A systematic review and meta-analysis estimates a nearly 50% long-COVID rate months after infection in Africa, with psychiatric conditions the most common manifestations.
Published today in Scientific Reports, the February 2023 literature search and analysis involved 25 observational, English language long-COVID studies with 29,213 infected African patients.
Nearly half (48%) of the studies were from Egypt, the average patient age was 42years (range, 7 to 73 years), 59.3% were females, and the median follow-up was 3 months.
"In low-income countries, the estimates of its [long COVID's] incidence vary greatly due to a significant number of hidden infections (i.e., asymptomatic or undisclosed) and difficulties in accessing testing," the study authors wrote.
The team, led by researchers from the University of Bari in Italy, found a long-COVID rate of 48.6%, with a predominance of psychiatric conditions, especially post-traumatic stress disorder (25.8%).
The most common neurologic symptom was cognitive impairment (15%), and shortness of breath was the most common respiratory symptom (18.3%), followed by cough (10.7%). Other notable symptoms were loss of appetite (12.7%), weight loss (10.4%), fatigue (35.4%), and muscle pain (15.5%). A quarter (25.4%) of patients reported poor quality of life.
The high incidence of fatigue is particularly worrisome because of its debilitating nature. "This is concerning because, in Africa, it has the potential to lead to important impairment in productivity and further loss of economic agency," the researchers wrote.
The study recommends identifying at-risk people and defining treatment strategies and recommendations for African long-COVID patients.
Likewise, the mental illness burden in long-COVID patients poses a challenge on a continent with few mental health resources: "These findings highlight the pressing need for immediate policy implementation and reallocation of resources to address this severely underestimated public health issue."
Risk factors for long COVID included older age and hospitalization during infection.
"The study recommends identifying at-risk people and defining treatment strategies and recommendations for African long-COVID patients," the authors concluded, noting that high-quality studies are urgently needed.
Boris Johnson shown all the times he said 'let Covid rip' in uncomfortable inquiry moment
Rishi Sunak is next up to be questioned on his actions during the Covid-19 pandemic when he appears before the inquiry on Monday.
The prime minister, who was chancellor during the pandemic, will respond to claims that his Eat Out to Help Out scheme spread the disease.
The plan formed part of Mr Sunaks summer economic update in July 2020, and provided 50% off the cost of food and non-alcoholic drinks.
WhatsApp messages shown to the Covid-19 Inquiry have revealed that government advisers referred to Mr Sunak as Dr Death during the pandemic, because of concerns about the impact of his push to keep economic activity going.
Professor Sir Chris Whitty, Englands chief medical officer, is said to have privately referred to the scheme to boost the restaurant industry as eat out to help out the virus.
The PM is the latest member of the Covid-19 cabinet to face the inquiry. Last week, former prime minister Boris Johnson defended his actions and hit out at dramatic representations of the Partygate revelations.
While the current prime minister, Rishi Sunak, is set to face the Covid-19 Inquiry on Monday, the former prime minister gave his evidence last week.
Boris Johnson delivered two days of highly-charged Covid testimony, forcing him to face up to his administrations failings during the crisis.
He stuck to his guns on lockdowns, describing the decision to impose a national lockdown in March 2020 as probably timely, adding: I do not believe it should have been made earlier.
However, he admitted the possibility that earlier interventions could have been introduced.
Mr Johnson did also admit in his statement that his tiered local lockdown system was a failure and admitted to not remember any specific consideration being given to the question of testing hospital patients before they were discharged to care homes in March 2020.
The former prime minister did however defend the decision for him to not chair the Cobra meetings held at the start of the pandemic.
Boris Johnson faced two days of questioning at Covid-19 inquiry (UK Covid-19 Inquiry/PA)
(PA Media)
Athena Stavrou10 December 2023 21:10
Rishi Sunak is set to face the Covid inquiry tomorrow, but he has been mentioned in the hearing multiple times since it began several weeks ago.
In one of the most explosive claims heard at the inquiry so far, the now prime minister, who was chancellor at the time, allegedly believed it was time to just let people die and thats okay in the autumn of 2020.
The accusation, made by former chief of staff Dominic Cummings, was documented in Sir Patrick Vallances diary and was heard by the inquiry on November 20.
WhatsApp messages shown to the Covid-19 Inquiry also revealed that government advisers referred to Mr Sunak as Dr Death during the pandemic, because of concerns about the impact of his push to keep economic activity going.
Athena Stavrou10 December 2023 20:10
The prime minister is due to face the Covid-19 Inquiry tomorrow and respond to claims that his economic policies spread the disease further.
These are some of the key questions he will most likely have to answer:
- Did he seek medical or expert advice on Eat Out to Help out?
- Why was 800m was spent on East Out to Help Out which lasted just over a month, but just 385m was spent on the self-isolation support scheme in total throughout its 18-month existence?
- Was there a trade-off between public health and the economy?
- Why wasnt more done for those required to self-isolate under government rules?
(PA Archive)
Athena Stavrou10 December 2023 19:10
Rishi Sunak is set to face the Covid-19 inquiry on Monday and respond to claims his Eat Out to Help Out scheme spread the disease.
The prime minister was chancellor at the time of the crisis and has been referred to as Dr Death in Whatsapp messages seen by the inquiry between government advisers.
The plan formed part of Mr Sunaks summer economic update in July 2020, and provided 50% off the cost of food and non-alcoholic drinks.
Professor Sir Chris Whitty, Englands chief medical officer, is said to have privately referred to the scheme to boost the restaurant industry as eat out to help out the virus.
(PA Archive)
Athena Stavrou10 December 2023 18:10
Prof Edmunds told the inquiry on Thursday the Dr Death reference could well be about the Eat Out to Help Out scheme, which was devised by then-chancellor Mr Sunak and deployed a month earlier in a bid to kickstart the restaurant industry following lockdown.
The announcement that Mr Sunak will face a whole day of questioning on Monday came as former prime minister Boris Johnson began his second day of questioning.
Baroness Halletts inquiry has heard that scientists and then-health secretary Matt Hancock were left out of discussions around the Eat Out to Help Out scheme, which offered discounted meals in summer 2020 to help the hospitality trade after lockdown measures were lifted.
Mr Hancock told the inquiry he was not told about the scheme until the day it was announced and argued very strongly against the possibility of extending it at the end of August 2020.
The inquiry has also heard that former Government chief scientific adviser Professor Sir Patrick Vallance, Englands chief medical officer Professor Sir Chris Whitty and their former deputies Dame Angela and Professor Sir Jonathan Van-Tam were also not told about the scheme.
Rishi Sunak during Thursdays emergency press press conference in Downing Street
(PA)
Sam Rkaina8 December 2023 07:00
Rishi Sunak will be questioned about his actions during the Covid-19 pandemic when he appears before the hearing on Monday.
The Prime Minister was chancellor during the crisis and is likely to be questioned about the impact of his policies such as the Eat Out to Help Out scheme.
Government advisers referred to Mr Sunak as Dr Death during the pandemic, WhatsApp messages shown to the UK Covid-19 Inquiry have revealed, because of concerns about the impact of his push to keep economic activity going.
The correspondence between epidemiologist Professor John Edmunds and Professor Dame Angela McLean now chief scientific adviser to the Government took place during a meeting in September 2020.
Dame Angela messaged Prof Edmunds, referring to Dr Death the Chancellor, the inquiry was told.
Sam Rkaina8 December 2023 06:00
Boris Johnson was jeered as he left the Covid-19 inquiry after two days of giving evidence.
Protesters outside shouted murderer and shame on you as he left Dorland House in west London to his awaiting car.
(Getty Images)
Sam Rkaina8 December 2023 05:00
Boris Johnson appears to talk down the clock on questions about Covids impact on minorities
Sam Rkaina8 December 2023 04:00
Boris Johnson referred to his own Governments facemask policy as f***** up in the summer of 2020, the Covid-19 Inquiry has heard.
It also emerged the former prime minister would bullshit no surrender ideas from his ministers and then come to regret it later.
Mr Johnson was being questioned on Thursday about his u-turn on policies around facemasks in secondary schools in August 2020.
At the time, then-education secretary Gavin Williamson had insisted measures being adopted by schools to limit the spread of coronavirus meant masks were not required.
However, the Government revised its recommendations following updated guidance from the World Health Organisation (WHO), which said: Children aged 12 and over should wear a mask under the same conditions as adults.
A statement from the Department for Education on August 25 2020 said that nationwide, while the government is not recommending face coverings are necessary, schools will have the discretion to require face coverings in communal areas if they believe that is right in their particular circumstances.
Sam Rkaina8 December 2023 03:00
Gasps as Boris Johnson snaps at Covid inquiry lawyer over death toll figures
Sam Rkaina8 December 2023 02:02
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The Chicago Department of Public Health is trying to help people get vaccinated through one of its last city college clinics, with COVID cases on the rise in nearly half of the state's counties.
Chicago-area residents are certainly noticing that cases of COVID-19 and R.S.V are popping up, and doctors say they're feeling the impacts in clinics and hospitals too.
Its definitely spreading like wildfire all throughout, said Dr. Juanita Mora, national spokesperson for the American Lung Association.
Mora added that vaccines are still the first line of defense, with the shots available for COVID, RSV and a flu shot.
Making sure everyone in the family, 6 months and older has received a flu shot," Dr. Mora said. "A Covid-19 vaccine, remember this is going to be an annual vaccine...
Mora says that residents should be staying home when theyre sick, washing their hands more often and ventilating spaces where gatherings are taking place.
We make sure that a window gets open, that the air purifiers are on as well, so that way we keep the ventilation going on," she said.
The Centers for Disease Control and Prevention are monitoring COVID hospitalizations.
The data for the week ending on Nov. 25 stated there are 39 counties in Illinois at a medium level of hospitalizations, and five counties at a high level.
That is a 20% increase from the previous week, according to the C.D.C.
The closest to Chicago at the medium threshold is Kankakee County, while all other counties in the region are still at "low" levels.
In order to prepare for a possible uptick, the Illinois Department of Public Health launched its own respiratory disease dashboard, but the simplest ways to stay safe are still the ones that carried through the pandemic.
Make sure to mask up on the train, on the plane, etcetera, so that way when you get home and you kiss Grandma, youll be infection free," Mora said.
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Posted: December 08, 2023
About one in nine Canadian adults have experienced long-term symptoms from COVID-19 infection, according to a Statistics Canada report issued Friday.
That amounts to 3.5 million Canadians, it said.
Almost 80 per cent of those people with long-term symptoms have them for six months or more, the report said. In addition, more than half of those who ever had long-term symptoms still had them as of June 2023.
"Among Canadians who reported ever experiencing long-term symptoms, those who continue to experience these symptoms (58.2 per cent) outnumber those who have reported them resolved (41.8 per cent)," the report said.
Long COVID, also known as post COVID-19 condition, is defined by the World Health Organization as symptoms that persist for three months or longer after infection and can't be explained by anything else.
The Statistics Canada findings aren't surprising, said Manali Mukherjee, an assistant professor of medicine at McMaster University in Hamilton who specializes in respiratory diseases and immunology in an interview on Friday.
WATCH | Research suggests most long COVID symptoms clear after a year:
Show more
"There is a subset of patients who have long COVID symptoms affecting their quality of life, their productivity on a daily level," said Mukherjee, who is a long COVID researcher and also spent about 18 months recovering from her own symptoms.
The most common long COVID symptoms are brain fog, fatigue and shortness of breath, she said.
Two-thirds of Canadian adults who have tried to get health-care services for their long-term symptoms say they haven't received enough treatment or support, the Statistics Canada report said.
Research shows that getting vaccinated against COVID-19 reduces the risk of getting long COVID, as well as the severity of symptoms, Mukherjee said.
The Statistics Canada report also noted nearlyone in five Canadian adults have had more than one known or suspected COVID-19infection.
The percentage of Canadian adults who ever tested positive for or suspected a COVID-19infectionincreased from roughly 39 per centin the summer of2022to64 per centby June2023.
As of that time,45 per centof Canadians had experienced one infection,14 per centhad experienced twoanda little more than five per cent had experienced three or more.Statistics Canada said those numbers are likely an underestimate.
WATCH | Winnipeg woman shares her experience with Long COVID:
Show more
As the December holidays take off, public health experts advise Illinoisans to be vigilant against COVID-19 with cases rising along with other respiratory diseases.
"As we anticipated, we are seeing an increase in respiratory viruses -- including COVID-19, flu and RSV -- both in Illinois and across the nation," Illinois Department of Public Health Director Dr. Sameer Vohra said Friday.
New hospitalizations for COVID-19 spiked by 1,225 people or 22.3% as of Dec. 2 compared to the previous week, according to the latest U.S. Centers for Disease Control data.
Flu and RSV are also increasing across the state, the IDPH reported.
The agency also announced it was launching an infectious respiratory disease dashboard with information about hospitalizations, lab test positivity and other metrics. The dashboard is available at dph.illinois.gov/topics-services/diseases-and-conditions/respiratory-disease/surveillance/respiratory-disease-report.
COVID-19 hospitalizations in the Chicago metro region remain low. Of Illinois' 102 counties, 41 are at medium levels for patients and 10 counties in west-central Illinois are seeing high hospitalizations. They comprise Brown, Cass, Christian, Knox, Logan, McDonough, Menard, Sangamon, Schuyler and Warren counties.
With multiple gatherings under way for Hanukkah and stretching through Christmas and New Year's, officials recommend testing for COVID-19 if celebrating with older family members, washing hands, providing robust ventilation at home parties, masking in crowds and staying home if you're feeling sick.
Vohra also urged residents to get vaccinated for COVID-19, flu and RSV.
Meanwhile, officials reported COVID-19 outbreaks at a number of state-run developmental centers serving individuals with severe intellectual or developmental needs.
As of Wednesday, "there were 58 residents, out of approximately 1,650 total, and 35 staff, out of approximately 3,500 total, who have tested positive for COVID-19 since Nov. 20," the IDPH said.
The state has seven developmental centers including sites in Waukegan and Park Forest. The Ann Kiley Center in Waukegan reported 40 COVID-19 cases with 30 residents and 10 staff members testing positive.
Pandemics have killed millions of people throughout history. How many deaths were caused by different pandemics, and how have researchers estimated their death tolls?
COVID-19 has brought the reality of pandemics to the forefront of public consciousness. But pandemics have afflicted humanity for millennia. Time and again, people faced outbreaks of diseases including influenza, cholera, bubonic plague, smallpox, and measles that spread far and caused death and devastation.
Our ancestors were largely powerless against these diseases and unable to evaluate their true toll on the population. Without good record-keeping of the number of cases and deaths, the impact of outbreaks was underrecognized or even forgotten. The result is that we tend to underestimate the frequency and severity of pandemics in history.
Often, we have records of epidemics occurring in some countries but lack good records from other regions, despite knowing that the geographical impact of the disease would have been very wide. Additionally, we often lack knowledge about which pathogens caused outbreaks and, thus, if a historical event can be considered a pandemic or if it consisted of parallel outbreaks of different diseases.
To deal with the lack of historical records on total death tolls, modern historians, epidemiologists, and demographic researchers have used various sources and methods to estimate their death tolls such as using data from death records, tax registers, land use, archaeological records, epidemiological modeling, and more.
In this article, I present the various methods they rely on and visualize the estimated impact of what are now considered the major pandemics in history.
Although there is no universally accepted definition of a pandemic1, diseases called pandemics share several characteristics.
Pandemics generally refer to diseases with a vast geographic range such as spreading across a continent or multiple continents. In addition, they tend to describe outbreaks that are rapidly growing or expanding in range; highly infectious; affecting a large number of people; and caused by novel pathogens against which there is little or no pre-existing immunity.2
Researchers have estimated the death tolls of pandemics in different ways, depending on the data available.
Some death tolls have been estimated by looking at excess deaths: researchers estimate the additional number of deaths that occurred during a pandemic compared to the expected number of deaths in a typical year. This can be helpful to understand the pandemics overall impact, even if records from death certificates are unavailable.
For some pandemics, death tolls are estimated from the net population reduction, where researchers calculate the difference in population size before and after the pandemic. This is often used for severe events such as the Columbian Exchange where a significant fraction of the population died.
Some death tolls have been estimated through epidemiological modeling based on knowledge of the transmission of the disease and its geographical spread, its fatality rate (the share of people affected who die from it), access to treatment, and other types of data.
Finally, some death tolls have been calculated only using recorded deaths (also referred to as confirmed deaths). This is the number of deaths officially reported with the disease as their cause of death. This method may vastly underestimate the number of deaths caused by the pandemic, as comprehensive historical records are lacking. Even today, cause-of-death registration is lacking in many parts of the world, which is one reason why the number of confirmed deaths from COVID-19 is much lower than the total death toll from the pandemic.
I have brought together estimates of death tolls from different pandemics in history for this article, which we have visualized in a timeline below.
The size of each circle represents one pandemics estimated death toll. Pandemics without a known death toll are depicted with triangles.
This overview shows us the vast impact that pandemics have had over history.
You can see that the largest pandemics such as the Black Death killed more than half of the population. Several pandemics have swept through the population repeatedly: in just the last two hundred years, seven major pandemics were caused by cholera, and another seven were caused by the flu.
Pandemics devastated millions and left a shadow on those who survived. The suffering they caused may once have felt inescapable.
Before the formation of germ theory,we lacked good knowledge of pathogens that caused them, how they spread, and how to protect ourselves from them. Before molecular testing to analyze pathogens genomes, we lacked a good understanding of how they evolved and changed over time.
Our ability to respond to pandemics has been transformed by advances in scientific understanding but truly depends on a wide range of efforts from data collection to research and communication, public health efforts, healthcare access, and cooperation.
For example, the collection of death records allowed scientists to discover how cholera spread and how to prevent it. Coordination to address HIV/AIDS has prevented millions of deaths worldwide. Global testing for new influenza strains has helped adapt flu vaccines each year.
With better understanding, resources, and effort, much more progress can be made. The world can respond more swiftly and effectively to pandemic risks and avoid and reduce the impact of future pandemics. But without such efforts, we will continue to face major pandemics as we have experienced so far.
The full dataset and sources used in the chart can be found in our spreadsheet.
In the appendix below, I review some of the major pandemics in history and their historical impact and describe how their death tolls have been estimated.
The Black Death (13461353 CE) one of the earliest pandemics with a methodically estimated death toll killed around 5060% of Europes population, approximately 50 million people, in just 6 years.3
Researchers have established that many people also died elsewhere as large outbreaks are also recognizable in historical records from Western Asia, the Middle East, and North Africa but comprehensive estimates of the global death toll are not available.
Population censuses were not conducted then, so our understanding of the Black Deaths impact in Europe comes from historical records such as tax and rent registers, parish records, and archeological remains. But uncertainty remains, as these records come from a limited number of European regions and are extrapolated to the rest of the continent, based on demographic estimates.
Careful examination of these sources has led to historians revising estimates of the death toll upwards4 and confirmed the bacterial cause of the pandemic: Yersinia pestis (Y. pestis).5
People in the fourteenth century were not aware of this bacterium, nor did they know how it was transmitted from rat fleas to humans as this was long before the development of germ theory in the late nineteenth century.6
Without this knowledge, they also had little understanding of how to protect themselves, resulting in the relentless spread of the Black Death. Even after its initial wave, the pandemic continued with frequent, though smaller outbreaks until around 1690.7
Y. pestis caused diseases known as bubonic and pneumonic plague, where patients experienced fevers, chills, vomiting, and excruciating headaches, and distinctive buboes formed in their swollen lymph nodes typically in the groin, thighs, armpits, or neck.
As Y. pestis spreads through the lymph nodes, it emits toxins that break down blood vessels and form clots, potentially blocking blood circulation and leading to death.8
It is now recognized that the Black Death was not the only plague caused by Y. pestis. Genetic evidence suggests that this bacteria emerged at least 4000 years ago.9
The first known bubonic plague pandemic began in 541 CE and had recurrent outbreaks until the mid-8th century. This devastating pandemic affected the Eastern Roman Empire (Byzantine Empire), the Middle East, North Africa, and the Mediterranean.
The initial and most severe outbreak, known as the Justinian Plague (541549 CE), was named after Emperor Justinian, who ruled Constantinople at the time.10
The third pandemic occurred between 1894 and 1940, mainly affecting Asia and Africa.
Bubonic plague is less common today due to improved sanitation and hygiene measures which reduce the density of rats and rat fleas, improved public health surveillance, and effective antibiotics, but cases have been seen even in recent years, in different continents, mainly in small towns and villages.11
The chart shows the immense impact of the Columbian Exchange, with an estimated 48 million deaths.
The Columbian Exchange describes the period following Christopher Columbuss voyage to the Americas in 1492 during which populations, ideas, and crops,such as tomatoes, potatoes, and maize,spread between the Americas and the rest of the world.
But the Columbian Exchange also involved extensive war, conquest, slavery, and the spread of multiple deadly diseases, which led to the devastation of indigenous populations.12
Smallpox, cholera, measles, diphtheria, influenza, typhoid fever, bubonic plague, and other diseases had already killed many in Europe. But theytended to be more severe to Native Americans,who had been previously isolated from these diseases and lacked immunity to them.
The immense death toll shown on the chart is calculated as a net population reduction compared to the pre-1492 population size.
The Native American population was estimated to be around 54 million before Columbuss arrival. Over the following century, around 48 million died and the population had declined to 5.6 million in 1600 a reduction of about 90%.
Both numbers are estimated by compiling data from a range of sources, including archeological records, tribal records, censuses, epidemiological modeling, and land and crop use.13
Influenza (flu) pandemics arise through sudden evolutionary changes in flu viruses when different strains combine to form novel flu strains14, which can be more infectious and lethal than previous ones.
Although flu has affected humanity for thousands of years15, comprehensive death tolls have only been estimated for the flu pandemics in the last 140 years.
The largest the 1918 Spanish flu pandemic has an estimated death toll of 50 to 100 million.16 This estimate is a compilation of various historical sources, including recorded death tolls and estimates of excess deaths from different regions.
You can read more about the impact of the Spanish flu pandemic in our article:
The Spanish flu pandemic had a devastating impact on the global population.
The chart also shows the estimated impact of other significant flu pandemics:the 1889 Russian flu pandemic (an estimated 4 million deaths), the 1957 Asian flu pandemic (2 million), the 1968 Hong Kong flu pandemic (2 million), and the 2009 Swine flu pandemic (100,000 to 1.9 million deaths).17
Their death tolls have been estimated from excess mortality during the pandemics compared to the years immediately before and after, using available national mortality records and extrapolation to the global population.
As the chart shows, seven cholera pandemics have occurred in the last two centuries.18 Mostare considered to have originated in the Indian subcontinent and expanded across countries and continents through war, travel, and international trade.19
Our knowledge of the total global death toll from cholera in history is limited20, but historical reports from across the world suggest an immense impact of the disease. For example, between 1865 and 1947, at least 23 million people died from cholera in India alone.21 But significant outbreaks have been recorded in many more countries.22
Cholera is particularly severe because, if left untreated, the bacteria Vibrio cholerae can cause severe dehydration and death within hours or days of the first symptoms.23
Its severity has been reduced with a range of scientific advances: the understanding that cholera spread through contaminated water and food, and thus that clean water and sanitation could prevent it; the identification of Vibrio cholerae as the cause; the development of antibiotics; and the knowledge that severe forms of the disease could be substantially reduced with simple rehydration treatment.24
Cholera continues to kill, even today. Since 1960, over 900,000 deaths have been recorded from cholera globally as part of whats considered the seventh cholera pandemic this is shown in the chart.25
When HIV/AIDS (acquired immunodeficiency syndrome) was first identified in the early 1980s, it had a fatality rate of 100%, and patients had a median survival time of about one year after being diagnosed.26 It spread rapidly as the world grappled to recognize, understand, and respond to the growing epidemic.
HIV, the virus that causes AIDS, attacks white blood cells which are critical for our immune function and leaves patients vulnerable to a wide range of opportunistic infections and diseases.
Learn more on our page on HIV/AIDS:
A global epidemic and the leading cause of death in some countries.
The timeline shows the enormous and continuing impact of HIV/AIDS, which has resulted in an estimated 33 million deaths worldwide between 1981 and 2022.
Our understanding of its death toll comes from available data and statistical modeling. The estimates consider various factors, such as characteristics of the viruss transmission, behavioral and clinical data, the availability of treatment, and recorded deaths from countries with high levels of death registration. 27
The global response to HIV/AIDS has involved international cooperation, resource allocation, and scientific advances in antiretroviral therapy, which together have transformed HIV from a fatal diagnosis to a manageable chronic condition with treatment.
In recent years, around 1.5 million deaths have been averted annually due to the effects of antiretroviral therapy which prevents the virus from replicating and thereby reduces the severity of the disease and its spread to other individuals.
This is shown in the chart below, along with the estimated number of HIV/AIDS deaths that still occur around 600,000 deaths annually in recent years.
The COVID-19 pandemic was caused by the novel coronavirus SARS-CoV-2, which emerged at the end of 2019 and rapidly evolved into a global health emergency. Characterized by its highly infectious nature and severe respiratory symptoms, COVID-19 led to widespread illness and fatalities across the world.
The timeline above shows the vast global impact of the COVID-19 pandemic with around 27 million excess deaths between January 2020 and November 2023.28 This makes it one of the deadliest pandemics of the last century.
COVID-19s death toll has been measured by excess mortality, which describes the number of deaths above what would have been expected based on previous years.
This method is used because the global number of confirmed deaths from COVID-19 (those where COVID-19 is listed as the cause of death) is certainly much lower than the total number of deaths from COVID-19. This is because, in many countries, testing for COVID was very limited throughout the pandemic, and cause-of-death registration was, and still is, lacking in many countries.29
Excess mortality also has the advantage of not only considering deaths directly caused by the virus but also those indirectly caused by the pandemics impact on healthcare systems and economies.
Learn more about excess mortality here:
To estimate excess mortality, researchers use national mortality data from countries where data is available, as well as statistical models which rely on data on COVID-19 testing rates, confirmed cases and deaths, population age structure, state policies, and more for other countries.
The estimated death toll we show for COVID-19 27 million deaths by November 2023 comes from The Economist. The main reasons why I am relying on The Economists estimates are that they are continuously updated, and their methodology is well documented.
In contrast, while the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME) have also estimated the number of excess deaths, their latest estimates were only based on the time period until the end of 2021. For this time period, all three sources provide similar estimates (18.2 million deaths were estimated by the IHME; 14.8 million deaths were estimated by the WHO; and 17.8 million deaths were estimated by The Economist).30
The chart below shows the excess mortality during COVID-19, as estimated by The Economist, along with the number of confirmed deaths. As you can see, there is wide uncertainty around the total number of excess deaths during the pandemic. However, even the lowest estimates are much higher than the number of confirmed deaths reflecting the limited amount of testing and death registration globally during the pandemic.
Our articles and data visualizations rely on work from many different people and organizations. When citing this article, please also cite the underlying data sources. This article can be cited as:
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All visualizations, data, and code produced by Our World in Data are completely open access under the Creative Commons BY license. You have the permission to use, distribute, and reproduce these in any medium, provided the source and authors are credited.
The data produced by third parties and made available by Our World in Data is subject to the license terms from the original third-party authors. We will always indicate the original source of the data in our documentation, so you should always check the license of any such third-party data before use and redistribution.
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Boris Johnson's first Covid inquiry appearance video highlights Covid inquiry
The former PM is scheduled to be questioned for two days. Here is what happened at his first session at the inquiry
The UKs former prime minister Boris Johnson has issued a series of apologies about mistakes made during the pandemic.
But, on the first of his two days of evidence to the Covid inquiry, he also defended the bulk of his decision-making.
Here are some of the key points from day one of his evidence:
Johnson began his appearance by issuing an apology for the pain and the loss and the suffering
As Johnson was attempting to deliver his prepared apology, four people staged a protest inside the inquiry room. One held a sign saying: The dead cant hear your apologies. They were led away.
Johnson said: Can I just say how glad I am to be at this inquiry and how sorry I am for the pain and the loss and the suffering of the Covid victims.
About 5,000 WhatsApp messages on Johnsons phone from 30 January 2020 to June 2020 were unavailable to the inquiry
A barrister acting for the inquiry, Hugo Keith KC, said a technical report provided by Johnsons solicitors suggested there may have been a factory reset at the end of January 2020 followed by an attempt to reinstate the contents in June 2020, but Johnson denied knowledge of that.
I dont remember any such thing, he said.
Johnson defended the disputatious culture in No 10
A toxic culture of backstabbing and misogyny has already been laid bare at the Covid public inquiry. A key figure has been Dominic Cummings, Johnsons former and now-estranged chief adviser, who was accused in October of aggressive, foul-mouthed and misogynistic abuse toward others working in government.
Johnson avoided mentioning Cummings by name. He said: I knew that some people were difficult. I didnt know how difficult they were clearly.
But I thought it was better on the whole for the country to have a disputatious culture in No 10 than one that was quietly acquiescent to whatever I or the scientists said.
Johnson defended his decision not to sack Matt Hancock as health secretary
The inquiry has heard that Hancock became a lightning rod for criticism and that Johnson was urged to sack him by Cummings and the then-cabinet secretary Mark Sedwill.
Johnson said: If youre a prime minister, you are constantly being lobbied by somebody to sack somebody else. It is perfectly true that this adviser in particular had a low opinion of the health secretary.
I thought he was wrong. I thought the health secretary worked very hard and whatever he may have had [in] defects, I thought that he was doing his best in very difficult circumstances and I thought he was a good communicator.
Asked about claims from Cummings that Johnson wanted to keep Hancock as a sacrifice for the inquiry, he said: I dont remember that at all. And its nonsense.
Covid decision-making was too male-dominated, Johnson admitted
The gender balance of my team should have been better, Johnson told the inquiry. The inquiry previously heard from Helen MacNamara, a senior civil servant who held the role of the deputy cabinet secretary, that there was institutional bias against women in Covid decision-making.
Johnson said: I think sometimes during the pandemic too many meetings were too male-dominated.
Johnson apologised for failing to call out misogynistic attacks on a civil servant
The inquiry previously heard that Cummings urged Johnson to sack MacNamara and complained to him of dodging stilettos from that cunt. Asked why he did not put a stop to such language, Johnson said: Ive rung Helen MacNamara to apologise to her for not having called it out.
Johnson repeatedly disparaged those suffering from long Covid
The inquiry heard that Johnson scribbled disparaging remarks about long Covid, including describing it as bollocks. In February 2021 he suggested it was similar to soldiers falsely claiming they were suffering from Gulf War syndrome.
Johnson apologised for the remarks, saying they were not intended for publication.
He said: Im sure that they have caused hurt and offence to a huge numbers of people who, who do indeed suffer from that syndrome and I regret very much using that language. I was trying to get my officials to explain to me exactly what the syndrome was.
Johnson admitted vastly underestimating the risks in the early stages of the pandemic
The former PM said both he and Whitehall more generally failed to understand the seriousness of the pandemic in late January and February 2020.
Asked why information on 29 January about the virus spreading outside China did not become a lightbulb moment, Johnson said: I dont think that we were able to comprehend the implications of what we were actually looking at.
The problem was that I dont think we attached enough credence to those forecasts and, because of the experience that wed had with other zoonotic diseases [infections transmitted between species], I think collectively in Whitehall there was not a sufficiently loud enough klaxon.
He added: Its clear that we vastly underestimated the risks in those early weeks. If we properly understood how fast Covid was spreading and the fact that it was spreading asymptomatically, there are many things we would have done differently we were operating on a fallacious inductive logic about previous reasonable worst-case scenarios.
Johnson insisted he was working during the February half-term school break of 2020, the focus of controversy over an alleged lack of engagement
The inquiry previously heard that from 14 February to 24 February 2020, Johnson was on a break in Chevening House, a country residence used by Britains prime ministers, and was not updated by his staff about Covid and had no briefings on two Cobra meetings that took place during this period.
But Johnson insisted this was not accurate. There wasnt a long holiday that I took I was working throughout the period and the tempo did increase.
He said he rang both the Chinese president, Xi Jinping, in part to discuss the origins of Covid and to compare notes on what was happening, and the then US president, Donald Trump, to discuss the same thing.
Johnson said that in a 28 February meeting the worst-case scenario (WCS) figures were presented and were a horrifying figure and I couldnt believe it.
I thought: Well, we have plenty of bad flu pandemics in the UK and if its milder than that then it wont be an exceptional thing at all, so why am I also being told that the WCS is 520,000?
The inquiry chair rebuked Johnson for leaks of his witness statement
Before Johnsons evidence began, the chair of the inquiry, Heather Hallett, complained about media briefings about what he would tell the inquiry.
Lady Hallett said: Id like to express my concern about reports in the press over the last few days of the contents of Mr Johnsons witness statement to the inquiry and what his evidence will be.
Until a witness is called and appears at a hearing, or the inquiry publishes the witnesss statement, its meant to be confidential between the witness, the inquiry and the core participants failing to respect confidentiality undermines the inquirys ability to do its job fairly, effectively and independently.
Johnsons remarks about people dying anyway showed cruelty of choice
A March 2020 internal government note showed that Johnson questioned why damage was being inflicted on the economy for people who will die anyway. Asked about the note, Johnson said it was an indication of the cruelty of choice at the time.
He was also asked what he meant in a handwritten note that said: Were killing the patient to tackle the tumour.
Johnson said if I did say something like that he was referring to the need to do things that were damaging in other ways in order to stamp down the virus.
Johnson also confirmed that the then chancellor, Rishi Sunak, warned him about risk to the UKs bond market and the ability to raise debt. Previous evidence has suggested that Sunak was among those in government who had been more reluctant than others to countenance a national lockdown.
Johnson almost certainly discussed Covid with the Russian media mogul Evgeny Lebedev just days before lockdown
Previous evidence has raised questions about the closeness between Johnson and Lebedev, who was controversially given a life peerage in 2020.
Records read out showed that Johnson met with the newspaper proprietor and also phoned him at the height of what counsel for the inquiry described as a 10-day crisis about a change of strategy in the run-up to the first lockdown.
Asked about this, he said that Lebedev, who owned Londons Evening Standard newspaper, doubtless wanted to know what was happening in London and Johnson said he wanted to inform and support him.
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COVID-19 words in green and blue.
(Adobe Stock 331001452 by Web Buttons Inc)
The COVID-19 pandemic has brought about numerous challenges in controlling the transmission of the SARS-CoV-2 virus. To combat this, various measures, both low and high-tech, have been suggested and implemented to reduce transmission risks. This review discusses these measures and practical tools that can assess their effectiveness.
High technology and low technology measures to reduce risk of SARS-CoV-2 transmission recently published in the American Journal of Infection Control1 authored by Curtis J. Donskey, MD.
Low-Tech Measures
Hand Hygiene: One of the simplest and most effective ways to prevent viral transmission is proper hand hygiene. Regular handwashing with soap and water for at least 20 seconds is recommended. Additionally, hand sanitizers with at least 60% alcohol content can be used when soap and water are not available.
Ventilation: Improving ventilation in indoor spaces is crucial. Opening windows and using fans can help dilute indoor air and reduce the concentration of infectious aerosols. Monitoring carbon dioxide levels can be a useful tool to assess ventilation adequacy.
Donskey wrote, The concentration of carbon dioxide in outdoor air is approximately 400 parts per million (ppm) versus approximately 40,000 ppm in exhaled breath. Thus, carbon dioxide levels rise in occupied spaces that are inadequately ventilated for the number of people present. Handheld devices that cost less than $100 are commercially available and easy to use. The CDC has recommended that carbon dioxide levels above 800 ppm in buildings be considered an indicator of suboptimal ventilation requiring intervention.
Donskey told Infection Control Today (ICT), "The pandemic has highlighted the importance of ventilation. However, the lack of practical tools to assess ventilation has been a limitation of the pandemic response. How do people know if they need to take steps to improve ventilation if they cant identify areas where improvement is needed? We have found that simple tools like carbon dioxide monitoring (ie carbon dioxide from breathing builds up when ventilation is inadequate for the number of people in an occupied area) and measurements of clearance of 5% sodium chloride aerosol particles can be very useful. For example, in response to evidence of transmission of SARS-CoV-2 in patient transport vans, we used these tools to show that ventilation was inadequate and identified simple measures to improve ventilation (ie open windows or run the fans continuously to maintain airflow). These tools can also be used to provide healthcare personnel with reassurance that ventilation is adequate in their work area."
Masks: The use of masks, particularly high-filtration masks like N95 respirators, can significantly reduce the spread of respiratory droplets containing the virus. Proper mask-wearing and fit are essential.
Plexiglass Barriers: Plexiglass barriers have been employed in various settings, such as checkout counters and between seats on public transport. While they may provide some protection, their effectiveness depends on factors like airflow and proper installation. However, little evidence is available regarding the impact of barriers in real-world settings, Donskey wrote. An intervention that included physical barriers and universal masking was associated with a significant reduction in COVID-19 cases in meat processing facilities, but placing barriers between students was not associated with a reduction in COVID-19 in schools in Georgia.2 Moreover, there is concern that barriers that are not carefully installed have the potential to hinder good ventilation resulting in increased aerosol exposure.
Oral and Nasal Antiseptics: These antiseptics have been suggested to reduce the viral load in individuals with COVID-19, potentially reducing transmission. However, more research is needed to establish their real-world efficacy.
High-Tech Measures
Portable Air Cleaners: These devices, equipped with high-efficiency particulate air (HEPA) filters, can help improve indoor air quality by capturing aerosol particles, including viruses. They are especially useful when adequate natural ventilation is not possible.
Air Cleaning Technologies: Some technologies release reactive oxygen species, hydroxyl radicals, or hydrogen peroxide gas to inactivate viral particles in the air. However, further studies, including clinical trials, are needed to confirm their efficacy and safety. One tool is ultraviolet germicidal irradiation (UVGI).
UVGI is effective for inactivation of SARS-CoV-2 and other respiratory viruses in air," Donskey wrote. "The CDC recommends considering the use of UVGI as a supplemental treatment to inactivate SARS-CoV-2 only when other options for increasing room ventilation and filtration are limited. UVGI can be provided as upper-room UVGI fixtures that provide a disinfection zone of UV above the height of people in the room or as in-duct UVGI systems that kill viruses in central ventilation systems. Upper-room UVGI can be considered in areas likely to include sick people (eg, school nurse's office), in spaces where people must remove masks (eg, cafeterias, restaurants), or in crowded spaces. For upper-room UVGI, the ceiling must be at least 8 feet high."
Assessing Transmission Risk: Practical tools can aid in assessing ventilation and transmission risk. Carbon dioxide monitoring can indicate the adequacy of ventilation by measuring the concentration of exhaled CO2, which can reflect indoor air quality. Devices that release smoke or condensed moisture fog can visualize airflow patterns and assess the effectiveness of ventilation measures.
While some low-tech measures like hand hygiene, ventilation, and mask-wearing are likely to be helpful in reducing transmission, others, like plexiglass barriers and oral/nasal antiseptics, require more substantial evidence. High-tech measures like portable air cleaners and air cleaning technologies can be valuable in settings where natural ventilation is limited.
Donskey told ICT, "One measure that I did not comment on in the article is environmental cleaning. Environmental cleaning was downplayed as hygiene theater as evidence accumulated suggesting that the environment plays a relatively minor role in transmission of SARS-CoV-2.
"However, I think it is important that we dont generalize the findings for COVID-19 to all respiratory viruses. There is good evidence that contaminated fomites can transmit non-enveloped cold viruses and that RSV can be transmitted from contaminated surfaces."
References
Brigham and Women's Hospital (Boston main campus) 75 Francis Street Boston, MA 02115 617-732-5500 By appointment in office Codman Square Health Center
637 Washington Street, Boston, MA 02124
To make an appointment for a test, you can call 617-822-8271.
Walk-ins are held on a first come first serve basis.
Monday - Friday, from 8:30 a.m. - 12 p.m.
1266 Commonwealth Avenue Allston, MA 02134
3 Post Office Square, Boston, MA 02109
Varies
207 Market Street, Brighton, MA 02135
181 Brighton Avenue, Allston, MA 02134
1921 Centre Street West Roxbury, MA02132
4600 Washington Street, Roslindale, MA 02131
1150 Saratoga Street, East Boston, MA 02128
703 Gallivan Boulevard,Dorchester, MA02124
To get tested, register in advance online with CVS.
Testing for symptomatic and asymptomatic patients.
Appointments only, make an appointment by calling 617-569-5800before arriving on site. This helps reduce traffic and crowding.
Walk-up testing: Monday - Friday, 8:30 - 11:30 a.m. and1:30 - 3p.m.
Testing available by appointment only. To make an appointment call 617-323-4440.
Testing is available at no cost and regardless of symptoms.
Drive thru available in municipal parking lot.
Monday Tuesday and Thursday, 1:30 - 3 p.m.
Patients only. Registration required. Please call617-825-3400if you would like to get vaccinated or tested for COVID-19.
Monday, Wednesday, Thursday, Friday, and Saturday, from 10 a.m. - 3 p.m.
Tuesday from 3 - 5 p.m.
This location is subject to changes due to staffing availability, please call to confirm your appointment.
To schedule an appointment call 617-245-8206
Tuesday and Wednesday, 4 - 7 p.m.
617-388-5007
COVID-19 testing now takes place by appointment and for current patients only. Testing is located in the outdoor parking lot testing tent.
Monday Wednesday, Thursday, 9 - 11:30 a.m.
Tuesday, 1 - 4 p.m.
Friday, 10 - 11:30 a.m.
Saturday, 9 a.m. - 12 p.m.
Call 617-989-3071to make an appointment.
Take-home tests only offered to those who are symptomatic. No longer offering PCR testing
Monday through Saturday, 9 a.m. - 1 p.m.
