Several of you have noted that I cleverly used my vacation as an excuse to stop posting daily COVID charts. The truth is that I never intended to keep doing that for so long, and it's a bit of a pain in the ass. What's more, these days there are so many places with this information that we hardly need one more anyway.
However, I figure that maybe I'll keep doing this once a week, using a chart copied directly from Our World In Data. This is a lot less trouble, and it's probably where you should go anyway if you want data of your own. It covers every country and has options of showing cases, deaths, and vaccinations over any timeframe you want. Here's the latest, displayed in deaths per million.
Hospitalization appears to be going up, at least that’s what I’ve seen in the news lately. If I tested positive with symptoms the first thing I’d do is ask for treatment with monoclonal antibodies. I’ve seen very little about this and I wonder to what extent they are being administered. They’ve even been approved for preventive treatment after exposure. Is this kind of thing given routinely or do you have to be “important” or go to the right Dr to get this treatment?
https://www.nbcnews.com/health/health-news/fda-authorizes-covid-antibody-treatment-preventive-after-exposure-n1275737
Love that it's a treatment directed at cytokine storms. It'll be extremely useful far beyond COVID.
There was an ad blitz about them on TV, mostly during evening newscasts I think but I haven't seen the ads in awhile. I heard that the manufacturer was having trouble getting folks to use them at first because folks were not aware of them.
Shouldn’t the hospitals be offering them to people who test positive and have symptoms? I’ve been seeing stories of unvaccinated people who have the disease asking for the vaccine and being told it’s too late. Were those people offered the monoclonal antibody treatment? I haven’t seen anything about this happening and if it isn’t think it’s scandalous.
Monoclonal antibodies attack the virus, so treatment after exposure can be useful--especially if you are at high risk for complications, e.g. elderly or immuno-compromised. Once you're going to the emergency room, your body is already producing antibodies, and the monoclonal antibodies won't help much, if at all.
The ads were running because infection levels dropped a lot. Now that levels are spiking, no need to advertise.
Trump's treatment was unique, and without constant monitoring by a cadre of doctors, I don't know how successful it would be.
I have been under treatment with pembrolizumab, a monoclonal antibody (mab), since April this year for stage 4 metastatic bladder cancer. The first three cycles over seven weeks reduced the 'nodule' of concern in my right lung by 70%!
My understanding is that these mabs are expensive. (Mine are covered in Canada through our health care system). They are working on using mRNA to produce the appropriate antibodies in-situ. I hope that Pfizer and Moderna will use much of their windfall vaccine profits on continuing this research.
So little in the news about treatments and whether those treatments are lowering death rates. I did see this article in the Jerusalem Post about a very promising Israeli drug:
“ Some 93% of 90 coronavirus serious patients treated in several Greek hospitals with a new drug developed by a team at Tel Aviv’s Sourasky Medical Center as part of the Phase II trial of the treatment were discharged in five days or fewer.
The Phase II trial confirmed the results of Phase I, which was conducted in Israel last winter and saw 29 out of 30 patients in moderate to serious condition recover within days.”
https://www.jpost.com/health-science/covid-90-percent-of-patients-treated-with-new-israeli-drug-discharged-in-5-days-675961
Obviously this is just hydroxychloroquine with the name changed so no one will give Trump credit for saving us all.
Seriously, Josh Marshal at TPM has been tweeting updates on that drug. It looks like in a few months (2? 4? 6?) there will be effective treatments and the death rate will drop to near zero. Of course, if everyone was vaccinated we wouldn't need to worry about new drugs. Plus, I have no doubt that all the people who claimed that the vaccine was dangerous will immediately take the new drug that has had much less testing. Because they are idiots.
To be honest, I was never that worried about dying. I was always worried about "long covid". I hope the vaccine and new drugs will make that disappear.
I have lost hope that we will reach herd immunity. A significant minority is just too resistant to vaccines or even masking. Our only hope is that treatment will get us out of this’d d I don’t know to what extent it is being used.
We will almost certainly reach herd immunity one way or another. If the unvaccinated persist, the virus will sweep through them and they will be left with natural post-infectious immunity, or, at least those who survive the illness will. It may take a few waves for that to happen, but eventually everyone will be either vaccinated or infected.
What may prevent herd immunity from being eventually reached is if the immunity from vaccines or natural infection wears off sufficiently rapidly that new susceptibles are created at a more rapid rate than the vaccine or illness can render them (temporarily) unsusceptible. (Well, there are other ways to create new susceptibles: all newborns are susceptible, or at least become so once maternal antibodies disappear, and if we allow unvaccinated people into the country, they become new susceptibles as well.)
I agree with the basics of your response to iamr4man .
I might also note that it is not at all correct to blame lack of masking or any sort of measures to prevent the spread for failure to reach herd immunity. Just the exact opposite. To the extent that masking or anything else works to prevent spreading the virus, that will also slow you getting to herd immunity. One sure way of getting 100% with some sort of immunity is for every single unvaccinated person to get covid.
In this , I am assuming a definition of herd immunity where R would be below 1.0 without restrictions ( i.e. going back to normal). And I think that people will eventually do that whatever happens. So I tend now to think masking, to the extent it works, is counterproductive in the long term. We have to get to herd immunity eventually- enough unvaccinated have to catch it. Delaying that just makes it worse in the end.
I think it is best now if we just have the huge wave now, get well below the herd immunity threshold for these conditions and drive the #s way down. Before we get to winter weather and the immunity from the winter wave ( and winter vaccinations) wears off seriously and the R goes above 1.0 again ( I think it will). Any restrictions today might reduce R to closer to 1.0 but will also not allow it to drop as far below 1.0 and thus might cause higher remaining cases by November.
And I might add there is one huge caveat re herd immunity.
If the virus is still transmissible enough for the R to be over 1.0 even when vaccine or natural immunity is at its peak even if 100% have that immunity, then herd immunity is impossible by definition. And, even if immunity wears off enough within say 3 to 6 months, it would make it practically impossible. In which case it becomes endemic and, as not going to mask forever, we are just going to have to accept it as part of life.
And I am somewhat concerned about whether this is the case given the amount of cases we are seeking among vaccinated. I still think the "100% vaccinated" R is below 1.0 - for today. But what about winter? Some hope might be that it appears that you become " super immune " if you had both covid and also were vaccinated. So we might need more than 100% to be either vaccinated or have had covid, we might also need a good chunk to have both to get to true herd immunity.
Thanks for the post. That's potentially huge. I wonder if Israel and the US can fast-track this thing even further. If we can get an available treatment that lowers the long hospitalization/death rate by 93%, then at that point the pandemic would be basically over.
I assume by discharged, you don't mean to a hospice.
It promising--but, still need more data. The trial mentioned was not meant to evaluate effectiveness. Stopping the immune system from going haywire would be good, but it does not treat the viral infection. They'll have to make sure to administer it at the right time and make sure it's doesn't open you up to other infections. I do hope it works and works well.
Wow! The US was hovering around .8 for a few weeks, but in less than 2 weeks it has doubled. Hopefully it will top out soon, but wow!
Nice to see Germany and Canada seem to have gotten things under control again.
Although it was a pain for Kevin to do, so I'm not surprised he stopped it, the daily Covid posts sometimes had comments from people that were interesting. So I do miss them.
Yes, same with me. I do not begrudge kevin wanting to stop doing his daily posts which were a lot of work when you can get thr same or better data easy enough in other places.
I might ask if it is acceptable to use perhaps the daily cat thread as an " open thread" for comments on covid?
Vaccine-resistant coronavirus 'mutants' are more likely when transmission is high, new model finds,
https://www.livescience.com/coronavirus-vaccine-resistance-mutation-model.html
Not sure there conclusion makes sense to me, assuming they are arguing that restrictions will help prevent such a mutation.
For one they just " assume " that low transmission rates are because of restrictions. Well what else could slow transmission rates, holding vaccination rates constant? Having high natural immunity from a lot catching covid. And restrictions stop that from happening.
The dynamics there long term are more complicated. If you just assume all reductions in transmission rate are because of restrictions ( and not herd immunity developing) , kind of set up to conclude restrictions help. Basically the assumption by itself causes your conclusion.
Plus, if you want a vaccine resistant mutation to "die out" by low transmission, the R for that variant in the population has to be below 1.0. But, if it makes vaccines useless, that means the restrictions have to be so effective as to keep R below 1.0 if 0% were vaccinated. And we have seen nothing indicating this is possible.
But consider this. Mutations are almost all disadvantages for the virus and they die out. And quite likely there could be mutations that get around the vaccine effect but at the cost of making the virus less effective for unvaccinated. So best way to stop a vaccine resistant variant is to have less vaccinated and more with natural immunity!
To some extent, a goal of 100% vaccinated and almost nobody catching covid ( like say new Zealand might get to) is dangerous for a vaccine resistant variant. It is putting all your herd immunity eggs in one basket. If that fails, you are screwed. Note that having some be vaccine resistors and get immunity naturally can be better for those who are vaccinated if it inhibits the ability for a vaccine resistant mutation to spread.
Thanks for the link. Unfortunately their desktop publishing engine really blows; is it $$R_t^r = \frac{\beta(S + V)}{N(\lambda + \delta)}$$ or is it $$R_t^r =(S + V) \beta/N(\lambda + \delta)$$, for example.
Also, this is an extremely, er, adjustable model, if you get my drift. They give themselves lots of room to run around in.
I see that Kevin has omitted Sweden from his chart, either a deliberate choice or a mistake since the rest of the previously followed countries are still there.
For those interested, new cases are rising because of delta in Sweden as everywhere else, while deaths are so far on a very low level (no deaths the last couple of days, before that several days with one or two, interspersed with one day when the number of deaths was adjusted down with one).
We’ll have to wait and see if vaccinations have come far enough for deaths to stay on this level. Number of ICU patients is rising slightly, but numbers are small so not necessarily a trend. Still a bad sign.
Looking at deaths as Kevin's graph shows, Canada looks well under control. But look at cases. Still well below us level but , after continuing to go down well into july ( while us cases were going up), they started up a few weeks ago and have really jumped the past few days. Have not yet had time to see that reflected in deaths.
It looks potentially scary for canada now. Sort of like the usa a few months ago when cases were still real low but you could see them start to explode.
Have not heard anything re canada for delta dominance. If reason it had been low weeks ago was delta had just not yet gotten established, and this recent increase is just delta finally showing up, canada could be in a bit of trouble too.
One thing I think I notice is that, with delta and maybe more cases in the young, the old conventional wisdom of a 3 week lag from reported cases to reported deaths might need to be extended to 4 weeks or so. Seems it takes a little longer for the change in case #s to show up fully in deaths.
Canada has passed US in vaccinations, so that should help them.
The uptick in Canada is almost entirely driven by Alberta, which is led by Canada's version of Gov DeSantis. He simply decided he'd had enough of all restrictions and lifted all of them, including getting rid of widespread testing and contact tracing.
Throughout the pandemic he had been getting a lot of criticism from his own base (Alberta, and Calgary in particular, is the Conservative epicenter of Canada) for taking measures to stop the pandemic "hoax" and finally decided to please them at the start of July.
That of course was a recipe for disaster considering that Alberta is the Canadian province with the lowest vaccination rates, although having said that, even in Alberta the vaccination rate is still higher than in most of the US, so that will help to mitigate the damage (cases and deaths are almost entirely among the un vaccinated).
Re Alberta, that might be an interesting point if it was true but it is not. British Columbia has had the highest number of new cases recently, not Alberta.
It might be correct to say that Alberta has had a disproportionately large share of the increase, but almost entirely driven is nonsense.
For reference, the population of Canada is a bit less than the population of California, and larger than any other state. Some of the provinces don't report on weekends, but as of Friday Aug. 6 the country was reporting just over 1,000 new cases a day as a seven day rolling average. Compared to, for instance, Florida, that's still small numbers even though it's more than double the minimum of 377 cases per day reported on July 17.
Perhaps Delta is spreading significantly faster than even the data can track, and tracking breakthroughs is just about impossible? You gotta think there's even more underreporting of breakthroughs if the prevailing symptoms of Delta match allergies and we're still in the middle of grass pollen season.
Yes, I have been thinking this myself for a while. The case number trends and how they are distributed across states seems more consistent with the idea that there are a whole lot more undiscovered vaccine breakthrough cases than we thought. Note that vaccination levels have not correlated well at all with lower Rs which would make sense if vaccinated are still spreading it " under the table ".
And these might not just be cases with symptoms mild enough to seem like allergies, but totally asymptomatic.
But this is not necessarily bad news. It means also then the ifr is a lot lower than we thought. And we are building up to herd immunity faster if only by vaccinated becoming super immune after catching covid. And also means that the estimated base R for delta is too high ( as that is being extrapolated from case counts assuming too high vaccine effectiveness). Which would be very good news for Australia.
I had been thinking that the base R for delta really was 3 or more times higher than original. But now my guess is much less, maybe twice, and it is just that it is getting around the vaccine more than we thought
But also that further restrictions might be fairly pointless.
This is just so much model wanking. Note that they don't try to incorporate any percolation models when talking about the actual vector mapping, for example.
No, cases aren't translating to deaths or hospitalization like before. If the vaccinated weren't tested, cases would be 30% lower than reported. Delta is more hype than reality. Outside the south.
Fwiw, positivity has peaked. I suspect next week cases begin to fall nationally.
It will be a tragedy if some innocent people get sick or die because they are unable to be vaccinated or have a serious underlying condition which leads to a steroid breakthrough illness. Tragic.
For the rest of these who suffer and die? They deserve their fate. Good riddance.
Serious breakthrough illness.
The Financial Times also has a good set of charts:
https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386938
thanks for the link
Yeah, and it was time to redo the scaling again....
But we did hit 70% vaccinated (adults, first dose) by Aug 4th. Though no new states crossed that threshold by Aug 4th, though FL did recently. And MS--finally broke through to 50% of adults vaccinated (at least first dose), or 40% of their population.
CovidActNow had to modify their maps when it got really bad here--and added a darker shade of red once states got >75 new cases/day/100K. Well, FL and LA have crossed passed that marker in this outbreak. AR and MS may get there in the next week or two.
The only good news is that infection rates are leveling off, if not falling, in many areas. Of course, cases numbers are still on the way up as long as the infection rates are above one--and they all are, at least for now....
In los angeles county, although the number of cases shown on covidactnow and other sites is still increasing, the county reported Thursday that the weekly " case rate", which I believe is adjusted for testing volume, actually declined from the prior week. And yesterday did explain that the higher numbers are being driven by increased testing at schools and businesses. I expect that some of this is testing as schools reopen.
And the positive test rate has dropped in the last few days significantly so does make sense the higher cases are caused by increased testing to some extent.
I expect you will see some stories saying that it looks like school reopening caused an increase in cases, but it might be just the testing due to school reopening catching more cases.
Good catch about the schools. That will be going on this month and into Sept., depending on area. Schools starting back up, both grade schools and universities, will hopefully mean more vaccinations, not new outbreaks.
The positive test rate is high everywhere, but typically very high as Republican controlled areas. Testing does lag cases, so some increase expected, But some places are still in denial....
CovidActNow does not let you sort on red or blue state--but sorting on positive test rate is pretty close. Twenty three states above 10% positive test rate, and all but one, PR (ok, not a state) are red states. Twelve states are at 5% or lower, and they are blue states.
I am not sure you are getting my point. Those going in for testing can be maybe broken into four groups. Group 1 are those who have symptoms due to covid and thus get tested and are positive. Group 2 are those that have covid like symptoms not caused by covid ( maybe allergy) and get tested. The vast majority of these will test negative but a small fraction will be positive ( they have asymptomatic covid but symptoms caused by something else). Group 3 are those who test voluntarily with no symptoms as they were exposed are maybe they are just chronic hypochondriac worries. Some % will.test positive but a fairly small minority. Group 4 are those who are required to have routine testing by their job, school or govt. Again a small % will be positive ( approx the same as avg infected in population).
The 100% from group 1 will be dragged down by groups 2,3 and 4. The final positive rate is a very poor proxy for how many cases there are. It is largely a function of how many there are in groups 3 and 4, which is affected strongly by government policy and attitudes of population. Group 2 numbers are driven largely by how much other sicknesses like colds and allergies there are, that could mimic covid symptoms.
Large numbers in groups #2,3 and 4 will both decrease positive testing rate and also increase reported cases ( by catching more asymptomatic or very mild covid cases).
Based on your stereotypes ( which I would say are exaggerated but have some truth) , a typical " red state " should have less in group # 4 as the govt, businesses and schools are less likely to require general testing. Also fewer in group 3 as less will test due to exposure or just general fear if not taking covid as seriously. Note no clear bias for group 2 except maybe areas with a lot of allergies will have more?
Net result is that the discrepancy in positive test rates is greatly biased to make it look worse for red states vs. Blue because blue states are diluting the rate through more testing of those without symptoms.
But this also means that the greater random testing done in blue states also means they find a greater % of total cases. Although this bias will not be nearly as large as the distortion of positive rates, it will mean reported case numbers for red states are a smaller % of actual cases than for blue states.
Now both effects will be offset to some extent by blue states having more vaccinated ( with a larger % of asymptomatic and vaccinated having less feeling they need to test with mild symptoms) but I doubt fully offset.
Note also that testing is somewhat correlated with blue and red states but not anywhere near fully. Depends a lot on govt organization. Here in la, although very tough restrictions in early pandemic last year, we sucked bad in testing. Now la doing good there.
And my point re R is, if you are going to derive that from reported cases, it will be distorted too high when testing of groups 3 and 4 increases. Like due to school reopening. Then you will see an increase in cases numbers and decrease in positive rate, even if actual infections are decreasing..
Random thought -
We now know that vaccinated people can pick up the virus and infect others even if they themselves rarely get sick. However, doesn't this mean the whole idea of herd immunity goes out the window? We all keep passing the vaccine to each other, whether we are vaccinated or not.
No, but how possible herd immunity is depends on how effective the vaccine is in reducing the spread. It will never be 100% effective but it does not have to be. It just has to be effective enough to get the overall R below 1.0, i.e. so one infected person spreads to less than one other person. Note reaching herd immunity does not mean cases immediately drop to zero, just that they decline.
And you also have to factor in effectiveness of natural immunity from catching covid, plus effectiveness of double immunity from catching covid and getting immunized or maybe getting covid twice.
Plus note here by effectiveness I mean effectiveness at reducing spread, which should hopefully be significantly better than just effectiveness at stopping you from catching covid. It also would factor in how effective a vaccine or natural immunity is in reducing the chance of a breakthrough infection infecting someone else. I see little discussion of this.
The recent semi panic of studies showing same viral load for breakthrough cases as for infections of unvaccinated was exaggerated. First, by looking only at those who got tested, it excluded less infectious asymptomatic or mild cases that never got tested ( and those are more prevalent in vaccinated). Plus , by only looking at viral count when first tested ( near when first infectious presumably) and not the entire course, they miss that viral count declines faster in vaccinated. A better uk study doing random testing shows that viral count is lower on average for vaccinated and declines quicker.
So say vaccine reduces risk of catching covid by 60% ( 40% as much chance) and also reduces chance of spreading whole infected by 50%, then it is 80% effective in reducing spread. So the R for a population fully vaccinated who never got covid should be 1/5 of that for unvaccinated. Of course if the initial R is over 5, not good enough.
If vaccine effectiveness not enough to reduce R below 1.0 ( and say natural immunity the same), then still might get to natural immunity if double immunity is much better. Say vaccinated R is exactly 1.0, and same for natural immunity R, then even if everyone got either vaccinated or got covid ( but only one) , still will just leave cases staying the same. But, if double immunity R is .3, then can get total R well below 1.0, but only by having a good % be both vaccinated and having got covid.
I still do think the vaccinated and natural immunity R is below 1.0 ( and maybe natural immunity a bit better) but not confident of that. And of course we really would like to have some never have to be either vaccinated or got covid , so would want R for vaccinated to be well below 1.0.
My guess is we can and will still get to herd immunity fairly soon.
Now whether we can stay at herd immunity as vaccine or natural immunity fades over time is another matter. I suspect that long term permanent immunity for either vaccination or natural is an R above 1.0. So question is whether we can do boosters enough to keep R below 1.0.
Thanks, that all makes sense. R below 1.0 is the key. And your point about double immunity makes sense too. If the vaccine does not take R below 1.0, and we have to rely on most people getting double immunity, that is quite different from what I had expected. We are back to waiting for far more people to get covid.
Rep Marjorie Taylor Greene suggests gun owners kill people encouraging vaccinations: “…in the South we all love our Second Amendment rights. And we’re not really big on strangers showing up at our door, are we? They might not like the welcome they get.”
Meanwhile those same people in Arizona were planning on sending around squads of crackpots knocking on peoples' doors demanding to know who they voted for.
It's a matter of probabilities. There is nothing unusual about the performance of covid vaccines. No vaccine is 100% effective, there are always breakthrough infections. Very few vaccinated people will pick up the covid virus and transmit it to others. For most people, more than 90%, the vaccine is completely effective in preventing infection. For the minority who do get reinfected, the vaccine reduces both the severity and the duration of infection and makes transmission much less likely.
The same high but not perfect effectiveness in the smallpox vaccine was enough to make smallpox extinct.
Through August 6th, 2021:
Rank Population (millions) Country Cumulative Deaths/Million
1 32.51 Peru 6054
2 9.68 Hungary 3101
3 3.30 Bosnia and Herzegovina 2936
4 10.69 Czechia 2841
5 211.05 Brazil 2662
6 2.08 North Macedonia 2641
7 7.00 Bulgaria 2607
8 50.34 Colombia 2425
9 44.78 Argentina 2394
10 5.46 Slovakia 2298
11 11.54 Belgium 2190
12 7.04 Paraguay 2163
13 2.08 Slovenia 2131
14 60.55 Italy 2117
15 4.13 Croatia 2002
16 37.89 Poland 1987
17 67.53 United Kingdom 1932
18 127.58 Mexico 1910
19 18.95 Chile 1893
20 329.06 US 1873
21 17.37 Ecuador 1829
22 19.36 Romania 1772
23 11.69 Tunisia 1768
24 46.74 Spain 1755
25 3.46 Uruguay 1729
26 65.13 France 1725
27 10.23 Portugal 1705
28 512.50 EU w/o Brexit 1687
29 444.97 EU 1650
30 4.25 Panama 1619
31 2.76 Lithuania 1603
32 2.96 Armenia 1567
33 11.51 Bolivia 1558
34 4.04 Moldova 1552
35 4.00 Georgia 1505
36 10.04 Sweden 1460
37 1.91 Latvia 1342
38 8.59 Switzerland 1270
39 58.56 South Africa 1270
40 43.99 Ukraine 1268
41 2.49 Namibia 1266
42 1.81 Kosovo 1254
43 10.47 Greece 1243
44 8.96 Austria 1200
45 6.86 Lebanon 1157
46 82.91 Iran 1123
47 145.87 Russia 1101
48 83.52 Germany 1099
49 17.10 Netherlands 1062
50 4.88 Ireland 1033
51 5.05 Costa Rica 1015
52 10.10 Jordan 1000
53 1.33 Estonia 963
54 2.88 Albania 853
55 1.64 Bahrain 843
56 9.75 Honduras 833
57 8.77 Serbia 813
58 1.39 Trinidad and Tobago 801
59 4.97 Oman 785
60 8.52 Israel 765
61 2.30 Botswana 740
62 1.15 Eswatini 727
63 4.98 West Bank and Gaza 725
64 37.41 Canada 711
65 83.43 Turkey 623
66 17.58 Guatemala 605
67 4.21 Kuwait 561
68 6.78 Libya 544
69 18.55 Kazakhstan 534
70 10.05 Azerbaijan 503
Rank Population (Millions) Country Deaths/Day/Million 7-dav Avg
1 11.69 Tunisia 14.37
2 2.49 Namibia 9.11
3 2.30 Botswana 8.37
4 4.00 Georgia 7.97
5 11.33 Cuba 7.13
6 1.15 Eswatini 6.97
7 58.56 South Africa 6.52
8 31.95 Malaysia 6.50
9 18.55 Kazakhstan 6.41
10 7.04 Paraguay 6.27
11 270.63 Indonesia 6.18
12 54.05 Burma 6.13
13 145.87 Russia 5.28
14 44.78 Argentina 5.19
15 1.39 Trinidad and Tobago 4.81
16 82.91 Iran 4.72
17 50.34 Colombia 4.70
18 211.05 Brazil 4.27
19 9.75 Honduras 4.19
20 18.95 Chile 3.87
21 6.78 Libya 3.79
22 127.58 Mexico 3.67
23 21.32 Sri Lanka 3.61
24 14.65 Zimbabwe 3.07
25 17.58 Guatemala 2.88
26 96.46 Vietnam 2.75
27 5.05 Costa Rica 2.66
28 32.51 Peru 2.65
29 4.97 Oman 2.64
30 69.04 Thailand 2.43
31 4.25 Panama 2.25
32 1.18 Cyprus 2.18
33 11.51 Bolivia 1.87
34 39.31 Iraq 1.79
35 6.45 El Salvador 1.73
36 36.47 Morocco 1.69
37 4.21 Kuwait 1.60
38 46.74 Spain 1.59
39 2.35 Gambia 1.58
40 6.42 Kyrgyzstan 1.54
41 329.06 US 1.51
42 17.37 Ecuador 1.50
43 163.05 Bangladesh 1.47
44 3.23 Mongolia 1.42
45 2.96 Armenia 1.35
46 10.23 Portugal 1.34
47 10.47 Greece 1.34
48 16.49 Cambodia 1.31
49 2.95 Jamaica 1.31
50 67.53 United Kingdom 1.28
51 108.12 Philippines 1.26
52 18.63 Malawi 1.24
53 83.43 Turkey 1.24
54 10.10 Jordan 1.20
55 3.46 Uruguay 1.11
56 16.30 Senegal 1.09
57 4.53 Mauritania 1.07
58 9.45 Belarus 1.03
59 28.61 Nepal 0.92
60 43.05 Algeria 0.89
61 43.99 Ukraine 0.88
62 12.63 Rwanda 0.86
63 7.00 Bulgaria 0.82
64 8.52 Israel 0.79
65 38.04 Afghanistan 0.76
66 30.37 Mozambique 0.75
67 65.13 France 0.74
68 4.04 Moldova 0.71
69 17.86 Zambia 0.66
70 512.50 EU w/o Brexit 0.65
71 2.08 North Macedonia 0.617
72 6.86 Lebanon 0.604
73 2.76 Lithuania 0.569
74 4.13 Croatia 0.553
75 444.97 EU 0.550
76 1.33 Estonia 0.539
77 28.52 Venezuela 0.531
78 34.27 Saudi Arabia 0.463
79 52.57 Kenya 0.440
80 10.05 Azerbaijan 0.412
81 10.86 Burundi 0.381
82 9.77 United Arab Emirates 0.380
83 1366.42 India 0.372
84 17.10 Netherlands 0.359
85 44.27 Uganda 0.355
86 8.77 Serbia 0.342
87 11.54 Belgium 0.334
88 60.55 Italy 0.330
89 12.77 Guinea 0.324
90 1.92 Guinea-Bissau 0.297
91 216.57 Pakistan 0.288
92 4.98 West Bank and Gaza 0.287
93 4.88 Ireland 0.263
94 15.44 Somalia 0.259
95 11.26 Haiti 0.228
96 10.74 Dominican Republic 0.226
97 1.91 Latvia 0.225
98 37.41 Canada 0.221
99 32.98 Uzbekistan 0.217
100 83.52 Germany 0.209
101 2.13 Lesotho 0.202
102 19.36 Romania 0.199
103 8.96 Austria 0.175
104 3.30 Bosnia and Herzegovina 0.173
105 28.83 Ghana 0.154
106 31.83 Angola 0.153
107 2.08 Slovenia 0.137
108 5.38 Norway 0.133
109 5.46 Slovakia 0.131
110 5.77 Denmark 0.124
111 1.20 Mauritius 0.119
112 8.59 Switzerland 0.116
113 9.68 Hungary 0.103
114 5.80 Singapore 0.098
115 25.20 Australia 0.085
116 126.86 Japan 0.084
117 37.89 Poland 0.083
118 1.81 Kosovo 0.079
119 8.08 Togo 0.071
120 2.17 Gabon 0.066