WHO COVID Epi Report # 138 - A Mixed Bag of Incomplete Data

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Based on incomplete and inconsistent reporting by WHO member nations, COVID appears to be generally in decline around the globe, with the WHO reporting in their latest weekly update:

Globally, 3 million new cases and over 23 000 deaths were reported in the last 28 days (13 March to 9 April 2023), a decrease of 28% and 30%, respectively, compared to the previous 28 days (13 February to 12 March 2023).

But these numbers are based on what is reported, and as we've seen increasingly over the past year, fewer and fewer countries are submitting timely data on hospitalizations and/or deaths.  In their latest report, the WHO acknowledges that:

Globally, during the past 28 days, 53 (23%) countries reported data to WHO on new hospitalizations at least once.

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Across the six WHO regions, in the past 28 days, a total of 40 (17%) countries reported data to WHO on new ICU admissions at least once.

Which means that 77% of nations did not report at all.  They also report:

Among the 33 countries consistently reporting new hospitalizations, seven (21%) countries registered an increase of 20% or greater in hospitalizations during the past 28 days compared to the previous 28-day period

As the following chart illustrates, in Southeast Asia and the Eastern Mediterranean regions, those increases are far above 20% (481% and 144% respectively).  Some of this may be due to delayed reporting of previous data, while some of it may reflect the recent rise in XBB.1.16 (particularly in India). 

There are obviously huge gaps in reporting of COVID around the globe, not the least of which stems from China, which barely reports anything at all.  As a result, the WHO regularly posts the following disclaimer:

Current trends in reported COVID-19 cases continue to be underestimates of the true number of global infections and reinfections as shown by prevalence surveys. 1-4 This is partly due to the reductions in testing and delays in reporting in many countries. Data presented in this report are therefore incomplete and should be interpreted with caution. Additionally, data from previous weeks are continuously being updated to incorporate retrospective changes in reported COVID-19 cases and deaths made by countries.

For political and economic reasons, most governments around the world have decided to deescalate their COVID response - and the reporting of cases - in the hopes that we can declare victory and move on from this pandemic. 

While North America and much of Europe - where we get the most complete reporting - appears to be in a welcomed lull in COVID activity, our visibility of what is happening elsewhere in the world is severely compromised. 

And it isn't just COVID.

As we've discussed often (see Flying Blind In The Viral Storm) - between pandemic `fatigue', and increasing international tensions - our ability to see disease threats around the world has deteriorated significantly over the past few years.

• Visibility of MERS-CoV in the Middle East has plummeted since 2020 despite concerns over the the potential for MERS-CoV to recombine with SARS-CoV-2  (see Nature: CoV Recombination Potential & The Need For the Development of Pan-CoV Vaccines).

• The last H5N6 case we heard about was on March 1st, but it was about a case from December of 2022. Delays of 2 months or longer in notifications out of China are increasingly common. 

• There remains little or no surveillance across a large swath of Asia and much of Africa. 

Granted, there are some hopeful signs that the COVID pandemic is winding down; increased community immunity, continued relatively low severity of Omicron, etc. 

But the SARS-CoV-2 virus continues to mutate unpredictably (see Preprint: Virological characteristics of the SARS-CoV-2 Omicron XBB.1.16 variant).

Making the collective decision to stop reporting cases and deaths to the WHO a risky move, as it leaves us open to being blindsided by a new, potentially more dangerous variant.