They currently do not have a lockdown. The three graphs below tell this story. The cumulative cases graph shows the sharp increase associated with exponential growth and then the flattening out of that curve.
The two graphs below that show the daily new coronavirus cases and coronavirus deaths. You can see the rise in new cases, followed by a plateau, and decline. Currently, South Korea has about 50 new cases and 5 deaths per day, which has been very consistent for several weeks. With more time, we can hope that the graphs of new cases for Italy, Spain, Germany, and the U.K. will have the long tail of very few cases and very few deaths that you can see below! That’s what we’re all working towards!
Singapore is a cautionary tale about the rebound in coronavirus cases that can occur after containing the virus. In January, Singapore was one of the hardest hit countries after the virus spread from China. However, a strict surveillance and quarantine regime contained the coronavirus. Recently, Singapore has experienced a spike in cases that is being driven by migrant workers. Most of the new cases occur in migrant workers who live in large dormitories. Health officials are now isolating the infected migrant workers. Fortunately, coronavirus deaths have not increased. We’ll keep tracking the changing in Singapore.
New confirmed coronavirus cases peaked on April 20 with 1,426 new cases. Since that date, there’s been a consistent decline. Interestingly, Singapore has not seen any increase in the number of daily deaths.
Japan has had a rather lax response to coronavirus. It has had a very low rate of testing and no social distancing measures until very recently. As of April 12, Japan has tested only 67,000 people, including only 7,000 in Tokyo (population 9.3 million). Japan was very hesitant to postpone the 2020 Olympic Games but eventually did so. However, their number of confirmed cases has remain low. Of course, the low testing rate, about 1200 per day, will help keep the numbers low.
The daily number of new cases rose to a peak on April 9 with 863. The 21 days since that peak show a downward trend where new cases have declined from 863 to 193, which is a 89% reduction.
What about China, where it all started? The number of cases of coronavirus in China is over 81,000 as I write this blog post.
China experienced a period of exponential increases in COVID19 cases, but that has since leveled out. China was criticized for initially responding slowly and even covering up the virus. However, beginning on January 23rd, China started severely restrictive lockdowns and quarantines on its cities. On the chart, China began its restrictive measure on day 1 of the graph when it had 548 cases. These measures were so restrictive and on such a large-scale that they have been described as being possible only in an autocratic society.
Despite these extreme measures, it took about 30 days and an additional 80,000 cases before the curve flattened out. That’s the cost of delaying!
Like South Korea, China is a great model for how the data looks for when a country controls the spread of coronavirus. The cumulative cases have that steep, exponential rise followed by a flattening out. The daily cases rise to a peak and then decent to a long, low tail. Daily coronavirus deaths also rise to a peak and then decent to its own long, low tail. I realize there are questions surrounding China’s data. However, I believe that they have controlled the spread of coronavirus.
India is currently in the midst of a lockdown. It’s clear that there are positive trends in both the number of new daily cases and the numbers of daily deaths. It’s been reported that India has a low rate of testing. Currently, I don’t have good information about what is happening around the country. I’ll add more information as I find it.
What Happens Next Depends on You!
Graphing the data can be a surprisingly powerful technique for understanding complex problems. The line chart shows how countries have had very different experiences with the coronavirus. By linking the quarantine and testing practices to the different outcomes, we can see which approaches work and what happens when countries don’t implement these measures.
It’s uncertain whether Italy and the United States will match China in the number of cases and how quickly they might do so. There are undoubtedly other countries which are in the same general situation. While the future is uncertain, experts know that early, serious efforts are far more effective than late or halfhearted measures. Please take all the guidelines from your medical professionals seriously! COVID19 is serious business and can easily overwhelm medical systems if too many cases occur at the same time. We need to flatten those curves!
Read my post about the exponential growth of coronavirus and how it relates to hospital capacity. For other virus related information, please read my post about the effectiveness of flu vaccinations.
Stay safe out there! And, please follow all the protocols recommended and required by your local authorities!