Why did Covid-19 spread so fast globally?

 The Problems with Testing and Case Statistics for Covid-19.    

“We are dealing with a very treacherous, dangerous virus that tends to lure you into a false sense of complacency and then overwhelm you...”

- Jina Moore

To begin to understand disease transmission in a country requires adequate testing of your population with properly vetted, accurate tests. As the world struggles to find what 'adequate percentage' of the population is necessary, it is likely that we are only seeing the tip of the iceberg with regards the real numbers of affected by this virus globally.[1] Estimates predict that the lower end of the spectrum requires 750,000 tests per week in a country like the United States up to as high as 1-2 million tests per day. Ultimately, the inability to fulfill the requisite diagnostic testing measures in a timely fashion has been a major reason for the explosion of the Coronavirus throughout the world.  So what has gone wrong? What have we learned and where were the failings in our initial testing regimes, our bureaucratic responses, and our ability to gather correct statistics globally to inform key decision makers on the severity of the health crisis unfolding and thus the measures on how best to respond?

With initials alarms being raised from the pandemic crisis in China, South Korea, and Italy it was clear that the USA needed to mount a rapid response. In the beginning, fearing a global shortage of testing kits and reagents, the Federal Government decided not to utilize the World Health Organization (WHO) test-kits, and instead had the Center for Disease Control (CDC) develop their own version. The CDC lab facilities in Atlanta violated manufacturing practices when assembling the kits, which resulted in contamination of one of the three test components used in the detection process. Despite being faulty, CDC officials took weeks to address the issue and fix the kits, yet the Trump Administration continued to rely on these results when forming health policy for the country. This frustrated academic, hospital and public-health scientists who demanded alternatives to the CDC test, but were prevented from doing so by the Food and Drug Administration's (FDA) wieldy bureaucratic requirements. With limited testing available, the initial decision was to test only a narrow set of people, (those who were exhibiting symptoms and had also traveled to China, or those that had come into contact with a confirmed case). This is despite the fact that the pathogen had by this point almost certainly spread into the general community. The limited testing thus left top officials blind to the true dimensions of the outbreak.

Testing was also very slow in the United Kingdom, potentially resulting from the right-wing led Government's initial strategy of a potentially devastating herd immunity approach. With herd immunity, the disease is allowed to run rampant, and those that survive would hopefully pick up long-lasting antibody immunity to the virus to protect them from future outbreaks. Those immune individuals then also break the chain of infection, creating a protective environment to reduce the risk to non-infected people. For some diseases this requires upwards of 95% of the population to be infected, and also relies on the assumption that those with antibodies are protected from subsequent infections.[2] With millions at risk of losing their lives, (estimated at up to 16 million in the UK alone), the strategy was severely criticized globally, especially as hospitalizations surged. The herd immunity approach was also attempted in Sweden, which declined to institute any major lockdown social isolation measures and continues to do so to this day. The Swedish death rate has risen to 5938, far higher than Norway's 282, Finland's 358, Denmark's 719 and Iceland's 13 as of October 30th, 2020 statistics, (highlighting the dangers of the herd immunity strategy on even smaller populations).[3] Furthermore, GDP loss statistics coming out  from those countries shows that despite leaving its cafes open, Sweden's GDP will still go down up to 8.7% due to a breakdown of the manufacturing supply chain and loss of global exports they are so reliant on. This is compared with Finland's 6%, Norway's 5.5% and Denmark's 6.5% loss of GDP estimates.[4] Further to this, Sweden has still only recorded just over 124,355 Coronavirus cases, so with already over eight months into the virus' trajectory, it would take many years to reach any valuable level of herd immunity for its 10.5 million population.

It is interesting to note that Simon Bridges, (recently ousted) National Party Leader of New Zealand also initially propagated the herd immunity approach when Boris Johnson first touted the idea which could have seen up to 50,000 cases and potentially 3000+ deaths from March through October if New Zealand had followed suit. The UK soon backtracked on its herd immunity approach embracing the lockdown model, especially as hospitalization numbers grew including their Prime Minister, Boris Johnson, who required attention at the Intensive Care Unit. Luckily a bed was available to him, which was the greatest risk under a herd immunity approach. The death rate for ICU patients in general is exceptionally high (approximately 20%), especially if one is forced onto a ventilator to facilitate breathing to give time for the body to develop antibodies to fight off the virus before one's lungs and vital organs fail altogether. Fortunately the 55-year-old Johnson did not get to the ventilator stage, and ironically was saved by the work of nurses from New Zealand and India, whom he openly praised (despite their government's strong policy stance against immigration). Demonstrating that the powerful are not immune, the future King, Prince Charles, also contracted Covid-19. Albeit a mild form, Prince Charles was asymptomatic and was just one day off from meeting with the Queen, whom at 93, was at massive life and death risk had she contracted it. Prince Charles' age also placed him at sufficient enough risk to have his son Prince William worry about the realities of being second in line to the throne. 

The UK were hoping to ramp up testing to 100,000 a day by the end of April, but Public Health England was unable to spread the work initially to all the university and other public health labs throughout the country. By the end of March they had ultimately only reached 10,000 tests a day. The lack of early testing gave the government an erroneous perspective on how the virus was tracking throughout the region - which also led to a delay in setting up a much needed shutdown as the death rate was set to soar. By April 25th the testing regime was still labouring towards just 20,000, sadly the same number as the country's overall death rate at that time.

As an aside, it is also interesting to note that when the UK government looked into securing specific antibody tests on the 11th of April, 2020 to help show exactly how many people had actually caught the virus (and since recovered), the initial two million testing kits secured from a company in China for $20 million were all faulty.  Other countries such as the Czech Republic who also purchased testing kits from China found that 80% of their tests were unreliable as well, (as reported by their major news organization Seznam Zpravy.) With 1.83 million Euros spent on the 300,000 rapid Covid-19 test kits many false positives as well as wrongly negative results had come to light after being assessed by hygienists from the University Hospital Ostrava which led to no end of confusion in the early days of the outbreak.[5]

Testing continued to be very slow in the United States, with President Trump minimizing the existence and impact of Covid-19 and its spread. After inserting travel restrictions on China on Jan 31st, he stated publically that 'the virus was completely under control' despite warnings from US Intelligence and his Trade Adviser Peter Navarro to the contrary, not to mention Joe Biden putting an op-ed in USA Today on Jan 27th stating 'that with 2,700 affected in China and over 80 dead, the Coronavirus will get worse before it gets better.'[6]

Trump then doubled down on his anti-alarmist views stating that the virus was a hoax made up by the Democrats, misinformation that was widely spread by Fox News who only retracted these statements over ten days later. Despite Health officials wanting social distancing to be exercised by mid-February, Trump plowed on with his original "deny at all costs" strategy holding numerous political rallies and predicting that Covid-19 was "just like the Flu" and would be gone before establishing itself. It was only until March 16th when the stock market had plummeted to over a third of its value, (bigger drops than even the 2008 crash and the Depression of 1931), that Trump recommended that Americans not congregate in groups of more than ten. Roughly 2,500 Americans had died by the end of March, yet President Trump still floated the idea of opening the country again by Easter. Towards the end of April over 60,000 Americans had died, (over twice that of Italy, the second leading country for fatalities), and yet Trump still officially encouraged the economy to be fully reopened by May 1st, 2020 not to mention a series of tweets enticing conservative groups to protest for their freedom to work. Many 'back to work' protests took place with some individuals brandishing semi-automatic weapons outside State Capitols in Pennsylvania, Michigan, Ohio, Virginia, Texas and Florida to mention but a few. As an interesting side note, Denver, Colorado had protests during the 1918 Spanish Flu epidemic to reopen the State up after a five week lockdown. Reopening on Armistice Day November 11th, 1918, the decision resulted in a second major surge of the virus killing over 8,000 people (which were more Coloradans than had been killed in World War I altogether.)

America eventually performed 5 million tests as of the 25th of April - over 90 days after Covid-19 had reached the country. While 5 million is more than any other nation in the world, per capita America was only achieving 15 tests per 1000 people, compared with Italy's 30 per 1000 people who was Europe's leading viral hotspot through February, March and half of April. (Italy's testing regime equates to approximately 20,000 tests per day, easily eclipsed by the wealthy United Arab Emirates which was the highest per capita testing nation in the world during the virus' first three months with almost 80,000 tests completed per day.)[7]     

With America's first confirmed case of community transmission falling on the 29th of February (but may have been as early as mid-January as discussed below), Trump had also wasted the majority of March to secure vital levels of Personal Protective Equipment (PPE) for Public Health workers. The Federal Government had completely run out of masks and was asking medical staff to re-use masks and gowns, (often using garbage bags instead), as well as having a massive shortage of ventilators. Individual States who had secured contracts with Chinese, German and other global providers for these PPE necessities had them usurped by the Federal Government itself and placed where President Trump deemed them most necessary. This total breakdown in governance not only contributed to the massive rise in cases and deaths throughout March and April, (including the infection and death of thousands of key health professionals), but led to enormous bipartisan criticism of the President, in particular by Democratic Governors like Gretchen Whitmer in Michigan, and Andrew Cuomo in New York as vital PPE supplies were sent instead to Republican Governors that kowtowed to Trump instead. 

As Governors fight for resources against other States, it becomes a capitalistic bidding war with prices surging and some States clearly losing - with the ultimate winners being the companies producing PPE. (Capitalism is certainly opportunistic and potentially harmful during the enhanced pressures of a global pandemic.) It is worth noting that this "supply and demand" crisis was foreseeable and avoidable. In 2005, US President Barak Obama raised the issue and called for greater preparedness surrounding the availability of PPE in the inevitable advent of a pandemic crisis. This was discussed in Trump's and Obama's first meeting in the White House in 2017, but Trump chose to ignore the important advice being passed on - interested instead in bragging about the clearly inflated numbers he had at his inauguration.[8] 

The unique health system of the United States also presents a challenge for testing compliance. Socio-economically vulnerable areas are the hardest hit, and would also be the population least likely to have affordable, preventative health insurance. This means to achieve a Covid-19 test, an individual must pay between $1,300.00-$2,600.00 USD - severely limiting the testing regime. This was changed when the $2.2 trillion stimulus CARES Bill from the US government was finally passed through Congress making testing free - albeit hospital stays were still being charged for - making it out of reach for the nearly 80 million uninsured Americans (in addition to the 40+ million Americans recently furloughed or laid off, many of them also losing their health insurance packages which were tied to their jobs.) It always boggles the mind that the richest country in the world is one of the only developed nations on the planet not to offer its citizens free health care. A prime candidate for mass devastation by a relentless, respiratory spread pandemic. 

Bad Statistics Globally

When trying to establish informed policy as to how best slow the spread of the virus, initially it comes down to the number of cases, testing numbers, hospitalization and death rate to help provide evidence for such analysis. Many third world countries cannot even afford a testing regime except for humanitarian / public health work being done by the UN or other NGOs if they are lucky to access this, so their statistics are essentially useless to form any viable opinion on global health policy. For example, news video showed two doctors entering an Indian Slum to conduct testing and being chased away with rocks and sticks by a wild mob. This is often the case with UN Health workers in developing countries like Africa working on the Ebola virus as they are seen with so much suspicion by locals, (because once they take a patient away to stop the spread - they often never return).  

Ultimately, there is no realistic way to assess exactly how far the disease has penetrated into the human population at large in these developing countries, especially where testing has been so low in places like India, Pakistan, Bangladesh, Sri Lanka, Afghanistan, Maldives, Nepal and Bhutan - the overall death total for all these countries combined a miniscule 3766 as of May 15th, 2020 statistics. (Despite housing a quarter of the world's population!)[9] For example, antibody tests in New Delhi, India have shown there to be approximately one-quarter of the mega-city's population affected by the disease which would equate to 4.3 million cases, yet the total official case count for the entire Indian subcontinent was just over 5 million cases as of September 15th, 2020 statistics. As another example, in Ecuador's largest city Guayaquil, dead bodies were piling up in the streets due to Covid-19 because of the myriad of homeless victims as well as families not knowing what to do with their loved ones given all the morgues and funeral companies were completely inundated. Ecuador's statistics showed for the month of late March and early April that 7000 more people had died in the country than figures for the same timeframe in 2019, (and thus likely attributable to Covid-19), although their official death count due to the virus at the time was a paltry 450.[10] 

Even in the USA, numbers were just being counted by those that had officially gone through the hospital system, yet thousands of casualties had never made it to hospital at all. In New York there had been an alarming surge in the death rate of younger and middle aged people stealth killed by the virus at home due to it attacking the neurological systems of its victims and causing a deadly stroke. China and much of Asia's statistics and resulting strategies have been seen as world leading in the fight against the virus - yet have simultaneously been seen by some with relative suspicion given many of their numbers are incredibly low when compared with their population sizes and the carnage going on in the United States and Europe. For example, Vietnam had just 3 deaths, Singapore 27 deaths, Thailand 58 deaths, Hong Kong 33 deaths and Taiwan only 7 deaths as of August 1st, 2020 statistics despite housing densely inhabited populations, and living on or close to China's borders.[11]   

China's numbers itself remained stagnant after the initial wave swept through Wuhan and the wider Hubei Province. Although the virus was arguably 'stamped out' by the Communist's Party's strict yet effective Authoritarian shutdown where 81,000 cases and 3100 deaths were recorded, by April 15th the number in Wuhan was doubled, raising the overall death count in China to 4200 deaths. This figure, coming seemingly 'out of fresh air' was based primarily on the deaths they had missed retrospectively due to the intense pressure on the hospital system at the time, (and all the pressure from the USA and the rest of the world arguing that they were not showing their true numbers.) Furthermore, Journalists from the Associated Press also uncovered the fact that the Chinese State delayed 6 days until January 20th, 2020 when having full knowledge of the virus and its fatal effects before informing the Chinese populace at large.[12] They only instilled precautions just after the Chinese New Year, (where the whole country shuts down and everyone leaves from the cities to head home to their rural communities), which served to help spread the virus and further enhance the public health disaster.[13]   

By late January, it was reported that Wuhan's 90,000 hospital beds were under severe strain and had to add 100,000 more beds in schools and hotels to cope with the influx of patients, yet there was an official case tally at this time of only 33,000.[14] By March 23rd the 90,000 doctors working on the virus in Wuhan had to be supported by a further 42,600 doctors, (having built two hospitals in a mind-boggling ten days during their infrastructural building frenzy), and yet the official case count in the country was still just 50,000.[15] A recent study by Washington and Ohio State Universities assessing cremation records show that 8 crematoriums in Wuhan were working around the clock from January 25th which would have seen 10 times the number of fatalities as recorded by the Chinese government at the time.[16] Thus, if these had been running through till the 23rd of March at such capacity as is suggested by the report, there would have been as many as 36,000 deaths. Through the report's inferred data it is predicted that there were between 305,000 and 1.27 million cases in China by February 7th, 2020 which would have been a critical time for the world to know the true facts of what was happening to appropriately respond to the seriousness of the viral threat emerging.[17]

Numbers in Africa in general have been increasing very slowly, the majority of Sub-Saharan countries officially stating that they still had less than 1000 cases and averaging under a 100 deaths as per March through June's statistics. The optimistic view is that given the travel bans worldwide, the transmission into Africa may have been slowed especially with the knowledge and experience African governments have had fighting Ebola and utilizing these strategies to keep the Coronavirus at bay; however, the more pessimistic view is that the slow case numbers are due to the lack of actual testing. Furthermore, looking at the higher numbers of deaths in Algeria and Morocco through March onwards, there is no doubt that the virus had spread south from Covid-19 ravaged Spain.[18] Guardian Journalist, Ruth Michaelson was also expelled from Egypt in late March for reporting on a document that stated Egypt's numbers were way higher than the numbers the government was submitting and picked up by John Hopkins University - the official global tally.[19] 

Observing the gradual spread through the Middle East and Arabia over the months of April through September has shown that the virus is certainly making its way through these parts of the world, (Saudi Arabia currently recording 346,880 cases on October 30th, 2020), although one can perhaps never fully trust their statistics given their death tally is still only 5,383.[20] For example, Iran, the first hotspot in Arabia initially stated that the virus was not affecting them at all. However, the Minister of Health who was making the statement to local and international press, (surrounded by many of his governmental peers), was clearly showing signs of having caught the virus - sweating profusely on television. As he went into quarantine the next day, the vice premier and a whole hoard of other politicians and media had picked up the virus as cases surged to 604,952 with over 34,478 deaths by October 30th, 2020.[21] Syria is another country that is significantly underreporting its statistics with the Bashar al-Assad government providing just 5,633 official cases and 281 deaths as per October 30th, 2020 statistics yet doctors throughout the country stating openly that hospitals have been inundated with patients as the virus has completely got out of hand. One other Arabian country that requires more attention is definitely Qatar, which is currently showing 132,343 cases yet only a diminutive 232 deaths, which constitutes a case to mortality ratio of less than .002% - well below that of countries like Italy at 14.5%, France 15.4%, UK 14.2%, Spain 11.3%, Sweden 11.1%, USA 5.8%, Brazil 5.6% and Russia at 1.2%.

In Africa where disease, hunger and other ravages are common, (with up to 5,000 people dying a day purely due to a lack of sanitized water), it is clearly a lot more difficult to attribute deaths at this time simply to Covid-19.  This is compounded by the economic and food insecurities caused by border closings from the virus. The loss of tourism, humanitarian aid, and trade will no doubt result in Covid-19 related deaths among individuals whom never see the disease. Although the reality is, were it to make its way into any of the many slums or migration camps where health and sanitation is so poor, it would absolutely decimate these populations - possibly without any way for the local governments to accurately track these numbers. These are the raw realities of having a human population nearing 8 billion and its ongoing and unsustainable plundering of finite resources.

The disease has also hit Brazil hard, essentially the epicenter in South America as President Bolsonaro, (named the 'Denier in Chief'), due to his utter disregard for Covid-19 and his desire to keep the economy open at all costs.  As a result their Covid-19 testing has been less than adequate currently 7 times less than the United States is achieving as of October 31st, 2020 statistics. Despite conducting 22 million tests, the number of affected inhabitants is a staggering 5,499,875 - a positive test rate of 25%. (Compare this with New Zealand which is getting a strike rate of only .0023% of positive cases per test.) With Brazil's death toll surging to 160,000 come October 31st, 2020 it will be interesting to see what the actual case and mortality statistics really amount to given that The Economist estimates the cases to be 7 times higher than currently portrayed.[22] Ironically, Bolsonaro's chief advisor was carrying the disease while he and his political cadre were visiting Trump in the White House back in March, 2020 which led to Mike Pence and Donald Trump being tested for the virus on numerous occasions. (Over 50 US Senators, House Representatives and State legislators have since picked up the virus). And President Bolsonaro himself picked up the disease in early July also passing it on to his wife.

On the other extreme, Belgium, which has the highest rate of death per capita in the world, has taken a death-toll counting measure that includes not only those that died in hospital, but also those that perished in rest homes as well, even though they hadn't been specifically tested for Covid-19.[23] Open to criticism by Belgium's political elite due to the negative light in which the country gets framed, health experts adamantly held onto their liberal counting system to provide an over awareness of the numbers at stake, rather than the risk of significant undercounts due to many nations only counting formally Covid-19 tested deaths in hospitals. This policy was also eventually mirrored by New York whose daily death rate rocketed up more than 3,700 in one day in mid-April when they decided to count the deaths of people that were presumed to have Covid-19, but were never tested. (Spiking the daily US tally which was averaging 2,000 to a staggering 6,000 deaths.)

One way to capture what we miss when testing is inadequate is to compare the current deaths to what is typical at the same time of year, and when you do this the staggering impacts of Covid-19 cannot be missed. The Financial Times compared the rise in deaths over the period up through April 2020 and found that the UK had 42,900 excess deaths and France had 20,100 more deaths than normal, (yet not attributed to Covid-19.) The list also included Italy at 24,500 extra deaths (a 55% rise), Spain 32,000 extra (at a 60% rise), Netherlands 7,700 extra (at a 52% rise), Belgium a 5,200 rise (at 60%), Sweden at 2,300 (a 28% rise), Turkey at 3,800 (50% rise) as well as Portugal, Sweden, Germany and Switzerland also recording over 1000 more deaths than normal. All up it has been suggested that 60% of extra deaths throughout Europe have not been counted in official tallies, and poor countries' data would clearly be way worse. For example, figures in March for burial statistics in Jakarta, Indonesia's capital suggest that they may have only captured 5% of the true toll of Covid-19 deaths.[24] 

Furthermore, Hugo Lopez-Gatell, the Deputy Health Minister spearheading Mexico's response to the outbreak told Reuters that the country's Covid-19 death toll is way higher than the official count which as of May 31st stood at just 4000.[25] (The late March to end of May death certificates in Mexico City suggest a toll of 27,394 during this period alone.) Thus it has been unsurprising to see the country's overall death count surge past France, Iran's, UK's, Italy's and Spain's tally and is currently at 90,733 as per October 30th, 2020 statistics. (Many critics have claimed that the Mexican government has hidden the true numbers while politicians have denied that undercounting has occurred.) Hugo Lopez-Gatell believes that a true reflection of the actual death count will only be available in about 2 years time. Meanwhile, Chile's death tally of 14,148 is estimated to be at least 3000 deaths higher due to the Covid-19 mortality undercounts especially given the fact that over 508,571 cases have swarmed the country as of October 30th, 2020. In Peru, the excess death rate according to the Economist is even more staggering at 36,224 for figures representing March 31st to June 29th, while the formal figures published by the government at the time remained at just 9,647.[26]  

Even starker is the case of Russia, who is currently 4th in the world for confirmed cases at 1,599,976 cases (significantly higher than the case count of the UK), yet posting a seemingly diminutive 27,656 fatalities as of October 30th, 2020.[27] Moscow and the northern oil fields in the Russian Arctic have been particularly hard hit with the virus, putting their major prospecting projects at great risk, and of course, raising questions surrounding Putin's official death tally. Bloomberg news also states that the poorer regions in the south that have limited hospital capacity have been hit hard as well, but have not been officially counting mortality numbers.[28] Moscow alone had 11,080 excess deaths recorded from March 31st through June 29th, but posted an official tally of just 3,796. Furthermore, St Petersburg also issued 1552 more death certificates in May 2020, than in May 2019 yet the Covid-19 death toll for the city was only 171.  Finally, the death rate for April in all Russia was 18% higher than the equivalent month in 2019 so maybe Putin just left his abacus back at home?[29]

In hindsight, this under-utilized opportunity to compare Covid-19 deaths relative to the standard number of mortalities that would normally occur each month during the same time could have had a profound impact on communicating the seriousness of this disease and perhaps could have been a real game-changer for the US response in particular. The most recent statistical evidence coming out of Yale School of Public Health show that for the month of March and the first two weeks of April there were 37,100 excess deaths from the same period last year all of which could potentially be attributed to Covid-19 yet not showing in the USA's death tally at that time. If the numbers in the USA had been portrayed in this way, and the sheer escalation illustrated, surely the number of protests outside State Capitol buildings wanting the lockdowns to be dropped and freedom installed would have been even more harshly criticized, or never actually happened at all? Because there hasn't been enough testing to determine the exact numbers of Covid-19 caused fatalities - government leaders should be studying the estimates of excess deaths in their communities and basing consequential decisions about reopening businesses and social activities on those figures, rather than strictly using reported Coronavirus figures that are often incomplete and misleading. This is not to say that the work of experts is wrong. This is the way it goes when dealing with a new disease. You are learning as you go and constantly having to revise your response based on what you have learned. 

As it turns out, according to a CNN article on April 20th, new autopsy results showed that two Californians actually died of Covid-19 in early and mid-February - up to three weeks before the (previously) known first death in the USA. The two deaths in Santa Clara County happened on February 6th and 17th, and not February 29th in Kirkland, Washington as was initially deemed the first. Because it takes at least 2 weeks to progress from contracting the virus to death, this means that a death in early February, would have contracted the virus in mid-to-late January. The two in California had no known travel histories to China or anywhere else, and thus presumed to have caught the virus through community spread leading to the high possibility of both significant case number and death undercounts. Two studies in Santa Clara and Los Angeles Counties stipulated that the suggested number of people infected in these areas is dozens of times higher than officially reported. The Los Angeles County study estimated between 2.8% and 5.6% of the population - 221,000 to 442,000 people, had Covid-19 antibodies, based on drive-through testing conducted on April 10th and 11th, 2020. That would have been 28 to 55 times the number of cases that county officials recorded around that time.[30]

In Santa Clara County, the study estimated 2.49% to 4.16% of people there had been infected by April 1st, 2020. That represents between 48,000 and 81,000 people - and 50 to 85 times the cases that county officials recorded by that date.[31] Similar efforts to estimate local antibody prevalence has since launched in places like New York, Miami, and Colorado to ascertain case numbers to help improve projections and disease modeling to give a more realistic sense of how deadly Covid-19 really is, (or not) in different parts of the United States.[32] The New York Times and Dr. Anthony Fauci, the top medical expert on the White House Coronavirus Taskforce have both strongly rebuked reports from Fox News stipulating that the death count is lower than the current official tally. The New York Times also goes so far to state that the global mortality total is twice that of the official numbers presented.[33] 

As we learn more and improve testing, only time will tell what new viral response strategies will be entertained and history will judge our choices accordingly.  Each country must weigh out their individual costs and benefits of actions to be taken, as well as the degree to which they can get public buy-in. The different political realms make for staggering differences. While we weather the same storm, we are clearly in different political boats leading to diametrically opposed (and disturbing) realities - as the next chapter clearly shows.

[1] Iceland was the first country in the world to test 10% of its population for the virus, [given its diminutive population of 346,000], so is a useful test case for understanding the virus' trajectory in island nations given their adequately sourced statistical data. It has currently tested a number just over their entire population as of October 30th, 2020 statistics with 350,762 tests and 4,797 cases and also has only had 13 deaths.

[2] Research has yet to precisely uncover exactly how effective or how long antibody immunity lasts in the body to protect from future infection from Covid-19. Although Measles gives you lifelong antibody protection after catching and surviving from it, other Coronavirus' like SARS and MERS tend to fade after 2-3 years immunity, whilst the four other known Coronaviruses, (which cause varieties of the common cold), just provide months of antibody immunity. Most recent studies suggest it falls in the latter category. 

[3] As the 6th highest in the world for deaths per million inhabitants, and the highest number of deaths in the first six months of a year since 1869, Sweden has since publicly acknowledged the clear error of its ways regarding its governmental herd immunity approach to overcoming the virus.

[4] Studies of consumer spending data have shown that purchases have fallen by 25% in Sweden compared with 29% in Denmark, which instituted a strict lockdown. Furthermore, countries that have lost control of the virus have had far more catastrophic economic impact than those who have controlled it despite the initial economic losses due to a lockdown.

[5] Statistics for Czechia show 316,838 cases and 3,033 deaths.

[6] USA Today, Jan 27, 2020, Joe Biden. 'Trump is worse possible leader to deal with Coronavirus outbreak.'

[7] The U.A.E has taken a total of 13,040,169 tests for its 9,929,499 population.  As a source of comparison, New Zealand's testing regime of up to a maximum of 12,000 a day has produced 1.1 million tests comprising just over 20% of its population as per October 31st, 2020 statistics.

[8] None of Trump's hires attended any of the key briefing meetings set up by the outgoing Obama Administration to prepare them for the responsibilities of office, in particular those relating to pandemic preparedness .

[9] Although still deemed significant undercounts the current death rates in South Asia as of October 30th, 2020 is India 121,628, Pakistan 6,795, Bangladesh 5,905, Nepal 920, Sri Lanka 19 and Maldives 37.

[10] Figures for February 29th through to June 29th in Ecuador show 22,833 excess deaths rather than the official tally of 4,527 at that time. 

[11] Vietnam's strategy in particular has been highly praised by implementing early strict border screening measures, travel restrictions and mandatory 14-day quarantines, high testing rates and ongoing health checks, school closures, contact tracing and closing down of cluster infected regions. Vietnam's figures have since risen to 35 deaths as per October 30th, 2020 statistics after receiving its first wave of the virus, and Hong Kong accelerated to 105 deaths as it entered its second mini-wave.

[12] The Chinese government had been silencing medical doctors and medical boards from their reporting of a bizarre strain of pneumonia as early as December 2019. One of these doctors, Li Wenliang, actually died of Covid-19, his death placing the initially tardy Chinese response into the media spotlight.

[13] The Atlantic, August 4, 2020, Ed Yong. ’How the pandemic defeated America.'

[14] NZ Herald, June 14, 2020, Jamie Siedel, (news.com.au). 'Crematorium data indicates China was lying about Covid-19.

[15] Ibid.

[16] Ibid.

[17] Ibid.

[18] Morocco has 215,294 cases and 3,625 deaths as of October 30th, 2020 statistics while Algeria has 57,332 cases and 1,949 deaths. 

[19] Egypt has also significantly risen with its official case and death count set at 107,209 and 6,247 respectively as per October 30th, 2020 statistics. The highest counts in Africa currently are South Africa with 723,682 cases with 19,230 deaths, (although this is estimated at three times higher than officially designated), followed by Ethiopia with 95,789 cases and 1,464 deaths, Nigeria with 62,571 cases and 1,141 deaths, Libya with 60,628 and 847 deaths, Kenya with 53,797 cases and 964 deaths, and Ghana with 48,055 cases and 320 deaths.  

[20] Saudi Arabia's military enemy, the highly impoverished nation of Yemen has been massively undercounting their cases and death tallies due to the rebels who control the north of the country threatening medical workers to remain silent on true counts and the ill-equipped hospitals down south turning away patients to die unaccounted for at home. Their official tally is 2,062 cases and 599 deaths as of October 30th, 2020 but a myriad of social media posts acknowledging the high numbers of fatalities show infections to be in the thousands and the deaths well above the official rate. If all 30 million Yemenis were to get infected, there could be a total of at least 65,000 deaths.

[21] The BBC's Persian service reported in late July, 2020 that the death toll in Iran was up to three times more than being reported at approximately 42,000. They also stated that the case rate recorded by the country's internal governmental documents at that time was over 450,000 yet the official rate shown was only 280,000.

[22] The Economist, June 10, 2020. 'Coronavirus cases are surging in Latin America.'

[23] Belgium has 392,258 cases and 11,308 deaths as per October 30th, 2020 statistics within its 11.6 million population.

[24] Indonesia's case and death statistics are 406,945 and 13,782 as of October 30th, 2020.

[25] The Deputy Health Minister's response is in complete contrast to what is going on in Nicaragua where the Guardian reports that the country's express burials have raised fears that General Ortega is hiding its death count which has been estimated by independent tallies to be over ten times the official rate of 5,514 cases and 156 deaths as per October 30th, 2020 statistics.  See 'Nicaragua's express burials have raised fears that General Ortega is hiding true scale of the pandemic' by Wilfredo Alberta, May 19, 2020. 

[26] The Economist, July 15th 2020. 'Tracking Covid-19 Excess Deaths Across Countries.' Peru's official case and death tally has now since risen to 900,180 and 34,411 as of October 30th, 2020.

[27] The UK currently has 46,229 fatalities from its 989,745 cases as per October 30th, 2020 statistics.

[28] Bloomberg News, May 13, 2020, Henry Meyer. 'Experts Question Data on Covid-19 Death Toll.'

[29] Other countries accused of under-reporting for political reasons include Myanmar, Turkmenistan and North Korea.

[30] CNN, April 20, 2020, Michael Nedelman. 'Hundreds of thousands in Los Angeles County may have coronavirus, antibody study suggests.'

[31] Ibid.

[32] The result of these antibody studies in August 2020 found that 10 States in the USA are 6 to 24 times their officially shown case counts.

[33] New York Times, May 13, 2020, Nicholas Kristof. 'America's True Covid Toll Already Exceeds 100,000.' Studies have shown that 40 States have shown fatality figures significantly higher than what official results portray.