The Second Wave, Thoughts About The Pandemic

Have we entered into phase 3 of the pandemic?

Thoughts and numbers on the COVID-19 pandemic from a M.D. working in the front lines at the Emergency Department in a hospital in Stockholm, Sweden.

In the beginning of this pandemic I wrote daily for 25 consecutive days, from 25th March to 18th April, this is a little update, a lot has a happened since my last post.

In Sweden, if phase 1 was the initial exponentially growing pandemic in Mars/April, and phase 2 the more stable months of May until October, then phase 3 seems to be a second wave of, once again, the exponential (re-)growth of Covid-19. 

Things have changed, we know more about Covid-19 now even if there´s many questions left unanswered still, and we have (it seems) several promising vaccines on the horizon now. Three random thoughts since my last post follow below.

1. Socioeconomic toll: suicide rates in Japan in October are higher than their total Covid-19 toll

At day 24 I wrote about the long lasting socioeconomic effects of Covid-19, and how that would have a far greater toll on peoples lives than the lives the virus takes directly: 

“Disregarding the death toll, and just accounting for the devastating effect this pandemic will end up having on people’s life in the aftermath both economically and socially will be worse than anything we seen in recent history. (…) We will get through this, but what will it cost in the number of life’s both taken by the virus but also by socioeconomic circumstances?”

CNN published an article today about the surge of suicide rates in Japan during October (est. 2 153 deaths) being higher than their total Covid-19 toll for this year so far (est 2 087). They denote that Japan is one of the few major economies that discloses timely suicide data, what is happening there is probably happening everywhere: 

“We didn’t even have a lockdown, and the impact of Covid is very minimal compared to other countries … but still we see this big increase in the number of suicides,” said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides. “That suggests other countries might see a similar or even bigger increase in the number of suicides in the future.” 

2. Treatment: adding cortisone to anticoagulants, as first treatment options for Covid-19 pneumonia

I wrote early about anticoagulants being our first line treatment for severe Covid-19. Since then corticosteroids have been added to that list for treating severe Covid-19 disease. From WHO guidelines

“The guideline panel was informed by combining two meta-analyses which pooled data from eight randomized trials (7184 participants) of systemic corticosteroids for COVID-19. The panel discussions were also informed by two other meta-analyses, which were already published and pooled data about the safety of systemic corticosteroids in distinct but relevant patient populations. The resulting evidence summary suggested that systemic corticosteroids probably reduce 28-day mortality in patients with critical COVID-19 (moderate certainty evidence; seven studies,1703 patients; relative risk [RR] 0.80, 95% CI 0.70–0.91; absolute effect estimate 87 fewer deaths per 1000 patients, 95% CI 124 fewer to 41 fewer), and also in those with severe disease (moderate certainty evidence; one study, 3883 patients; RR 0.80, 95% CI 0.70–0.92; absolute effect estimate 67 fewer deaths per 1000 patients, 95% CI 100 fewer to 27 fewer). In contrast, systemic corticosteroids may increase the risk of death when administered to patients with non-severe COVID-19 (low certainty evidence; one study, 1535 patients; RR 1.22, 95% CI 0.93–1.61; absolute effect estimate 39 more per 1000 patients, 95% CI 12 fewer to 107 more). In addition, systemic corticosteroids probably reduce the need for invasive mechanical ventilation (moderate certainty of evidence; two studies, 5481 patients; RR 0.74, 95% CI 0.59–0.93). In contrast, harms, in the context of the mortality reduction in severe disease, are minor.
(…)
We recommend systemic corticosteroids rather than no systemic corticosteroids for the treatment of patients with severe and critical COVID-19 (strong recommendation, based on moderate certainty evidence).
(…)
We suggest not to use systemic corticosteroids in the treatment of patients with non-severe COVID-19 (conditional recommendation).”

3. Logarithmic graph

After exponential growth ebbing out in april, with weekly deaths decreasing for a period there seems to be a new rapid surge in Sweden since late october, as previously observed, the logarithmic graph from Aatish’s page illustrates this well: *

As I previously posted at 20-03-28, day 4, of this previously daily journal, logarithmic graphs are better for visualizing exponential trends.

COVID-19 Numbers Sweden 2020-11-27 *

  • 6 681 deaths nationally
    • 2627 of them in Stockholm
  • 243 129 confirmed cases nationally
    DEATHS [SWE]
  • New confirmed deaths daily in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates weekdays during mornings at 14:00 so weekends numbers are not yet complete until monday).
    ICU [SWE]
  • New Covid-19 patients Being Treated at the ICU in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates weekdays during mornings at 14:00 so this weekends numbers are not yet complete until monday 14:00).
    NEW CONFIRMED CASES [SWE]  
  • New confirmed cases daily in Sweden.
    (Number of COVID-19 cases over time in Sweden,updates weekdays during mornings at 14:00 so this weekends numbers are not yet complete until monday 14:00).
    TOTAL CONFIRMED CASES [SWE]  
  • New confirmed cases accumulated over time in Sweden. 
    (Number of COVID-19 cases over time in Sweden, updates during mornings at 14:00 so todays numbers are not yet complete until the next day).
  • Intensive care Sweden*
    • 887 COVID-19 confirmed patients treated in the ICU in total so far
    • 10,5 days from symptoms to ICU
    • 24,7 % women
  • Total number of recorded of COVID-19 patients needing ICU care each week. From Week 10 it increased rapidly each week for the first 7 weeks, then slowing down at week 18, ebbing out/stabilizing at week 25, and start increasing again i velocity at week 44. Weekly numbers from week ten: 4 →  24  → 131 → 437 → 793 → 1175 → 1525 → 1858 → 2133 → 2363 → 2549 → 2705 → 2876 → 3046 → 3179 → 3282 → 3363 → 3414 → 3437 → 3457 → 3475 → 3495 → 3516 → 3534 → 3544 → 3554 → 3564 → 3575 → 3585 → 3593 → 3608 → 3634 → 3657 → 3713 → 3786 → 3925 → 4082 → 4274 → 4 419 (4419 this week, however since the weekends numbers might not yet have been updated this number will probably increase when revised next week)

COVID-19 Numbers Globally (last updated yesterday 2020-11-28 at 03:48 CET) *

  • 1 439 784 confirmed deaths (139 387 in last post, in April 17th 2020)
  • 61 299 371 confirmed cases (2 074 529 in April 17th 2020)
  • 13 296 new deaths (7 911 in April 17th 2020)

That’s it until next time, keep calm and stay safe!

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