Follow Sweden and have more pain without any extra gain

There are 3 Covid-19 “experiments” going around the world in terms of controlling the virus

• The first is by countries like Malaysia or Australia where lockdowns are mandated when the community spread appears to be very large.  Note that Melbourne implemented its current lockdown when the number of daily cases is just below 200.  For those who have forgotten Malaysia implemented the MCO when we had about 120 odd cases

• The second is Sweden where there is no mandatory lockdown.  Instead, the country relied on its citizens to act voluntarily to stay at home, or social distance or even wear a mask.  Of course, gatherings were banned. 

• The third is like the US and Brazil where there are conflicting measures.  The top officials don’t think the virus is anything important while local officials are trying to implement some social distancing measures.

The above is based on impressions of the news.  I wanted to see whether there are any objective indicators to see the differences in the respective govt approach.

There are actually 2 indices that I have used in the past – The Oxford Stringency Index and the Malaysian GCI

For an apple to apple comparison, I thought that we should see the index score when the virus was at a peak in each of the relevant countries.

Unfortunately, the GCI only gives the current status whereas the Oxford Index has the historical performance. 

Let's see how these countries score on the Oxford Stringency Index at their respective Covid-19 peak. 

	Oxford Stringency Index	Peak period
Malaysia	73	26 March
Australia	71	29 March
Sweden	41	24 June
USA	69	8 Jul
Brazil	77	19 Jun

The real surprise is that the score of the US and Brazil are not much different from those Australia and Malaysia

Sweden, as expected, has a very low score.

So what does this mean – either the Oxford Stringency Index is not measuring the correct thing or that US/Brazil has the official measures (so that they are picked up by Oxford) but have poor compliance?

The details of the Oxford index are as follows

• Based on 17 indicators of government responses.

• Eight of the indicators record information on containment and closure policies, such as school closures and restrictions in movement. 

• Four record economic policies, such as income support to citizens or provision of foreign aid. 

• Five record health system policies such as testing or emergency investments into healthcare.

I can't tell whether is a measurement error or that the Stringency Index is not reliable enough.  

Can anyone have a better explanation for the US and Brazil?

But let's look at Sweden in more detail and see how it has performed compared to its 2 Scandinavian neighbors who had lockdowns. 

• I looked at Covid-19 cases as at today based on Worldodometer
• I then looked at 2 economic indicators as reported by the respective countries ie projected economic contraction for the year and the May unemployment rate.  For both economic indicators the bigger the number the worse it is

	Oxford Stringency Index	Peak Period	No of cases per m population	No of deaths per m population	Economic contraction	Unemployed in May
Norway	76	27 Mac	1,651	46	3.9 %	7.1 %
Denmark	72	7 April	2,227	105	4.1 %	5.6 %
Sweden	41	24 Jun	7,312	543	4.5 %	9 %

You will note that Sweden has the worst Covid-19 performance and its economy and unemployment rate is not better than those of its neighbors.

I have seen articles saying Sweden is worse off and did not gain any economic benefit because we are living in a global economy and even if Sweden wanted the economic activities to continue, it could not do so for those with international links.  At the same time, the locals are also wary of going out and spending.

I think the message is that opening up the economy without controlling the virus does not benefit the country.

Now whether this applies to the US is something worth watching.  

But I am still confused about the Oxford Stringency Index numbers for Brazil and US

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such. 

Australia's 2nd misfortune - are there any lessons for us?

Melbourne in the Victoria State of Australia has gone into its 2nd lockdown.

We should not be surprised at what is happening in Australia

• In my 30 June post, they were in the bottom 5 countries in terms of wearing masks

• In my 6 July post, I have identified them as a country with a 2nd wave pattern forming

It is very sad as in my 25 June post, they were ranked No 1 by the Global Covid Index (GCI) created by Malaysia.  The GCI scores and ranks 184 countries on how well they are coping with the COVID-19 pandemic.

So what happened?

• The govt is looking into the allegation that the source was the security guards at the hotels where the incoming travelers were quarantined

• I have seen an article to say that the Black Lives Matter protest which took place on 6 Jun did not lead to the surge

• The State Health Minister said that 201 cases are believed to be due to community transmission partly blaming families for having big parties, lunches and dinners attended by asymptomatic people

• I saw a report where health officials blamed family gatherings where “hugging and kissing” had occurred against the advice.

If you listen to the news and read in between the lines, the authorities have imposed an “EMCO” on several high rise blocks where foreigners are staying.

Let's see whether we can get any insight by looking at Victoria's mobility index synchronizing it with the number of cases in Australia like what was done for Malaysia in my post yesterday. 

I could not find info on cases just for the State of Victoria for this analysis.  However since the current spike is centred in Victoria, the number of cases (at least over the past 2 to 3 weeks) for Australia should represent what is happening in Victoria.

In the chart

• The red verticle line denotes when Australia declared a state of emergency and had the equivalent MCO

• The blue verticle line denotes when Victoria started to relax its measures

• The purple verticle line denotes 2 weeks before the current spike

I deduced the following from the chart:

• Unlike for Malaysia where there was a sudden change in mobility when the MCO was implemented, it looks as if it took some time after the emergency declaration for the peak "stay-at-home" or the peak "don’t-go-to-work" to be reached. 

• I don’t know enough about Australia to say why this is so.  Maybe the Australian readers can comment

• But even before the relaxation of measures (blue verticle line), people were already moving about – see how the residence and work line started to move back to the Feb levels even before the verticle blue line

Notice the spike in the park and work line in Jun.  This was the holiday for the Queen’s birthday so I can imagine people going to the park or not working.

Incidentally, the Black Lives Matter protest was held 2 days before the Queen’s birthday. 

 

Looking at the chart, all I can say is that the change in mobility is unlikely to be the cause of the current 2nd wave as people were already moving about long before this.

If you accept the logic that the 2nd wave today is due to large numbers of people getting infected about 2 weeks ago, and there was no “Sri Petaling” event, it meant that many small clusters were forming two or more weeks ago.

So around mid-June, some index cases began to infect the community (1st generation) and then at the end of Jun/early Jul, these 1 generation people started to fall sick.

According to Worldodometer, from 13 to 17 Jun, Australia averaged 16 cases a day.  It is not something unusual.   For the past few days, it averaged about 145 per day. 

If you take R0 as between 2 to 3, then the current sick people must have been infected by 48 to 78 people. 

So how did the authorities miss this large number of index cases back then? 

There are several possibilities on why there were no reported spike in cases in mid-June

• The index cases were all symptomatic

• The index cases fell sick but for some reasons they did not seek medical help – could it be that there were foreigners, either illegal (?) or lower social standing

Victoria never had any random sampling of people and just relied on people to report that they are sick.  So if people fell ill and did not seek treatment or were asymptomatic, it would not be detected.

Take the example of the security guards as the index cases.  These guards got infected from those incoming visitors who were under quarantine.

 

So these index cases must have spread it to the 1st generation as there cannot be so many security guards (to be infected) as to cause a shutdown today.

I suspect that today Victoria cases are due to 1st generation infection.  

To come back to my question. How come the Australian govt missed such large index cases?

I think there is an important lesson for us.

• It has to do with incoming travelers

• It has to do with continuous random testing

• It has to do with hugging and kissing 

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such. 

Is the world heading into a worst situation?

As of 6 Jul, we had 8 consecutive days of 10 or fewer daily cases of Covid-19. I hope we can maintain this number since many countries in the world are still struggling with the virus.

To see how bad it is, look at the 3 maps showing the number of cases worldwide at the end of Dec 2019, Mac 2020 and June 2020.


Chart 1: Covid-19 status: end Dec 2019  (Source: Our World in Data)

The white colour denotes a few cases while the dark red denotes lots of cases.


Chart 2: World Covid-19 status end Mac 2020. (Source: Our World in Data)

You can see how the world has gone from one pale pink place in Dec 2019 to almost red all over the world over a 6 months period. 

During the first 3 months, it seems to have skipped Africa, but today even Africa has not been spared. The only exception seems to be Greenland near the north pole and Papua New Guinea.

Chart 3: World Covid-19 status end Jun 2020.  (Source: Our World in Data)

The implication is that unless we quarantine ourselves from the rest of the world, the only way to be safe is when each nation of the world learn how to control the spread within its own territory. 

The sad thing is that not all countries are doing a good job in controlling the spread.

Which are the worst countries and still getting worst?

There are two ways to look at this

• the number of top countries (in terms of total Covid-19 cases) that are getting more cases

• others (not in top 100 countries in terms of the number of Covid-19 cases) but getting worst in that the time to double the total number of cases is under 10 days 

Chart 4: Countries that are not flattening the curve. (Source  Our World in Data)

One way to get a sense of the first scenario is to look at the cumulative curves for all the countries and pick out those with > 100,000 cum cases who are still not able to flatten the curve. This means that the number of cases in these countries will still go up. 

 
From Chart 4 above that shows how the countries are flattening the curve, you can see that there are 6 countries with > 100,000 cum cases and where the number of cases appears to be still growing ie the curve is not flattening.

These are 

• Brazil
• US
• India
• Pakistan
• Mexico
• South Africa

I am not surprised that the US and Brazil are on this list. What is surprising is that Russia is not among them ie Russia is actually slowing down the virus.

As to the second scenario, Chart 5 below shows the weekly number of cases around the world with the yellow being below 500 cases per week and dark blue with more than 100,000 cases per week.

You can see straight away that there are a couple of areas where the number of cases is very high. At the same time, you can see the places with a fewer number of cases.

Chart 5: Weekly Covid-19 cases.  (Source: OurWorld in Data)

You are not surprised to note that the US, Brazil and India are the ones with dark blue colour. BTW the other dark blue spot is Alaska in the top left-hand corner

We all know that countries with dark blue colour are lost cause. 

But what about places with light yellow colour?  Just because there are currently few cases does not automatically mean that it is good.  It is possible that the virus is just starting to hit badly and if true, it is bad. 

In such cases, I looked for those with the highest rate of infection in terms of how fast it takes to double the number of cases. 

There are 6 countries in the world where the rate of infection is such that it will take less than 10 days to double the number of cases. As can be seen half of them are African nations.

• Kazakhstan
• Botswana
• Namibia
• Turks and Caicos Islands
• Palestine
• Lesotho

You will be surprised to know that for the US, it currently will take about 60 days to double the number of cases.  Of course, the US has 3 million cases currently so in theory by Sep it will reach 6 million.  It may be faster if they continue to fight wearing masks and other social distancing measures.

Conclusion:  Most of the world is not really a place safe in terms of Covid-19 infection.  There is no place like home.

 

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such. 

An astounding record - we are among the the world top 10 best

Do you know that in the top 100 countries in terms of the number of total Covid-19 cases, there are only 8 who have less than 50 cases from 1 Jul to 5 Jul ie less than 10 cases per day?

Malaysia made it to this list. Those on this list are

Ireland

Norway

Malaysia

Finland

Ethiopia

Hungary

Thailand

Somalia

What about the other places where the virus was supposedly under control? 

Ranked 22 China – 72 cases

Ranked 63 South Korea – 241 cases

Ranked 72 Australia – 528 cases

Ranked 122   New Zealand – 5 cases

Ranked 155 Taiwan – 2 cases

Ranked 158 Vietnam – 0 cases

PS: The ranking refers to Worldodometer ranking in terms of the total number of cases with the US ranked as No 1

As you can see, popular names like China, South Korea and Australia are actually in the top 100 list whereas countries like New Zealand, Taiwan and Vietnam are not in the top 100.

So if a country is in the top 100 list, it is not so easy to be having less than 10 cases per day. Of course, if the country is outside the top 100 list, it may be easier. 

If nothing else, I think MOH has done a good job.

FYI, Singapore is in the top 100 list and they are nowhere near in getting less than 10 cases per day.

So what is the risk to Malaysia in terms of being able to keep the numbers low?

The most obvious is the imported cases.  The chart below shows the number of imported cases for the past 2 weeks.  It does not look like the numbers from this source is going to go away.

And if we really open up the sky and allow more flights from other countries, I am sure the numbers will go up.

In case you missed the news, the recent increase in New Zealand and Australia is due to imported cases.

The more frightening one is Australia where I read one news report that said the spread was due to security guards (in the hotel where the in-coming travelers were quarantined) caught the virus because they shared a cigarette lighter.

If nothing else the Australian story shows the danger with any lax quarantine process.

In Malaysia, we are requiring incoming travelers to self-quarantine at home.  I am not sure how effective this will be.

In my June 29 post I mentioned that from 10 Jun to 27 Jun, MOH has screened 6,609 individuals at KLIA.  6,573 were found negatives and told to self-quarantine at home. 36 found positives were hospitalized. It seems that police have conducted checks on 427 home quarantine cases and all complied with the SOP.  

I don’t know what % of those quarantined the 427 cases represent.  Even if I take the worst-case scenario of 4 per family, the 6,573 is equivalent o 1,643 families or homes.

If so, the 427 is just about 1/4 of those quarantined.

It is good that all the 427 were found to have complied with the SOP.  But are we so confident that we can have 100% compliance?

All we need is one or two bad apples and we will have a spike.

I have read stories about how in China, the checking of those self-quarantined are so stringent with daily monitoring, etc

I think this is one area that we need the govt to look into more seriously.

We don't want to have done so well in controlling the spread that we get screwed up over some quarantine lapses.

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such. 

Can New Zealand be a "warning lamp" for us?

I started doing research for this post after reading a Guardian article about the 45 countries that have recorded more than 25,000 Covid-19 cases to date.  The article looked at how these countries have relaxed their responses based on the Oxford University Stringency Index and what happened since then.

I was interested to find out among these 45 countries, 

• how many have got the virus really down (ie less than 50 daily cases)

• and of those who have got it really down, how many are experiencing a 2nd wave or spike

Newspapers have their own interpretation of 2nd wave or spike.  I think there is confusion between a 2nd wave and “simmering cases not amounting to a wave”

This has implications for risks. Let me illustrate:

First, let's talk about actual 2nd waves. There are two scenarios:

• The first is like the US where the 2nd wave is actually an upsurge from the first wave.  In my blog on 1 Jul, I have shown that there were 12 countries among the world top 50 in terms of the total number of Covid-19 cases that fall into this category

• The other is for countries like Australia where the virus was brought under control only to have it flare up as can be seen from the chart below.  Look at the 7 days moving average line shown in blue and you can understand why I say they have the making of a 2nd wave. 

Source:  Worldodometer

 

The other scenario is like New Zealand where the cases were supposedly under control but then a few cases re-appeared.  As per the chart below the NZ 7 days moving average number of cases does not show an upsurge like that of Australia.

Source: Worldodometer

If you have the Australian pattern, then there is a possibility of another tough measure.  But if you have the New Zealand pattern, you don’t have to worry about another lockdown.

I would call the Australian pattern as having a 2nd wave or spike while the New Zealand pattern as “simmering cases not amounting to a wave”

So how bad is the situation for these 45 countries?  

I saw 10 countries where the number of cases today has dropped significantly from the peak (looking visually at the respective charts for the daily number of cases). 

To verify, I have gone to Worldodometer to see whether the countries mentioned have the Australian or New Zealand pattern.  The results are as follows:

Those with the Australian pattern 

• Switzerland

Those with the New Zealand pattern

• China

• Germany (still > 200 cases)

• France (still > 500 cases)

• Belgium (still > 100 cases)

• Ireland

• Spain (still > 300 daily

• Italy  (still > 200)

• Netherlands (still > 50 cases)

• Canada (> 300)

I think that was my first shock.  You will notice that although they all looked as if the virus is under control, only 3 out of the 10 had less than 50 daily cases.

We are so used to the reporting of low cases in Malaysia that if we have 50 daily cases we would not have considered it as under control.

But imagine these countries where the cases were so large that today with 200 to 300 daily cases, they are celebrating!

The other point is that those who have got the "virus under control" are more likely to have simmering cases rather than real 2nd waves. 

Malaysia’s pattern looks like New Zealand. 

 

Source: Worldodometer

Conclusions

• I think we are much better than the Western world in terms of getting the virus "under control". Based on this anecdotal evidence, we are unlikely to have the 2nd wave. 

• I think New Zealand can be a “warning lamp” for us ie whatever happened there is likely to happen here so we should monitor their news closely

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Be fearless to get more to Stay Safe, Share this Blog

PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such. 

I there anything to worry with the zero reported daily tests?

Yesterday I talked about how some of the countries who had re-opened the schools found that they had to close down the schools again because of the new cases among the school children.

So what will happen to Malaysia then when the school re-opens and Covid-19 cases are detected among the student population?  Are we going to follow the example of countries I shown earlier to close down the whole school?

The risks in schools are in 2 ways

• The students spreading among themselves
• The students spreading to the parents and/or general public when they go home

I think that in the Tahfiz cluster cases, MOH tested all contacts and quarantined them.  But this was in the MCO days.

If there is an infection in schools, I would imagine that MOH would have to respond in the same way as any cluster and isolate everyone.

We shall wait and see whether there will be any cases in the schools.

In theory, if from now till the school opening date of 15 July, if we continue to maintain very low cases among Malaysians, the risk of infection in the school would be low. 

And even if there are local cases over the next 2 weeks among families with school-going children, I would imagine that MOH will isolate and prevent any children from such cases from going to school.

I saw a Washington Post report that there are also countries that have re-opened schools that did not have any Covid-19 cases.  These included Denmark and New Zealand

• for 2 weeks before re-opening schools, Denmark had 3,574 cases
• for 2 weeks before re-opening schools, New Zealand had 12 cases

In Denmark classes were split in two to keep two metres between each child, more lessons taught outside, and a rigorous hand-sanitizing regime – has not led to a spike in cases among staff.

So there are ways to open schools safely even if the cases are still high. 

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I have been tracking the number of daily tests reported by Worldodometer and I keep seeing the funny pattern as per below.  

 

Worldodometer reports the cumulative number of tests every day and I obtain the daily number by deducting the previous days cum number from the current day cum number.

So where there are days when the cum number remained that same as the previous day, the computed daily number of test is zero. 

You can see that for Jun, we have periods where there are zero daily tests and this is followed by a spike as all the backlog of tests came in.

Even on Fri we had zero testing reported

In mid-May, MOH said that the country (both the govt and private sector) have ported into a new national test reporting system.

So looking at the chart pattern, I would say that the reporting system is not working properly as we all know that there are tests carried out every day.

The authorities have to sort this out.

The admin issue is not why I am bringing this up.  My main worry is that if there are reporting gaps, then the number of daily cases reported may not be accurate and we could be lulled into a false sense of security ie zero or low daily cases could be because the test results have not come in yet.

The good news is that despite this reporting error (hopefully it is a reporting error and not some major screw up in the testing capacity), the positivity rate ie number tested positive divided by the total number of tests keep improving.

Month                     Positivity rate

Apr                                   2.65 %

May                                  0.45 %

June                                  0.38 %

Overall from the start of virus  1.10 %

WHO standard is to have it below 10%.  

The overall rates for the top 3 countries with cases are

USA       7.97 %

Brazil     46.9 %

Russia    3.27%

I am glad I am in Malaysia. 

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Be fearless to get more to Stay Safe, Share this Blog

PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such.