Thursday, January 12, 2023

WHO: Countries Reporting COVID Data Continues To Decline


Although the above chart from this week's WHO Epidemiological Update (#125) suggests that the incidence and impact of COVID continues to lessen - the WHO makes it quite clear that reporting of cases, ICU admissions, and even deaths around the world has declined sharply - making it difficult to draw firm conclusions from the available data. 

This week's report warns:
Globally, nearly 2.9 million new cases and over 11 000 deaths were reported in the week of 2 to 8 January 2023 (Figure 1, Table 1). This represents a reduction in weekly cases and deaths of 9% and 12%, respectively.

However, these trends need to be interpreted considering the reduction in testing and delays in reporting in many countries during the year-end holiday season. Therefore, data presented in this report, especially for the most recent weeks, are incomplete and the decreasing trends should be interpreted in that context as they may change with updated information provided following the holiday period. 

While diplomatically laying the blame on the `year-end holiday season', the WHO has been warning about reduced COVID reporting for months, and makes frequent pleas to member nations to improve surveillance and reporting (see WHO Statement 1/10/23).

The magnitude of this reporting deficient becomes much clearer when you dig deeper into the document. Under the heading Hospitalizations and ICU admissions  they report than only about 10% of countries are reporting data:

At the global level, during epidemiological week 52 (26 December 2022 to 01 January 2023), a total of 23 509 new hospitalizations and 1133 new intensive care unit (ICU) admissions were reported. The presented hospitalization data are preliminary and are likely to change as new data become available and are reported. Furthermore,  hospitalization data are subject to reporting delays. These data are also likely to include both hospitalizations with incidental cases of SARS-CoV-2 infection and those due to COVID-19 disease.

Globally, in week 52, 23 (10%) countries reported data to WHO on new hospitalizations. The region with the highest proportion of countries reporting data on new hospitalizations was the European Region (14 countries; 23%) followed by the Eastern Mediterranean Region (four countries; 18%), the African Region (four countries; 8%), the Region of the Americas (one country; 2%).

No country in the South-East Asia Region and the Western Pacific Region has reported data on new hospitalizations during week 52.

Across the six WHO regions, in week 52, a total of 14 (6%) countries reported data to WHO on new ICU admissions. The region with the highest proportion of countries reporting data on new ICU admissions was the European Region  (10 countries; 16%) followed by the Eastern Mediterranean Region (three countries; 14%), the Region of the Americas (one country; 2%).

No country in the African Region, the South-East Asia Region and the Western Pacific Region has reported data on new ICU admissions during week 52.

(Continue . . . )

This summary of countries reporting (or not reporting) data became a regular feature in the WHO weekly epidemiological reports in mid-November, and since then the number of countries reporting (which were low then) have steadily declined.

Last November 33 countries (17%) reported data to WHO on hospitalizations, while that number has dropped in the latest report to just 23 countries (10%). 

Even those countries that are reporting data (thank you!), are doing so with reduced testing and surveillance, making the numbers we have only part of the story.  This trend clearly began last spring, when we began getting warnings from the WHO that:

These trends should be interpreted with caution as several countries are progressively changing their COVID-19 testing strategies, resulting in lower overall numbers of tests performed and consequently lower numbers of cases detected.

While some of this reporting gap undoubtedly stems from a lack of resources, some countries have clearly decided it is `politically expedient' to hide or ignore the data, so they can declare victory over the pandemic. 

And sadly, it isn't just COVID data. 

A month ago, in Flying Blind In The Viral Storm, we revisited a familiar topic; the numerous blind spots we have around the world when it comes to avian and swine flu, MERS-CoV, and other highly infectious diseases. 

Over the past 3 years the COVID pandemic seems to have become an excuse for many nations not to report on novel outbreaks.  The WHO  often describes this diplomatically, as in their recent DON on MERS-CoV.

The number of MERS-CoV cases reported to WHO has substantially declined since the beginning of the ongoing COVID-19 pandemic. This is likely the result of epidemiological surveillance activities for COVID-19 being prioritized, resulting in reduced testing and detection of MERS-CoV cases. 

The World Health Organization, in almost every surveillance bulletin, reiterates the obligation of all nations to abide by the IHR (see below). 

All human infections caused by a new subtype of influenza virus are notifiable under the International Health Regulations (IHR, 2005). State Parties to the IHR (2005) are required to immediately notify WHO of any laboratory-confirmed  case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic. Evidence of illness is not required for this report. 


Yet we often only hear about novel flu cases months after-the-fact (see latest example). And we have no way of knowing how many cases are never reported. 

While `don't test, don't tell' may be deemed politically expedient by some countries, it leaves us open to being blindsided by the next novel virus that decides to embark on a world tour. 

As the WHO IHR infographic above  reminds us, `Until all sectors are on board with the IHR, no country is ready'.