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Putting the COVID-19 pandemic in perspective (Number 5)

This report was posted December 5, 2020, with several amendments made on December 6.

This series was spawned by my reaction to reporting on the COVID-19 pandemic that focused on raw numbers. Big numbers are impressive, even frightening, and hard to comprehend, but rarely were we given a context that helped lead to better understanding of the numbers or how to make comparisons between the U.S. and the rest of the world. This series has turned from occasional pieces to a monthly summary setting the U.S. numbers in global perspective. This analysis is based on data from worldometers.info.

Report Sections:
• Scope of This Report • Where We Are Now (Summary)
• COVID Deaths Compared to the Leading Causes of Death in the U.S.
• Profile of Monitored Continents & Countries • Detailed Analysis by Category

Scope of This Report

What we track

From the worldometers website we track the following Categories:

• Total Cases • Cases per Million
• Total Deaths • Deaths per Million
• Total Tests* • Tests per Million*
• From Cases and Deaths, we calculate the Mortality Rate

* Total Tests and Tests per Million are not reported by worldometers at the Continental level.

NOTE: It is important to distinguish CASES from INFECTIONS. I have recently read reports that as many as ten times the number of people with confirmed cases of COVID-19 have actually been infected.* That would make the U.S. Mortality Rate drop from 2.8% to something like 0.2%. That, however, does not diminish the growing number of deaths, the veracity of which is only impacted if COVID is assigned as the cause of death rather than triggering death by an underlying condition (see the chart below comparing COVID deaths to the top-10 causes of death in the U.S.).

Therefore, in these reports I will be careful to avoid referring to the potentially looser term "infection" when "confirmed cases" or "cases" is more accurate. Cases is what worldometers—my primary source of data—uses. The larger concerns of the impact of response to COVID-19 on the economy, society and other health issues will be dealt with in separate articles. This series is focused on understanding and putting into perspective the basis numbers about COVID-19. —SJ 12-6-20

*For one view of this, see comments by Jay Bhattacharya of Standford University, "A Sensible and Compassionate Anti-COVID Strategy" from the October 2020 issue of the Imprimis newsletter of Hillsdale College, in which he makes reference to the Greater Barrington Declaration, co-authored with Dr. Sunetra Gupta of Oxford University and Dr. Martin Kulldorf of Harvard University (in Greater Barrington MA), and signed by more than 50,000 health care professionals and 682-thousand "concerned citizens" (as of today). A statement on the website states "As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection."

Who we monitor

Our analysis covers countries that have appeared in the top-10 of the worldometers categories since September 2020. This includes most of the world's largest countries as well as some that are much smaller: China, India, United States, Brazil, Russia, Mexico, Iran, Germany, United Kingdom, France, Italy, Colombia, Spain, Argentina, Canada, Peru, Chile, Ecuador, Bolivia, and Belgium. This list could grow if other countries appear in the top-10 on any category in the future. A chart profiling the monitored countries and the five major continents will be found later in this report.

Changes in this report

Because of the scale of the numbers, last month I began to include totals for Europe, which in some respects provides a better comparison to the U.S. than individual European countries. This month, I expanded that to include aggregate data for the five major continents, adding Africa, Asia, North America, and South America (Latin America and the Caribbean). I did not include Oceania because it accounts for only 0.5% of the world's population and would not reach the thresholds used in this analysis.

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Where We Are Now

In the last report, what appeared to be (reported as) a global resurgence in COVID-19 cases and deaths had emerged in the last two weeks of October. That surge continued into November, with increasing warnings by public officials that things would only get worse if people ignored mitigation efforts as we approached Thanksgiving and the holiday season through December. It was not confined to the United States.

Britain had imposed a severe nationwide lockdown, which just ended. A number of U.S. states and cities, as well as European countries went back to tighter restrictions on businesses and guidelines for gatherings both public and private. Yet, in the U.S., despite the warnings, Thanksgiving travel was brisk. Airports were hardly back to normal for this time of year, but were noticeably much busier than at any time since the world acknowledged the pandemic in March and started shutting down. There remains a huge tug-of-war between official pronouncements of doom and rebellious disregard by sizable segments of the population in many countries, not just the U.S.

November Trends

News reports in the last week have pointed to record levels of cases and deaths, approaching and in some cases exceeding the beginning escalation of the pandemic, from March through May of 2020. Here are some key points, with more details in remaining sections of the report:

The Global View

At the end of November there were 64.5-million confirmed COVID cases around the world, up 37% from October, which was 39% higher than the 33.5-million at the end of September. To date 0.8% of the world's population of 7.8-billion has been reported with COVID-19 cases. Of those, 1.5-million have died—a mortality rate of 2.3% (deaths as a proportion of cases).

Perspective: The 1918-19 Spanish Flu pandemic is estimated to have struck 500 million, 26.3% of the world population of 1.9-billion at that time. Deaths have been widely estimated at between 50- and 100-million worldwide, putting the mortality rate somewhere between 10 and 20-percent worldwide. It has been estimated that 675,000 died in the U.S.

IF COVID-19 hit at the same rate as 1918, we would see about 2-billion cases worldwide today. with the global population now at 7.8-billion. There would be 200- to 400-million deaths. For the U.S., this would mean cases approaching 90-million and deaths of nearly 9-million and perhaps as high as 18-million.

However, at the present rate of confirmed cases and mortality after nine months, total confirmed cases from COVID-19 worldwide could be closer to 170-million after two full years, with deaths approaching 4.25-million. For the U.S., that could mean cases approaching 40-million, with more than 1-million deaths. It is, of course, impossible to predict what the future will bring between the conflicting trajectories of ongoing surges, lockdowns, and the availability and success of vaccines as we move into 2021.

The contrasts demonstrates the vast difference in scale between the Spanish Flu pandemic a century ago and COVID-19 now. Key differences are the mitigation efforts and available treatment today (though still leaving the health care system overwhelmed in some areas), and the promise of vaccines. In addition, in 1918 much of the world was focused on a brutal war among nations (World War I) rather than waging a war against the pandemic, which ran its course and was undoubtedly made much worse by the war, with trans-national troop movements, the close quarters of trench warfare, and large public gatherings supporting or protesting the war.

The Continental View

Because Africa, Asia, and the Americas were added this month, there will be no comparison with the previous month until the next report. Following are the high numbers, by category. Detailed analysis on each continent will be found later in the report. At the continental level, Tests and Test per Million are not reported

• TOTAL CASES: While raw numbers are commonly used (Europe leads in Total Cases among continents and countries, with 17.2M), the more important measure may be proportion of cases in the population, where North America leads with 4.4% (with 16.2M cases) compared to Europe at 2.3%. So far, the number of cases has reached 1.5% in South America, 0.4% in Asia, and 0.2% in Africa. Europe increased 74% in November, which shows the reality of the current surge.
• CASES PER MILLION: North America has the highest rate among continents, at 41,800, exceeded only by the country of Belgium at 49,662.
• TOTAL DEATHS: North America also leads in Total Deaths, among continents and countries, at 409,000. That is 27.8% of the 1.4-million deaths worldwide, far higher than its 4.7% share of world population. At the other extreme, Asia had 19.8% of all deaths (291,761) while it represents 59.3% of the world's population. Europe, second in number of deaths (394,182), with 26.8% of the world's total (and 9.6% of its population), increased 48% in November.
• DEATHS PER MILLION: North America accounts for the highest rate among continents, at 827, but six countries we are monitoring exceeded that rate in November, all from Europe and South America, ranging from .Belgium, with 1,425 deaths per million cases, to Argentina, with 848 (the other countries were Peru, Spain, Italy, and the UK).
• MORTALITY RATE (deaths as proportion of cases): South America leads among continents, at 2.9%, behind 10 countries, ranging from Mexico at 9.5%, to France at 3.2% (the other countries are Ecuador, Bolivia, China, Iran, Peru, UK, Italy, and Canada).

The apparent equity of Asia in the number of cases (second to Europe, at 17.2M ) drops away when considering the vast difference in population (4.6B or 60% of global population, with COVID cases accounting for only 0.7% of its population), leaving Europe and the Americas the hardest hit by COVID cases so far.

Africa has the least impact from COVID at this time, with 2.2-million cases representing 0.2% of its population.

India is the only Asian country to make the top-10 in any category, but that is because of its overwhelming size (1.3B), where even a small percentage of the population can have a huge impact in raw numbers when compared to other countries.

With the Americas and Asia added to our analysis this month, we will have a better picture of trends on a continental basis beginning in the December report.

Where does the U.S. stand?

The numbers seem overwhelming, adding to the impression one could get from media reports that the U.S. is the most irresponsible of nations. There is a lot of truth to that, yet for all of the rebelliousness and political division in America, the story is more complicated and nuanced. (High rankings in Tests and Tests per Million are good, while high rankings in all other categories are bad).

• Comparing the U.S. to the more than 200 countries tracked by worldometers:
  • The U.S. is No. 1 in Cases; Deaths; and positively, also No. 1 in Tests
  • The U.S. is No. 12 in Cases per Million; No. 7 in Deaths per Million; and No. 2, behind the UK, in Tests per Million
• Comparing the U.S. to the 20 countries we monitor:
  • The U.S. is No. 17 in Mortality Rate, below the global rate
  • The U.S. is No. 7 in the increase of Cases and Cases per Million, above the global rate
  • The U.S. is No. 12 in the increase of Deaths and Deaths per Million, below the global rate
  • The U.S. is No. 4 in the increase of Tests and No. 3 in the increase of Tests per Million
• COVID versus other killers (see detailed chart below)
  • In nine months, the COVID-19 death toll in the U.S. has reached 274,056. That is above 8 of the top-10 leading causes of death annually in the U.S., but remains well below cancer at 599,108 and heart disease at 647,467 over 12-months (1.2-million combined for 2017, the latest year available when I started writing this series).

Comparing Countries

TOTAL CASES worldwide stands at 65.5-million, up 37% from 46.4-million in October, which was up 39% from 33.5-million in September. It should not be surprising that larger countries dominate the ranking. There are simply more people to contract the virusn, thus higher numbers. The U. S. has been No. 1 all three months, with 13.9-million total cases, followed by India, Brazil, and Russia, all of which are in the top-10 countries by population. These are followed by Spain, France, UK, and Italy, smaller but all part of Europe, which ranked No. 1 among continents.

• By percentage of its own population, Belgium leads with 5%, followed by Spain (4.7%), the U.S. (4.2%) and Argentina (3.1%). All other countries are 3% or lower.
• By percentage of world cases, the U.S., with 4.3% of world population, leads with 21.9% of cases. Brazil, in third place, is also high, having 2.7% of world population, but 10.0% of cases. On the other hand, India, with 17.6% of world population, had 14.9% of cases. All other countries were below 4% share of cases and 2% share of population.
• By change from October. Those above the global increase of 37% are lead by Italy, with a 136% increase in cases, followed by Germany (102%). Increasing 50-75% were France, UK, Canada, and Iran; then the U.S. at 48%. Still above the world mark of 37% were Russia and Belgium at 44% and 40%.

CASES PER MILLION, 8,318 globally. Of the twenty countries in this analysis, only Belgium (No. 81 by population) makes the top-10 globally, at No. 6, with 49,662 cases per million. All of those with higher rankings are smaller countries like Belgium with populations of 11-million or less. The U.S. is next among the countries in this analysis, at 41,838 cases per million, but that puts it at No. 12 globally. Spain, at 35,604 cases per million, ranked No. 18 globally and was the only other of our twenty monitored countries to appear in the global top-20 by cases per million.

TOTAL DEATHS at the end of November were 1.4-million worldwide, up 25% from 1.2-million in October, which was up 20% from 1.0-million in September. There is a similar pattern to Total Cases, with five of the top-10 also among the ten largest countries in the world and five in the top-30. The U.S. leads, with 274,056 Total Deaths, maintaining its No. 1 position by a wide mark since October. Brazil is second, with 173,120, followed by India with 137,649 and Mexico with 105,655. U.K, at No. 5 drops to 58,448, and No. 10 Russia comes in at 39,805.

• By percentage of world cases, the U.S., with 4.3% of world population, leads with 18.6% of deaths (and 21.9% of cases). Brazil, with 2.7% of world population, has 11.8% of deaths (but 10% of cases). All other countries fall below 10% of world share, including India, with 17.6% of world population.
• By change from October. There are five ways to view changes relative to the global levels (37% for cases, 23% for deaths)::
  • Deaths increase higher than Cases, and both above global rate. Belgium
  • Cases increase higher than Deaths, and both above global rate: Germany, Italy, Russia, Iran, Spain, UK
  • Deaths increase higher than global rate, but Cases less: France, Argentina
  • Cases increase higher than global rate, but Deaths less: Canada and U.S. (48% increase in cases, 16% in deaths).
  • Cases and Deaths increase both lower than global rate: Colombia, Mexico, India, Chile, Brazil, Ecuador, Peru, Bolivia, China (China's reporting has not changed since September)

DEATHS PER MILLION, 192 globally. Seven countries we monitor were in the global top-10. Except for the U.S., at No. 10, the others all range from 12- to 68-million population. Belgium was No. 1, with 1,425 deaths per million. Peru also broke the 1,000 mark, at 1,085, followed by Spain, Italy, U.K., Argentina, then the U.S. at No. 10, with 826 deaths per million.

• By change from October, nine of the countries monitored were in excess of the global increase of 23% in Total Deaths, ranging from Germany at the top, with a 60% increase, to Argentina, with 24%. Other countries were Belgium, Italy, France, Russia, Iran, Spain, and U.K. The U.S. increase was 16%, with a global rank of 10, but 12th among monitored countries.

MORTALITY RATE: Mexico remains high at 9.5%, followed by Ecuador at 7.0%, then declining to the U.S. at 2.0%, which is No. 17 among the 20 monitored countries.

• The overall trend is down, despite a noticeable surge in cases in at least half the countries monitored. This reflects the good news that deaths are not increasing as quickly as new cases, though there can be considerable lag between infection and death. We'll have to keep watching the numbers, especially after the holidays into early 2021. Some examples: Mexico has declined from 10.5% in September to 9.5% in November, Italy from 11.5% to 3.5%, and the U.S. from 2.9% to 2.0%. Belgium has gone from 8.8% to 2.8%, then moved up slightly in November to 2.9%. France reflects a larger bounce, starting at 5.9%, going down to 2.6%, then up to 3.2% in November.

TESTS: The U.S. leads with 193.6M tests, followed by China at 160M (no reported change since Sept.) and India at 140.4M. The top-10 globally are also the top-10 of our monitored countries, with Brazil at No. 10 (20.6M tests). Below that, the reaming 10 countries we monitor ranked from Canada at No. 13 with 11.4M tests to Bolivia at No. 106 with only 400K tests.

• Among the twenty countries monitored, Ecuador showed the biggest change since October, with a 60.0% increase in tests. This was followed by Italy at 38.6%, Spain at 36.9%, and the U.S. at 34.3%. Also at or above 30% were Ecuador and Italy. At or below 20% were Mexico, Belgium, Canada and Peru. Showing no increase in reported tests were China and Brazil.

TESTS PER MILLION: The U.K. leads our monitored countries with 639 tests per million but is ranked No. 15 globally. That represents 64% of its population, with the caveat that this is not a precise figure since some people can be tested more than once. It does, however, give some idea of the scale of testing. The U.S. is next with 583 tests per million, ranked No. 18 globally, enough to cover 58% of the population. Russia, Belgium and Spain follow, with enough tests to cover about half of their populations. At 103 tests per million, Brazil in ranked No. 104 in the world, with enough tests to cover 10.3% of its population. Following Brazil in Tests per Million are India, Argentina, Iran, Ecuador, Bolivia and Mexico.

• Among the twenty countries monitored, Italy increased Tests per Million the most, 39.1% more than October. Also above 30% were Spain at 37.8% and the U.S. at 34.3%. At the bottom of list were Bolivia at 10.7% and both China and Brazil, which showed no change.

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COVID Deaths Compared to the Leading Causes of Death in the U.S.

According to the CDC, the 10 leading causes of death in 2017 (the latest year available) were as follows. These total just over 2-million deaths per year. COVID death milestones are shown in red. Even if the final toll by the end of 2020 is well below worst-case projections (upwards of 2-million deaths), it is striking how rapid the rise in deaths has been since early March.

COVID-19 death "milestones"

(2020) against the 10 leading causes of death in America (2017)

1. Heart disease: 647,457
2. Cancer: 599,108
   • COVID-19 deaths as of November 30, 2020: 274,056 out of 13.8-million cases, or 2.0% mortality—(22% increase in cases, 16% increase in deaths since October 31, drop in mortality of 0.5%—that is slower growth than October, despite news reports of continued surges nationwide, but preceded the Thanksgiving holiday when it appeared that many people were ignoring warnings to avoid travel. The December numbers should show whether the surge intensified because of holiday gatherings and travel.)
     The CDC's National Ensemble Forecast for November 23, the latest as of this writing, forecasts a total of 294,000 to 321,000 deaths by December 19." (The link will take you to the latest report.)
   • COVID-19 deaths as of October 31, 2020: 236,072 out of 9.4-million cases, or 2.5% mortality—(28% increase in cases, 17% increase in deaths since Sept. 24, drop in mortality of 0.2%)
     The CDC's National Ensemble Forecast for October 26 forecast a total of 243,000 to 256,000 deaths by November 21, indicating "an uncertain trend in new COVID-19 deaths . . . "
   • COVID-19 deaths as of September 24, 2020: 200,705 out of 7.3-millions cases, or 2.7% mortality
     latest number from WHO as of this writing
     The CDC's National Ensemble Forecast for September 17 forecast a total of 207,000 to 218,000 deaths by October 10.
3. Accidents (unintentional injuries): 169,936
   • COVID-19 deaths as of August 23, 2020: 167,201
4. Chronic lower respiratory diseases: 160,201
   • COVID-19 deaths as of August 10, 2020: 160,989
5. Stroke (cerebrovascular diseases): 146,383
   • COVID-19 deaths as of July 27, 2020: 146,331
6. Alzheimer's disease: 121,404
   • COVID-19 deaths as of June 26, 2020: 121,645
   • COVID-19 deaths as of May 18, 2020: 91,985
     latest number as of my May 19 report
     The CDC's National Ensemble Forecast at the time suggested that "the number of cumulative deaths are likely to exceed 100,000 by June 1st." As I stated then: "We will certainly surpass that number. The forecast is extended only four weeks at a time. If a downturn in deaths becomes reality, as expected, how will the final number at year's end compare to the 200,000 upper end of the window that gained currency in April? If deaths were to continue at the present rate—about 10,000 per week, the total by year's end would be around 372,000."
7. Diabetes: 83,564
   • COVID-19 deaths as of April 28, 2020: 58,365
     not only surpassed Vietnam (58,318), but flu and pneumonia in 2017
8. Influenza and pneumonia; 55,672
9. Nephritis, nephritic syndrome, and nephrosis: 50,633
10. Intentional self-harm (suicide): 47,173
    • COVID-19 deaths as of April 11, 2020: 18,516
      date US surpassed Italy in deaths
    • COVID-19 deaths as of March 28, 2020: 1,296
      date US surpassed Italy in reported cases (85,840)

There are those who question the veracity of assigning COVID-19 to many deaths among people with underlying conditions, such as heart and respiratory disease. Still others have suggested a rise in other health issues, including death, because of deferred health care. It will be years before all of that is sorted out. For my purposes here, I can only go by the most reliable sources available.

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Profile of Monitored Continents & Countries

Is the U.S. the worst in the world in terms of COVID-19 statistics? Overall, we are being hit harder by COVID than many other countries, sometimes with well-deserved criticism for the free-wheeling, anti-establishment, "cowboy" stereotype through which much of the world views the United States. However, in recent weeks there has been news of surges in Europe and other parts of the world.

To help frame the analysis that follows, consider a quick profile of a range of different countries that appear near the top of the measures included. The data was revised this month to include all five major continents, not just Europe. (Data from worldometers.info).

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Detailed Analysis by Category

Here is the latest (November 30) from worldometers.info, which reveals a complicated mix of cases versus population, mortality rates among those who do become infected, testing levels and other factors.

As stated in my previous articles, raw numbers can be powerful but somewhat misleading, so it is necessary to compare them with rates and shares, which the worldometers data provides.

Remember, this is a snapshot of a particular day (November 30, 2020), so running the reports again in the future will change both the numbers and the rankings. The threshold for highlighting changes in each category was selected to easily point out the most significant changes.

TOTAL CASES: 63.5-million worldwide, up 37% from 46.4M in October (which was 39% higher than 33.5M in September).
Those with an increase of 37% or more over October 31 are highlighted in red

• TOP TEN COUNTRIES + CONTINENTS, BY CASES (NOV. 30)
• The total comes from 215 countries and represents 0.8% of world population of 7.8-billion, up from 0.6% in October and 0.4% in September.
• EUROPE has 17.2M cases, 2.3% of its population (up 74% from 9.9M— with 9.6% of world population, Europe accounts for 27.1% of world cases (up from 21.3% and rising)
• ASIA has 16.7M cases, 0.4% of its population (with 59.3% of world population, Asia accounts for 26.4% of world cases
• NORTH AMERICA has 16.2M cases, 4.4% of its population (with 4.7% of world population, North America accounts for 25.5% of world cases
• USA (1—same), 13.9M cases, 4.2% of its population (up 48%, from 9.4M)—with 4.3% of world population, the U.S. accounts for 21.9% of world cases, trending back to September level after dipping to 20.3% in October
• SOUTH AMERICA has 11.1M cases,1.7% of its population (with 8,4% of world population, South America accounts for 17.5% of world cases
• India (2 -same), 9.5M cases, 0.7% of its population (up 15% from 8.2M—with 17.6% of world population, India accounts for 14.9% of world cases (down from 17.7% and declining)
• Brazil (3—same), 6.3M cases, 3.0% of its population (up 15% from 5.5M)—with 2.7% of world population, Brazil accounts for 10.0% of world cases (down from 11.9% and declining)
• Russia (4—same), 2.3M cases, 1.6% of its population (up 44% from 1.6M)—with 1.9% of world population, Russian accounts for 3.6% of world cases (up from 3.4% but stable)
• Spain (5—up from 6), 2.2M cases, 4.7% of its population (up 71% from 1.3M)—with 0.6% of world population, Spain accounts for 3.5% of world cases (up from 2.8% and rising)
• France (6—down from 5), 1.7M cases, 2.5% of its population (up 15% from 1.4M)—with 0.8% of world population, France accounts for 2.6% of world case (down from 3.0%, still higher than Sept)
• UK (7—up from 9), 1.6M cases, 2.4% of its population (up 63% from 1.0M)—with 0.9% of world population, UK accounts for 2.6% of world cases (up from 2.2% and rising)
• Italy (8—up from 13),1.6M cases, 2.7% of its population (up 136% from 679K)—with 0.8% of world population, Italy accounts for 2.5% of world cases (up from 1.5% and rising)
• Argentina (9—down from 7), 1.4M cases, 3.1% of its population—with 0.6% of world population, Argentine accounts for 2.2% of world cases (down from 2.6% and declining)
• Colombia (10—down from 8), 1.3M cases, 2.1% of its population—with 0.7% of world population, Colombia accounts for 2.1% of world cases (down from 2.4% and declining)
• OTHER MONITORED COUNTRIES WITH AN INCREASE OF 37% OR MORE 
• Germany (12—up from 15) 1.0M cases, 1.7% of its population (up 101% from 532K)—with 1.1% of world population, Germany accounts for 1.7% of world cases (up from 01.1% and rising)
• Iran (15—down from 14), 962K cases, 1.1% of its population (up 57% from 613K)—with 1.1% of world population, Iran accounts for 1.5% of world cases (up from 1.3%, but stable)
• Belgium (19—down from 18), 577K cases, 5.0% of its population (up 40% from 412K)—with 0.1% of world population, Belgium accounts for 0.9% of world cases (same as Oct, and stable)
• Canada (29—up from 18), 374K cases, 1.0% of its population ( up 59% from 235K)—with 0.5% of world population, Canada accounts for 0.6% of world cases (up from 0.5% and rising)

CASES PER MILLION
Increases of 37% or more highlighted in red (the rate of increases in cases worldwide since Oct. 31)

• TOP TEN MONITORED COUNTRIES + CONTINENTS, BY CASES PER MILLION (OCT. 31)
• Belgium (6—down from 5),49,662—up 40% from 35,542, following rapid rise last month of 261%
• NORTH AMERICA (new to report this month), 45,299
• USA (12—up from 15), 41,838—up 48% from 28,351 and up from 28% increase in October
• Spain (18—same), 35,604- up 32% from 27,042, but down from 69% in October
• France (19—up from 27), 34,018—up 63% from 20.937, but down from 152% in October
• Argentina (26—down from 22), 31,274—up 21.5% from 25,740
• Brazil (20—down from 20), 29,720—up 14% from 25,981, but down from 17% in October
• Peru (32—down from 17), 29,059—up 7% from 27,246, but down from 12% in October
• Chile (33—down from 19), 28,761- up 8% from 26,616, but down from 11% in October
• Italy (37—up from 56),26,505—up 136% from 11,249, up from 118% in October
• Colombia (39—down from 26), 25,766—up 23% from 21,036
• OTHER MONITORED COUNTRIES/CONTINENTS WITH AN INCREASE OF 37% OR MORE
• UK (44—down from 41),23,954—up 61% from 14,876, but down from 130% in October
• EUROPE, 23,050—up 74% from 13,241, but down from 102% in October
• Russia (64—down from 59), 6,240—up 42% from 11,086, and up from 40% increase in October
• Germany (77—up from 86),12,742—up 104% from 6,240, and up from 81% increase in October
• Iran (82—same),11,394— up 57% from 7,256, and up from 36% increase in October
  
• Canada (90—down from 88), 9.875— up 59% from 6,195, and up from 52% increase in October

TOTAL DEATHS—1,472,576 worldwide, up 22.7% from 1,199,743 in October
Increases of 23% or more highlighted in red. Trending is direction of share of world deaths.

• TOP TEN MONITORED COUNTRIES + CONTINENTS, BY DEATHS (OCT. 31)
• NORTH AMERICA, 409,006—new this report—27.8% of all deaths
• EUROPE, 394,182—up 48% from 44,725—26.8% of all deaths (up from 20.3%)
  trending up
• SOUTH AMERICA, 325,518—new this report—22.1% of all deaths
• ASIA, 291,761—new this report—19.8% of all deaths
• USA (1—same), 274,056—up 16% from 236,072—18.6% of all deaths (down from 19.7%)
  trending down
• Brazil (2—same), 173,100—up 8% from 159,902—11.8% of all deaths (down from 13.1%)
  trending down
• India (3—same),137,649—up 13% from 122,149—9.3% of all deaths (down from 10.2%)
  overall trend is stable (about same in November as September, up slightly in October)
• Mexico (4—same), 105,655—up 16% from 91,289—7.2% of all deaths (down from 7.6%)
  trending down
• UK (5 -same),58,448—up 26% from 46,555—4.0% of all deaths (up from 3.9%)
  overall trend is stable (October down slightly from September, then November up slightly)
• Italy (6—same),55,576—up 44% from 38,618—3.8% of all deaths (up from 3.2%)
  trending up
• France (7—same), 52,731- up 43% from 36,799—3.6% of all deaths (up from 3.1%)
  trending up
• AFRCA, 57,083—new this report—3.5% of all deaths
• Iran (8—up from 9),48,246—up 38% from 34,864—3.3% of all deaths (up from 2.9%)
  trending up
• Spain (9—down from 8), 45,069—up 26% from 35,878—3.1% of all deaths (up from 3.0%)
  no significant trend
• Russia (10—up from 13), 39,895—up 43% from 27,990—2.7% of all deaths (up from 2.3%)
  trending up
• OTHER MONITORED COUNTRIES WITH INCREASE OF 23% OR MORE
• Argentina (11—up from 12), 38,473—up 24% from 31,002—2.6% of all deaths (same)
  no significant trend
• Germany (17—up from 20), 16,830—up 59% from 10,583—1.1% of all deaths (up from 0.9%)
  trending up
• Belgium (18—down from 17),16,547—up 45% from 11,452—1.1% of all deaths (up from 1.0%)
  trending up

DEATHS PER MILLION
Increases of 23% or more highlighted in red (level of increase in deaths worldwide in November)

• TOP TEN MONITORED COUNTRIES, BY DEATHS PER MILLION (NOV. 30)
• Belgium (1—up from 3), 1,425—up 44% from 987
• Peru (2—same),1,085—up 4% from 1,041
• Spain (5—same), 954—up 26% from 672
• Italy (6—up from 14), 920—up 44% from 639
• UK (7—up from 12), 859—up 25% from 618
• Argentina (9—up from 13), 848—up 24% from 684
• USA (10—same), 826—up 16% from 712
• Mexico (12—up from 11), 816—up 15% from 706
• Brazil (13—down from 6), 812—up 8% from 750
• France (14—up from 18) 807—up 43% from 487
• OTHER MONITORED COUNTRIES WITH AN INCREASE OF 23% OR MORE
• Iran (29—down from 25), 571—up 38% from 413
• EUROPE, 527—up 49% from 355
• Germany (58—down from 51), 273—up 42% from 192
• India (68—up from 72), 201—up 60% from 126

MORTALITY RATE (Deaths as proportion of cases— worst to least, using countries listed throughout this analysis). While deaths per million seems to provide a fair gauge of how countries are doing, another significant measure is the mortality rate—which can be seen as relative risk of death for those who become infected. While the U.S. is at the top of cases and deaths, it's mortality rate has been at the lower end of countries monitored for this report.

Over the three months of analysis, the overall trend in mortality is down, with the average (mean) dropping from 5.5% in September to 3.9% in October and 3.4% in November. The median (mid-point in range of values) dropped from 5.1% in September to 2.8% for both October and November. This would seem to indicate that while more people are becoming infected, the chances of dying are going down, perhaps because the most vulnerable have already contracted the virus.

• Mexico—9.5% (down from 9.9% and trending down)
• Ecuador—7.0% (down from 7.5% and trending down)
• Bolivia—6.2% (up from 6.1% and trending up)
• China—5.3% (down from 5.4% with trending unclear because of incomplete reporting)
• Iran—5.0% (down from 5.7% and trending down)
• Peru—3.7% (down from 3.8% and trending down)
• UK—3/6% (down from 4.7% and trending down)
• Italy—3.5% (down from 5.7% and trending down)
• Canada—3.2% (down from 4.3% and trending down)
• France—3.2% (up from 2.6% with no significant trend over three months)
• SOUTH AMERICA—2.9% (new this report)
• Belgium—2.9% (up from 2.8%, but overall trend down)
• Chili—2.8% (unchanged)
• Colombia—2.8% (unchanged)
• Brazil—2.7% (down from 2.9% and trending down)
• Argentina—2.7% (up from 2.6% and trending up very slightly)
• NORTH AMERICA—2.5% (new this report)
• AFRICA—2.4% (new this report)
• EUROPE—2.3% (down from 2.7% and trending down)
• Spain—2.0% (down from 2.8% and trending down)
• USA—2.0% (down from 2.5% and trending down)
• ASIA—1.7% (new this report)
• Russia—1.7% (unchanged)
• Germany—1.6% (down from 2.0% and trending down)
• India—1.5% (unchanged)

TOTAL TESTS
Total tests and Tests per million will grow increasingly vague as testing methods improve and testing of individuals is done with varying frequency (i.e., some colleges and places of business requiring weekly tests, which will inflate the number of tests, but not provide a true sense of coverage of the population).
Increases of 30% or more highlighted in red.

• TOP TEN MONITORED COUNTRIES, BY TESTS (NOV. 30)
• USA (1- up from 2), 193.6M—up 34% from 144.2M
• China (2—down from 1), 160.0M—no new numbers reported since September
  
• India (3—same), 140.4M —up 29% from 108.8M
• Russia (4—same), 76.4M —up 27% from 60.4M
• UK (5—same), 43.5M —up 30% from 33/5M
• Germany (6—up from 7), 27.9M—up 27% from 21.9M
• Spain (7—up from 8), 23.0M—up 37% from 18.8M
• Italy (8—up from 10), 21.9M—up 39% from 15.8M)
• Brazil (9—down from 6), 21.9M—no reported change in November
• France (10—down from 9), 20.6M—up 28% from 16/1M
• OTHER MONITORED COUNTRIES WITH AN INCREASE OF 30% OR MORE
• Argentina (36—same), 3.9M—up 30% from 3.0M
• Ecuador (82—down from 80), 0.8M—up 60% from 0.5M
• Bolivia (106—down from 98), 0,4M—up 33% from 0.3M

TESTS PER MILLION
Increases of 30% or more highlighted in red

• TOP TEN MONITORED COUNTRIES, BY TESTS PER MILLION (NOV. 30)
• UK (15—up from 18), 638K—up 30% from 492K
• USA (14—up from 15), 583K—up 34% from 4347K
  
• Russia (20—up from 22), 524K—up 27% from 414K
• Belgium (22—down from 20), 508K - up 20% from 422K
• Spain (24—up from 28), 492K—up 38% from 357K
• Italy (36—up from 37), 363K—up 39% from 261K
• Germany (42—down from 38), 332K—up 27% from 261K
• France (43—down from 42), 316K—up 28% from 245K
• Canada (46—down from 39), 301K—up 17% from 258K
• Chile (49—down from 46), 225K—up 24% from 225K
• OTHER MONITORED COUNTRIES WITH AN INCREASE OF 30% OR MORE
• None met the 30% threshold

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This article was also posted on SeniorLifestyle, which I edit