Are there scientific reasons?
For example, Iraq, Syria, Egypt and African countries have a very low rate of infections and deaths due to (COVID 19) compared to countries like Italy, France and Britain
Since temperate climatic conditions favour the development of COVID-19, hence European countries such as United Kingdom, France, Italy, Switzerland, Germany, Spain etc. are more affected from disease.
Social distancing was applied at different times with different doses. Those countries that responded early with an aggressive policy and had compliance from the general public have relatively few cases of Covid-19. These countries would benefit significantly if they can remain locked down until a vaccine is available.
Social distancing measures can have significant effect on reducing the number of people affected with Covid-19 at any one time. It is almost inevitable that everyone will be infected, it is a matter of when. Social distancing allows healthcare systems time to organise and respond.
The availability of healthcare in general and specifically critical care will affect case fatality. In China and Italy where large numbers of healthcare professionals were infected the capacity to deliver healthcare was substantially reduced.
Excess deaths occur when the capacity for healthcare systems to provide organ support is exceeded.
The numbers of cases reported will also depend on strategies used for screening. Many countries are only screening symptomatic patients presenting to healthcare facilities. Others are attempting to screen a significant proportion of the population.
I believe the total number of cases of COVID-19 is significantly higher than that being reported. There are many confounding factors (both political and diagnostic) that make the initial number of deaths reported as being due to COVID-19 extremely difficult to interpret.
Another important factor to consider when trying to interpret variation in mortality rates between countries is differences in cultural interpretation of quality of life. This impacts the social and medical ethics and the delivery, limitation and withdrawal of life sustaining therapies.
In many Western cultures quality of life is valued far more than quantity of life. In those setting limitation and even withdrawal of life sustaining therapies are a common mode of death.
In many Eastern cultures quantity of life is valued more than quality of life. In these settings treatment limitations and withdrawals of therapy are rare. Admission to intensive therapy units and prolonged organ support are common. Mode of death is often cardiac arrest.
These differences are magnified when there are limited resources particularly in Western countries. The social and medical acceptance of treatment limitations is increased; this may significantly increase case fatality rates.
Article Checklist Proformas to Guide and Document the Assessment of ...
The availability of healthcare in general and specifically critical care will affect case fatality. In China and Italy where large numbers of healthcare professionals were infected the capacity to deliver healthcare was substantially reduced.
So, as the COVID 19 pandemic progresses we will need to upskill colleagues to facilitate the assessment and treatment of critically ill patients with and without COVID 19. This may be achieved by face-to-face education sessions. However this is very labour intensive and may result in spread of COVID 19 amongst healthcare professionals.
An alternative approach would be to use standardised checklist proformas for the assessment of critically ill patients (see link below).
Article Checklist Proformas to Guide and Document the Assessment of ...
The use of checklist proformas can facilitate the management of critically ill patients by staff who do not routinely work in intensive therapy units. This could improve outcomes in this high risk cohort of patients and improve the confidence of staff redeployed to ITU from other care areas.
Rajkumar Rajendram thank you very much
And I expect, as you mentioned, that social distancing measures can have significant effect on reducing the number of people affected with Covid-19 at any one time. It is almost inevitable that everyone will be infected, it is a matter of when. Social distancing allows healthcare systems time to organize and respond.
Different countries and different regions within countries are currently in different phases of their outbreaks. For example, within the US, New York and California had major outbreaks earlier than most other states. It's probably no coincidence that those states are hubs for air travel, both within the US and internationally. The countries and regions that are most internationally connected will get their first cases earlier, and those that have large and densely populated cities are more likely to have major outbreaks.
How quickly and how effectively measures like testing, contact tracing, and social distancing were applied also will have a large effect. Countries that got early warning (and took advantage of it) may be able to prevent worse outbreaks.
The reasons for the spread of the Corona virus in high-level medical countries than low-level medical and health countries because of their confidence in employees and health capabilities, which caused its collapse
Testing. If you don't test, you can't know how many cases you have. And of course, plus the interaction as a result of travels to and from the affected countries is low in low-income countries
...Since February 12, 4,226 COVID-19 cases were reported in the United States; 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths occurred among adults aged≥ 65 years with the highest percentage of severe outcomes …
COVID, C., & Team, R. (2020). Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep, 69(12), 343-346.
For years, healthcare systems have attempted to transform themselves into highly reliable organizations. At the onset of the COVID-19 pandemic, the American healthcare industry watched from television screens thinking “this will not reach us.” ...
Brown, J., Guru, S., Williams, K., Florentino, R., Miner, J., & Cagir, B. (2020). Rural Healthcare Center Preparation and Readiness Response to Threat of COVID-19. Journal of the American College of Surgeons.
As COVID-19 spreads across the United States, concerns mount that the need for hospital beds will overwhelm national capacity, putting severe strains on the health care system and limiting access to necessary care. ...
Blavin, F., & Arnos, D. (2020). Hospital Readiness for COVID-19.
… Undoubtedly, no other country could enact what China is currently doing. The daily decline in new cases by mid-February suggests that China is on the right path, showing that containment could be feasible. Other countries should be aware and reduce the spread of COVID-19 …
Wilder-Smith, A., Chiew, C. J., & Lee, V. J. (2020). Can we contain the COVID-19 outbreak with the same measures as for SARS?. The Lancet Infectious Diseases.
… during emergencies of such magnitude are challenging across African and other lower-middle-income countries …
Velavan, T. P., & Meyer, C. G. (2020). The COVID-19 epidemic. Trop Med Int Health, 25(3), 278-280.
...Governments will not be able to minimise both deaths from coronavirus disease 2019 (COVID-19) and the economic impact of viral spread. Keeping mortality as low as possible will be the highest priority for individuals; hence governments must put in place measures ...
Anderson, R. M., Heesterbeek, H., Klinkenberg, D., & Hollingsworth, T. D. (2020). How will country-based mitigation measures influence the course of the COVID-19 epidemic?. The Lancet, 395(10228), 931-934.
...All countries should increase their level of preparedness, alert and response to identify, manage and care for new cases of COVID-19. Countries should prepare to respond to different public health scenarios, recognizing that there is no one-size-fits-all approach …
World Health Organization. (2020). Critical preparedness, readiness and response actions for COVID-19-7 March 2020.
It is possible the the testing are not as effective. You will notice that it seems the more developed the african country the more cases they appear to have. There might be more cases and death, but maybe the health system is not capturing it.
The other explanation could be the fact that Africa has less international traffic compared to other parts of the world.
The SARS-CoV2 viral infection (COVID-19) has a worldwide distribution. To date 210 countries and territories around the world are the sufferer. Now resource-rich/resource-poor countries are equally affected. Pl, follow the following link. https://www.worldometers.info/coronavirus/
Harasit Kumar Paul thank you
But to now, the rate of infections and deaths in Arab and Asian countries is lower than America and European countries!!!
Since temperate climatic conditions favour the development of COVID-19, hence European countries such as United Kingdom, France, Italy, Switzerland, Germany, Spain etc. are more affected from disease.
The number of positive persons infected by Corona virus depends largely on the number of tests carried out for the total population. The more test you do, the more case you will find (not necessarily expressing the symptoms). In the low level medical and health countries the number of test made is probably lower than in other countries having better facilities to test the infection by the virus.
High leveled countries are ore "developed". Therefore there is more pollution, 5G, metabolic-illness, sugar in the food, industrial food, toxines in the water, antibiotics in meat and fruits, etc. and in the consequence to that more stress for the body. Therfore more illness in general is in those countries and a flu virus, or one of the more than 300 different corona viruses can spread faster like we had in our countries in so many flu seasons before...
The scientific reason is that the countries where the level of health care is low are the dependence of these countries on vaccinations for children up to the age of five with a large number of diseases for prevention. Therefore, the immune system is active, unlike in Western European countries. All vaccines have been canceled due to the absence of these diseases in their countries.
Ashraf S. Alias but not found relationship between (covid 19) and the vaccinations of children !!!
Hello!
Truly think it "may'' be because of climate or ethnic groups. Also, less reported cases it can also be because tests are not being carried out religiously.
Rami Ramadhan Your welcome :)
Has anyone noticed any difference in scars of bcg vaccine amongst kids during COVID 19 outbreak?
thanks!
Haadiyah Hosany
I personally did not notice! Is there anything new about this matter, please tell us ???
Dear Rami, well this is something that I noticed, and also there were some other moms in my country (Mauritius) who were asking about the pronounced scars caused by bcg. This was underlined during a period when we had cases of COVID -19 in the country.
Thanks!
@Haadiyah Hosany
Really this is unknown phenomena, and should be ask and search about the reason.
Thank you
It is a great question Dr. Thank you so much.
I pray for the safety of all the people.
I think that the political, economic and level of health care play a key role in answering such question. Sadly, the conflict, war and the unrest in the countries mentioned play a major role.
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