It is also worth highlighting that the number of cases really depends on the readiness of country and the development of its health care system. As shown in Chart 7, there is a clear correlation between the number of beds per 1,000 people and observed fatality rates. Countries with a low number of hospital beds such as Iran and Italy have much higher fatality rates (in the 3-4% range) compared to countries with a high number of beds (Korea, Japan and Germany).
This is what we can conclude:
- Countries that are well prepared see a fatality rate of about 0.5% (South Korea) to 0.9% (rest of China).
- CCountries that are overwhelmed will have a fatality rate between about 3-5%
Therefore, countries that act more quickly reduce the number of deaths at least six- to tenfold. Unfortunately, Tunisia is likely to be one of the overwhelmed countries.
Based on observed cases so far, around 20% of cases require hospitalization, 5% of cases require the Intensive Care Unit (ICU), and around 2.5% require very intensive help, with equipment such as ventilators or ECMO (extra-corporeal oxygenation).
So 100,000 people suddenly become infected, many of them will want to get tested. Around 20,000 will require hospitalization, 5,000 will need the ICU, and 2,500 will need machines. If we project that 50-60% of the Tunisian population will be infected by the virus, this implies that approximately 5.5 to 6 million people will be infected before the pandemic stems off. 50-60% is in line with estimates for other countries. Based on Tunisia’s current population (11.4 million), the table below provides a very sobering estimate of what is to come. According to anoptimistic fatality rate of 4%, between 228,000 and 273,600 people in Tunisia will die because of COVID-19. Using a more recent estimate of 8% like what we are seeing in Italy or Iran, our projections double to somewhere between 456,00 to 547,200 deaths caused by the virus.
|% of total population infected
||Number of infected
||Number of cases requiring hospitalization
||Number of cases requiring Intensive Care Unit
||Number of cases requiring very intense help
||Projected fatalities (assumes 4% fatality rate)
||Projected fatalities (assumes 8% fatality rate)
What can we do now?
The epidemic in Tunisia has gone down (as it was bound to happen) and can, at best, be mitigated.
Given limited capabilities in Tunisia, it is important to flatten the curve (a phrase that has become very popular these days). With a slower spread of the infection, Tunisia’s precarious health care system will be able to handle cases much better, helping to lower the fatality rate and gain precious time until a cure or vaccination is obtained.
So far, the only measures that seem to work are social distancing, better hygiene, and for immediate impact, total confinement. Much like other countries, Tunisian was hesitant in taking drastic measures to stop the spread of the disease. To its credit, Tunisia still acted faster than other countries although some actions such as closing air and maritime routes with Italy should have been taken much sooner.
Based on what we know so far, the virus can spread across two meters when somebody coughs. The worst infection spreads via surfaces, with the virus surviving up to nine days on metal, ceramics and plastics. This means things like door knobs, tables or elevator buttons.
The only way to truly reduce the spread of the virus is through social distancing: keeping people home as much as possible, for as long as possible until this recedes, as proven in the past by the 1918 flu pandemic. Tomas Pueyo showed the examples of the American cities Philadelphia and St.Louis. St. Louis enacted measures to enforce social distancing, whereas Philadelphia was much more lax. Chart 8 shows the effective impact of social distancing in St. Louis, with a much lower fatality rate over time.