Actually, there are two adverse affects possible with the spread of COVID-19.

One is that because of overwhelmed hospitals, COVID-19 mortality is higher than it would be if there were enough hospital resources to meet the surge in demand, because cases of sickness in which lives could be saved are not saved because the resources are not available.

The other effect, as mentioned in the framing of the question, is that the overwhelming of hospitals results in higher rates of mortality for non-COVID-19 cases due to the indirect effect, that resources ordinarily available for non-COVID-19 cases are swamped by patients infected by the epidemic.

If both of these adverse affects occur resulting in higher mortality rates than deaths per confirmed COVID-19 cases to the end of February 2020, then the death impact of the epidemic could be higher than currently estimated.

A worrisome possibility is that one of these adverse effects has been operative in northern Italy beginning in February 2020.

Dear Dr. Shour

All the developing countries have a shortage of equipments in hospitals, so primary prevention is essential by trying to prevent the onset of the disease, the mortality rate is very high in these countries( more than 10 %) like Iran and Iraq, for developed countries increasing the incidence of the disease is also high so that the existing health facilities can not cope with the increasing cases like Italy . Governments are trying to close any facilities that have people gatherings

Dear researchers have a nice Sunday. My question regard the nature of Lombardia (N. Italy) Coronavirus: its death rate is not compatible with COVID19 but with SARS. WHY??? >> see data >> https://www.researchgate.net/post/The_novel_Coronavirus_in_N_Italy_Lombardia_COVID19_2019nCoV_SARSCoV2_shows_a_fatality_rate_compatible_with_SARS_Why

Dear Colleagues and Friends from RG,

IF YOU CAN, STAY AT HOME! Recommendations for maintaining security policies are now particularly important. Also recommendations formulated by medical services. At present, this is very important in the era of the growing Covid-19 Coronavirus pandemic. The idea is not to leave the house without a serious and justified reason, not to infect other people, not to infect medical services, including doctors, nurses and other health care personnel, because if there are not enough healthy doctors, nurses and other personnel Health care is a pandemic problem Coronavirus Covid-19 will be much, many times larger. In connection with the above, I also join these recommendations and recommend to the community, to citizens of countries in which many infections of people with this virus have already been detected: IF YOU CAN, STAY AT HOME!

According to the latest knowledge in the field of virology, social distance may be important for the progression of the Covid-19 Coronavirus mutation, but unfortunately this impact is practically small, as there are many factors causing mutations in viruses and not only in viruses. In principle, everything that occurs in nature, from cosmic rays to changes in the chemical composition of a given environment, temperature changes, the action of subsequent i.e. third living organisms, etc. can cause mutations.

Unfortunately, the Covid-19 Coronavirus also quickly mutates, but most emerging new strains do not differ much in practice from this form of the Covid-19 Coronavirus, which now dominates. However, the possibility of quickly creating new types of viruses as a result of mutation processes is a very worrying issue. It is highly likely that Covid-19 Coronavirus appeared earlier before it began to infect humans. Earlier he could infect certain animal species and only after subsequent mutations did he move to human infection. The current Covid-19 Coronavirus also quickly mutates like other viruses. At the time you read this commentary, at least some new strains of Covid-19 Coronavirus will be created. It is possible that as a result of these ongoing mutations, a new type of Covid-19 Coronavirus will be created that will cause other diseases and symptoms in humans and / or certain animal species.

Interestingly, new scientific data on the high infectivity of Coronavirus Covid-19 has recently been obtained from studies. Well, most people who have been infected with this virus have been infected by other people who have not yet had symptoms indicating that they are also infected with this virus. This issue significantly increases the importance of the need for preventive isolation of people not only showing any symptoms, including cold and flu symptoms, but also for the isolation of people who show no symptoms. 80% people infected with no signs of Covid-19 disease at all do not have or are undergoing infection and disease very mildly, i.e. like a generally harmless cold. After a few days, they are healthy and it is also highly probable that they will naturally be immune to the relapse of Covid-19 again. However, among the remaining 20 percent infected people, at least a few people are at high risk and are seriously suffering from Covid-19 disease.

Therefore, until the vaccine for Coronavirus Covid-19 is created, the most effective method of protection against infection and against infection of other people is isolation wherever possible, i.e. staying at home and contacting other people only remotely by phone or new internet media. Therefore, in many countries governments, health ministries, etc. recommend even people who feel unwell, who detect symptoms of a cold, e.g. cough, runny nose, fever or other symptoms of a cold or flu to stay at home so that they do not go out and did not go to the hospital alone, but to call the hospital or specially appointed medical services, to first consult a doctor by phone or via the Internet.

In connection with the above, I also join these recommendations and recommend to the community, to citizens of countries in which many infections of people with this virus have already been detected: IF YOU CAN, STAY AT HOME!

Best wishes.

Dariusz Prokopowicz

@ Robert Shour and all respected researchers,

May be the my discussion below partly answers your question.

On closely following the present pandemic, in my humble assessment a combination of the following important factors are responsible for the day-to-day mortality, and fluctuations:

1. Economic capability of the country to test, contain (quarantine contacts and isolate confirmed mild cases at home), and treat seriously sick patients in the hospitals.

2. Hospital beds available in general and ICU beds with functional ventilators available in a country.

3. Number of tests done for SARS-CoV-19 to detect positive cases early vs the mortality (diluting effect on mortality rate) in the country.

4. Comorbidity rate of diseases (Diabetes, Hypertension, pulmonary diseases, obesity, smoking status, heart failure, immune status – congenital or acquired, vaccination status etc) in the country.

5. Viral factor depending on mutation (L or S type) of SARS-CoV-19 in that particular country.

6. Hospital beds, doctors, and nurse to the population ratio of the country.

7. Quality of the healthcare infrastructure of the country.

8. The occupancy rate of the ICU beds by serious cases due to seasonal influenza (responsible for up to 500,000 death yearly) and other locally endemic infections in that country.

9. Temperature and humidity level in that country that possibly may be impacting the transmission of the coronavirus.

10. Demographic factors i.e. population structure (children, young, old, and very old) of the country.

11. Literacy rate (capability to read, understand information, and act on local health policies) of the country.

12. Other factors e.g. malnourishment, quinine/chloroquine/hydroxychloroquine use for endemic malaria, or anti-retroviral medications being used due to high HIV prevalence, may be playing a role in certain countries (e.g. Africa).

13. Very selective testing of symptomatic COVID-19 cases and mortality of critical cases (concentrating effect on mortality), under-reporting (to avoid political effect, or a fear of international monetary support cuts), or over-reporting of mortality (including all SARS-CoV-19 positive cases even if the cause of death was some other comorbid cause; as has been seen in Italy).

13. Last, and most importantly, the BREAKING POINT of sustainability, at which the number of critical case overwhelm the ventilators and other health care in an area, city, or in the whole country. A current example is the situation in Italy, where the doctors are triaging COVID-19 patients for use of ventilators.

Ultimately, one will be able the gauge the definite mortality rate at the end of the COVID-19 pandemic.

An interesting adverse effect of social isolation for the Covid-19 pandemic has arisen. There has been a dramatic fall in the number of blood donors in Saudi Arabia a result of social isolation during the Covid-19 Pandemic. Supplies of blood are being depleted. This is likely to be a global phenomenon

Patients may die as a result of not being transfused blood for severe acute bleeding due to stress ulceration, for example.

If insufficient blood of the correct type is available a woman may die as a result of not being transfused blood for severe acute bleeding following delivery of a child. This situation which will increase non-cCovid mortality will be most challenging for patients with rare blood groups.

I would therefore be grateful if we could consider the answer to this question:

How can we maintain supplies of blood for transfusion during the Covid-19 pandemic?

https://www.researchgate.net/post/How_can_we_maintain_supplies_of_blood_for_transfusion_during_the_Covid-19_pandemic