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Home > Insights from IHME's latest COVID-19 model update

Insights from IHME's latest COVID-19 model update [1]

IHME director and lead modeler Dr. Christopher J.L. Murray shares insights from our latest COVID-19 model run. Explore the forecasts: covid19.healthdata.org [2].

September 16, 2021

 

 

This transcript has been lightly edited for clarity

In this week’s update from the Institute for Health Metrics and Evaluation, the good news is that we’re seeing continued drops at the global level in reported cases and in reported deaths. In our modeling of the true number of infections, we also see that estimated infections are dropping and getting down to levels that we last saw in March. We expect that decline to continue for the rest of the month.

 »Our projections have extended out by a month to January 1, 2021 in this update [3].

If we look more in detail about what’s behind those global trends, the peaks in Southeast Asia and rapid declines in a country like Indonesia continue. Vietnam has now peaked and is coming down. It’s really only for large countries in that part of the world – only the Philippines – that has a major Delta surge on the way up. 

In North America, we’re seeing states in the US and Mexico peak and start to come down. Meanwhile, Canada is still entering their Delta surges, and so that is still to unfold. 

In Europe, its sort of a tale of two zones. In western and southwestern Europe, Delta has peaked and is declining. But there’s a big block from the border of France right through to the border of the Russian Federation, extending all the way from Norway down to the border of Greece, where transmission is on the upswing. 

Read »IHME WHO Euro Region Policy Briefin [4]g [5] (Our COVID-19 Projections Explained) – Sample of the briefing below 

So we also see in some countries in sub-Saharan Africa where transmission is seemingly still increasing, but none of them have very large surges. These are either early on, or they’re just not taking off as we’ve seen in some countries like Zambia or Namibia in the past weeks or months. Learn more in our »IHME WHO AFRO Region Policy Briefing [6]

South America continues to avoid major Delta surges, and hopefully that will continue going forward. Learn more in our »IHME WHO PAHO Region Policy Briefing [7] 

In our models, in the Northern Hemisphere – where we would have anticipated a big winter surge – we see two stories. It’s a function of how many people have been infected to date, and how many people have been vaccinated. Put those together and you get our assessment of how many people are susceptible to Delta infection. 

In most of the United States, what we’ll see is probably declines of the current Delta peak at the national level, leveling off, and maybe some increase – but not profound – in December. So we should have many fewer deaths and also fewer hospitalizations compared to last winter in North America, even if reported cases are equal to what we saw last winter. That’s again the differential effect of the vaccines on preventing severe hospitalization and death as opposed to being less effective for preventing infections.

»Learn more in our COVID-19 Policy Briefing for the United States [8]


In Europe, however, we expect that there will be a winter surge, partly because fewer people have been infected to date, and vaccination rates are high in the western part but low in the eastern part of Europe. Put all that together and what you see is a steady increase into the winter period in our models for Europe – different expected experiences based on that experience of who has been infected naturally or through vaccination. 

If we think about the factors we’re worried about that might make our forecasts not reflect what will happen, there are two big factors: 

  1. Variants. Are there any variants out there like Mu that might be of concern to date? We haven’t seen any population-based data to suggest Mu is driving surges, so not much concern for us about that yet. But, like Delta back in April, variants can completely change our sense of what’s coming.

  2. Waning immunity. Of course, there has been steady evidence emerging from England, Scotland, Israel, a Mayo Clinic study in the US – and many other studies – that suggest there is waning immunity for infection for all of the vaccines. Of course, there is much more of a controversy about whether immunity for severe hospitalization and death wanes. Data from Israel published in the New England Journal of Medicine this week starts to suggest that immunity for severe hospitalization, severe cases, and for death may also start to wane. There was also an analysis from Public Health England out earlier in the week that also suggested that, at least for those with comorbidities, immunity for hospitalization and death also wanes – and wanes faster for AstraZeneca than for Pfizer or Moderna.   

Putting all that together, we’re quite concerned about waning immunity both for infection and severe disease and death. We will build that (we hope, in the next few weeks) into our models. That will change the long-term trajectory into 2022, and it’ll also allow us to explore how much we can mitigate, through the use of boosters or seasonal mask use, what may be a bigger effect in the winter due to waning immunity than we currently assess.

What We're Reading This Week: 

IHME In The News: 

September 10, 2021

This transcript has been lightly edited for clarity

In this week’s update from IHME on modeling the COVID pandemic, I think at the high level, what we’re seeing are a number of countries that have had their Delta surges peak, and are starting to come down more than a week ago. So many countries in Southeast Asia have peaked, with the exceptions being Vietnam and the Philippines. We’ve seen continued declines in all of South America, and we’re seeing peaks in Southern states of the US, most states in Mexico, and continued declines in southwestern Europe. 

If you put it all together at the global level, we’re seeing estimated new infections, reported cases, reported deaths start to go down. According to our own analysis, estimated daily infections are now at the lowest level we’ve seen since March. That’s good news at the global scale. It is a mixture of places where we haven’t seen the Delta surge arrive yet. There are three countries in Europe, for example: Czechia, Hungary, and Poland, where their Delta surges have not unfolded yet and we expect them to occur – combined with other parts of the world where the Delta surges have peaked and then come down. 

As we look ahead, particularly in the Northern Hemisphere, to the fall and winter, what our models suggest that is in places that are having Delta surges now – that did worse in the last 18 months, i.e., there are more people that have been infected, like in the US for example, we may not see a true winter surge, we may just a shoulder season, where the current Delta surge peaks, starts to come down, and then we see sustained transmission (maybe slight increases throughout the season) but not the big winter surge like we saw last year.

In contrast, in many countries in Europe that have had lower cumulative infection so far, we may see steady increases in transmission through the winter season. But again, the surges should not be as large as last year, and certainly not hospitalizations and death because the vaccines are very effective at preventing hospitalization and death. It’s because of the vaccinations that we’ll not see anything like last winter. 

When we think about other parts of the world, the factors that could change the trajectory of the COVID-19 pandemic are quite clear:

  • First, what will be the effect of school openings? We’ve seen the double Delta surge in Scotland, and many attribute that to transmission in schools, but we’ve not seen this happen in other parts of the world yet – so it’s a big question mark as to how much mitigation in schools is necessary to stop rampant transmission in schools. We may see a number of states in the US, for example, with surges coming in mid- to late September because of transmission in schools. We just aren’t sure.

  • The evolution of new variants. There’s a lot of discussion about the Mu variant, but we don’t yet see, at the population level, evidence that this variant is driving population-level surges anywhere. That doesn’t mean that they won’t occur, but in the previous four variants of concern we’ve seen very clear population-level signals that suggest they’re something that can drive transmission up substantially, and we don’t see that in Mu so far. However, other variants may come along and completely change our assumed trajectories in our models. 

  • Of particular concern for the future will be variants that demonstrate more immune escape. As the world progressively has more and more people that are immune to the Delta variant, either through natural infection or vaccination – even taking in to account that neither is perfect for preventing infection – we still think that by December 1, 2021, about half the world will be immune to the Delta variant. As time goes by, there are fewer and fewer people who are available to transmit Delta, but that changes entirely if there’s a new variant that can infect people who have been vaccinated or previously infected by Delta. 

  • The debate about waning immunity – which is not incorporated right now in our models. So far, there's no evidence that protection through vaccination against hospitalization and death wanes. All the studies show highly sustained protection. But there’s lots and lots of evidence that vaccination against infection does wane, and once you build that into the models, that means there will be more and more people to sustain transmission later in the year. 

At any rate, we expect that there are plenty of people globally on a country by country basis to sustain transmission well into 2022. And once you factor in new variants and waning immunity, it’s very likely that transmission will be quite broad-based throughout the world in 2022 and beyond. 

This leads us to the debate around Zero COVID. 

In a world of waning immunity from vaccination, incomplete protection from past infection, and the evolution of new variants, we should not expect Zero COVID strategies are going to work in any countries in the long term. 

IHME COVID-19 Resources: 

What We're Reading This Week: 

IHME In The News: 

September 1, 2021

This transcript has been lightly edited for clarity

In this week’s update from IHME on modeling the COVID pandemic, there are a number of important aspects to our analysis. First off, we’re seeing a number of places peaking from their Delta surges, states in the US – a number of them in the South – a number of states in Mexico have now peaked, a number of countries in Southeast Asia have peaked and started to come down.

We’re seeing continued increased transmission in other states in Mexico, the US, and much of Canada. There is sort of a central band in Europe, from Sweden and Norway right down to Greece, and then a band of countries below the Sahel in sub-Saharan Africa. Of course, Australasia is having large Delta surges.

So with Delta surges continuing, the experience in Scotland, which is now entering its second Delta wave, is very important. If you remember, Scotland had started their Delta surge in July, they reached a peak – a very abrupt decline – and in the last two to three weeks there’s been a second Delta surge. Scotland opens its schools earlier, and the current view, given the percent of cases under the age of 18, is that this second surge is due to transmission in schools and schoolchildren. Similarly large numbers of schoolchildren now being reported infected in Israel lends credence to the idea that because Delta is so much more transmissible, as schools open this may be a real driver for accelerated transmission. 

In the past, when we’ve seen peaks in transmission, there tended to be many weeks or months of decline after the peak, the Delta surge in India in April and May, for example. But now with Delta being so transmissible, combined with school openings, we may see much more complex patterns.

In terms of our forecasts, what we’re seeing is expected: large transmission at the global level through to December 1 – throughout that whole period transmission will be over 5 million infections a day, and we should expect to see, in our reference scenario, global deaths continuing to be in the range of 8,000 to 10,000 a day. 

Even though vaccination is scaling up, including in many middle-income countries now, and there’s a cumulative natural immunity through increasing Delta infections, we are, at the global level, not expecting to see COVID go away in any sense. 

As we look forward to 2022, there are several things that suggest that we will see considerable COVID transmission in 2022 as well. We will only have 35% of the world population fully vaccinated toward the end of the year, and the combination of natural infection and immunity or partial immunity derived from that, and vaccine-derived immunity and its partial effect on protection against Delta infection all combined, we expect that more than half of the world will still be susceptible to Delta toward the end of the year. Meaning there’s huge room – even without a new variant emerging – for continued transmission around the world. 

I think the other critical issue that we’re seeing around the world – both playing out currently in the policy debate and in our model – is whether high-income countries and some middle-income countries that are having higher vaccination rates are starting to debate whether the goal of control is stopping infection or harm reduction, that is, reducing severe hospitalizations and death through vaccinations and seasonal mask use for those who are at risk. And that debate, we expect, will intensify as waning immunity becomes clearer and clearer that it’s going to be quite challenging in all countries to control infection fully. 

So those are the sort of main themes that emerged from this week’s analysis. As we enter September and many countries have school openings, it may shift our forecasts from our reference case possibly toward our worst case, which has much larger numbers in the next two months particularly.

IHME COVID-19 Resources: 

What We're Reading This Week: 

August 25, 2021

This transcript has been lightly edited for clarity

In this week’s update from IHME on the COVID epidemic, we see around the world that with the Delta surges that have been dominating what’s happening to COVID pretty much everywhere so far besides South America, we’ve seen a number of epidemics peak and those peaks are occurring in quite widespread regions. 

So a number of US states – Arkansas, Missouri, Louisiana, Florida, Nevada – have peaked. We’ve seen similar peaks in previous weeks in Europe, and we’ve seen some new ones. We’ve seen peaks in the epidemic, unfortunately, in Southeast Asia in Thailand, Cambodia, and Malaysia as other examples where it appears that the surges are peaking. So that’s probably the most important observation. 

There’s a cautionary tale, however, in what’s been happening in Scotland, because Scotland did peak, and then came down by about 60%, and now in the last 8-10 days has had another rather rapid surge. Now I think what this is telling us is that with Delta being so transmissible, relatively small differences in behavior can account for transmission going down or transmission increasing rather rapidly. 

As we head into the season in many countries when children are going back to school, there’s a particular issue around how much the Delta variant will be fueled by children’s return to school – and what we’re seeing in Scotland might unfold in other countries as well. So we’ll want to watch very carefully what's happening. Other things that emerge from the data, of course, are some places where there’s a huge population of susceptible individuals – like Australia, as they haven’t had much in the way of transmission in the past and have not yet been able to vaccinate a substantial fraction of the population. 

We’re seeing continued very rapid increases in transmission despite lockdown in the two affected provinces. And I think this again is indicative just of how much more transmissible the Delta variant is and that strategies that worked well for the previous variants may need to be stronger if you want to actually contain transmission through mask use and social distancing. New Zealand is trying more stringent lockdowns than Australia as they’ve now got community transmission, and so we have this natural experiment running as to whether those will work in New Zealand compared to the somewhat less restrictive lockdowns in Australia. 

Elsewhere, I think monitoring what we’re seeing on first-dose vaccination is very indicative of where we’ll get to with full vaccination within 30 to 90 days, depending on the vaccine schedule in each country. There’s more progress in some low- and middle-income countries (LMICs) than I think many people appreciate – Chile, Argentina, Uruguay, the southern states of Brazil – are coming up to levels of first-dose vaccination commensurate with many US states or higher. We have quite high levels of first-dose vaccinations in Saudi Arabia, the United Arab Emirates, and Mongolia, and so we’re seeing some LMICs catching up to the high levels seen in western Europe and many parts of North America. 

Will the FDA’s full approval of Pfizer's vaccine change things?

We don’t really know what it’s going to do. The only mechanism that’s going to have an effect is through more employers feeling like they can mandate vaccinations, so that could be the vehicle by which we see an impact of the Pfizer approval by the FDA – normal use approval. But whether there are that many of the hesitant that of their own right are going to be swayed by that is unclear. 

So the story as mentioned last week that will also have a substantial effect on what comes in the next few weeks is – is Delta arriving in Brazil? We’re seeing some Delta-related increases, we believe, in Rio de Janeiro and a couple of other states in Brazil, and the sort of unknown factor for us all is what’s the impact of having been previously infected with P.1 and how much protection the Gamma variant gives you against the Delta variant. So that’ll be another important factor in how bad the Delta surges will be in South America, we believe. 

Last, just a reminder that our models, which suggest that by the end of November – by December 1st – 35% of the world will be fully vaccinated and about half of the world will have some effective immunity against the Delta variant through past infection and or vaccination: these models do not take into account waning immunity – waning immunity from natural infection and waning immunity from vaccination. So in many regards, especially as we look farther into the future, our models are probably optimistic. To put it another way, with 50% of the world at least – and maybe more – susceptible to Delta on December 1st, we should expect a lot of ongoing COVID-19 Delta transmission in 2022. And of course if a new variant comes along, that would be even larger than the current views would suggest. So that’s the main findings from our analysis this week. 

IHME COVID-19 Resources: 

What We're Reading This Week: 

August 19, 2021

This transcript has been lightly edited for clarity

In this week’s update from IHME on modeling the COVID-19 pandemic, we have made some changes to the assumptions around the transmissibility of the Alpha, Beta, and Delta variants – particularly the Delta variant. These changes in assumptions are based on a statistical analysis on the speed of Delta invasion. We did this analysis in June, and now we have a couple more months of data. We’ve re-estimated the combinations of cross-variant immunity (that’s how much protection you get from previous infection against the new variants) as well as transmissibility compared to the ancestral or Wuhan variants. That analysis has led us to lower cross-variant immunity for the Delta variant, down to about 50% on average, ranging in our models from 30% to 70%, and increased transmissibility. This has some effects on our forecasts, particularly in countries where there are many people who are still susceptible, whether they had previously low infection and/or low vaccination rates.

When we look around the world, we see diverse patterns for the epidemic right now. A lot of the Delta-driven surges have actually peaked and some are coming down. We’re seeing peaks in the United States in places like Arkansas, Missouri, Louisiana, and northern Florida. We’re also seeing peaks in a number of countries in Europe and Africa. At the same time, we’re seeing Delta show up and start to trigger surges in places where it hasn’t happened yet, like in Central Europe, the Philippines, Ethiopia, and Nigeria. 

The unusual pattern in the United Kingdom warrants attention, and it’s certainly a challenge on the modelling front, where we saw a Delta surge go up, peaks come down, but now transmission is going back up – albeit much more slowly than the surge in July, but still important for us to understand what has led to that increase. The other place that everyone is watching very closely for the insights it gives on vaccine effectiveness and how it wanes, as well as cross-variant immunity, is the very substantial surge we are now seeing in Israel. 

When you put this all together in our COVID-19 forecasts, we see in the Northern Hemisphere continued quite substantial epidemics from Delta in aggregate running through to peaks of deaths in, for example, the United States in late September. Peaks in US cases – probably late August or early September at the national level – vary by state. In the national forecasts, we expect transmission in aggregate to keep going up in Western Europe, and peaks may come later in the year. And we’re actually seeing the phenomenon where you get a Delta surge now, then it comes down, and then you go into the winter surge in the Northern Hemisphere, which will be smaller because of the Delta variant infecting more people (fewer susceptibles), but in many ways there are two waves that are starting to combine in many countries in our forecasts.

One of the big question marks for us, and of course the countries that are affected, is that as Delta shows up in South America after they’ve been through a major P.1 or Gamma variant epidemic, what sort of cross-variant protection is there from Gamma to Delta? There is essentially no data for us to anchor on for this, and so this will be a very critical question for how severe a Delta surge there might be in South America. 

Cases in South Asia remain low, like in India. We’re not seeing a return after the large Delta surges. Bangladesh has peaked and started and come down. However, we’re continuing to see – and the forecasts reflect it – big surges in Southeast Asia. It’s a very mixed story around Delta right now, but essentially we’re seeing the Delta variant driving the global pandemic – even in the face of vaccination in many countries.

IHME COVID-19 Resources: 

What We're Reading This Week: 

August 12, 2021

No update this week. The next model update will be ready on August 19th. In the meantime, check out the video below to learn more about a recent change to our model tool from Ben Hurst, a member of our Visualization Team. We now have an interactive toggle feature to show reported COVID-19 deaths, excess COVID-19 deaths, or both. These differences can vary significantly from location to location.

August 5, 2021

This transcript has been lightly edited for clarity

So in this week’s update on our models, first there’s been an important change in some of our assumptions about vaccination and the effectiveness of vaccines. We periodically review both the published clinical trials and also the more numerous post-vaccination studies that have been coming out. This week, we’ve incorporated another round of that information, including studies in Canada [56], Scotland [57], England [58] and Israel [59], which suggests two important findings. 

  1. The vaccines are probably more effective than we had previously assumed in preventing hospitalization and death, even against the Delta variant. So the mRNA vaccines are probably 90% or higher in preventing hospitalization or death, and we’ve upgraded quite considerably the estimate of AstraZeneca’s effectiveness against the Delta variant for preventing hospitalization and death.
  2. In contrast, I think the evidence continues to suggest that vaccines are much less effective at preventing infection, and that’s included in the latest version of our COVID-19 model, but we’ve not yet included in our modeling the evidence coming out of Israel that vaccine effectiveness wanes considerably over time from second dose for preventing infection – not for preventing severe disease and death, which is the good news, but in terms of controlling transmission that waning immunity matters a lot and it should be incorporated in our model in the next two weeks or so. 

This makes our model slightly or somewhat more optimistic in countries which have heavy use of the AstraZeneca vaccine in this week’s release.

 »Our projections have extended out by a month to December 1, 2021 in this update [3].

The other important directions that we’re seeing in our models is that we’ve been accurately forecasting peaks in a number of the delta surges. For example, the peak in Indonesia we had forecast has now occurred [60], and the case numbers are coming down. We’ve also forecast peaks in the near future in Bangladesh and likely in Pakistan, which are good news if the model turns out to be correct – and so far we have been tracking it reasonably well in the countries that we are predicting these peaks in. 

The graph below is from the August 5, 2021 version of our model and depicts daily COVID-19 death projections for Indonesia. »Learn more in our COVID-19 Policy Briefing for Indonesia [60].

There are important changes in our forecasts in the United States where we’re seeing the current Delta surge continuing with deaths starting to rising, and unfortunately rising into the beginning and middle of September, with cases perhaps reaching a peak sometime in August and then starting to come down rather slowly. So we do expect a period of ongoing increased transmission challenges as schools open in September during a period where transmission is either intensifying or still very high.

Read »IHME United States Policy Briefing [5] (Our COVID-19 Projections Explained) – Sample of the briefing below 

 

In other parts of the world, we’re seeing the continued decline in South America. And that’s in our forecasts as well, they’re continuing to go down in terms of daily cases and deaths. But we’re seeing this steady surge in Mexico continue to unfold [61], and because vaccination rates are quite a bit lower in Mexico than in, for example, the United States – that is associated with considerable death unfortunately in the next months.

Read »Time For A Smart Approach To Boosters by Ali H. Mokdad and Eric L. Ding [62] published in Think Global Health

In other parts of our forecasts, we are having a hard time understanding the peaks that have occurred in the Netherlands and the United Kingdom and in some parts of Spain, while at the same time, we’re seeing continued expanded surges in other parts of Spain, in Italy, and France and Germany. So it’s a very mixed picture, and these sort of unexpected peaks – at least in terms of the drivers that we have in our model – are making us really wonder what’s the transmission dynamics behind those abrupt reversals that we saw in those particular countries. So we’ll want to track those very carefully in the weeks ahead. One theory behind is that transmission was mostly in younger groups, and was very intense, and has actually infected most people in those younger age groups and so you run out of people to infect and older groups are more vaccinated and therefore more careful – but that’s just a hypothesis. We’ll have to see if evidence backs that up.

I’d say in general, one of the phenomenon that we’re seeing as we push our forecasts out to December 1st, as well as anticipating our forecasts into the first quarter of next year, is because there’s a lot of people that have been infected already in many countries – particularly those places that have bad epidemics – and there’s now a big body of people that are also vaccinated, we start to have quite a substantial fraction of the population that are now immune, even taking into account immune escape and partial effectiveness of the vaccines against infection. Even taking that into account, we’re up in the high-50s of percent of the population that are immune in some countries, and that’ll go up to about 70-percent in December for example in the United States. What that means is that we are now anticipating that the winter surge in the Northern Hemisphere may be smaller than we had previously thought it would be. One way to think about that is that the Delta surge is infection enough people earlier so that those infections have moved earlier in time, so we’ll see less of it concentrated in winter. That may then put less pressure on hospitals when they experience a flu epidemic this coming winter, if the COVID surge is more spread out over time due to the Delta variant. 

Super important but quite complicated interactions here, especially as we get closer in many countries to a much smaller fraction of the population that can get infected. All things we’ll want to keep tracking in the weekly modeling updates as we look farther and farther into the winter.

IHME COVID-19 Resources: 

What We're Reading This Week: 

July 29, 2021

First and most importantly, there continues to be an overwhelming need for redistribution of COVID-19 vaccinations from high-income countries lacking demand to other countries that are lacking supply. Top locations where we are observing significant surges:

  • Southeast Asia
  • United States
  • Bangladesh
  • Iraq
  • Iran
  • Lebanon
  • Mexico
  • Across Sub-Saharan Africa

Fortunately, the Centers for Disease Control and Prevention has changed their guidance by recommending that vaccinated people in the United States wear masks in areas of high transmission, and that’s going to help pull the brakes on continued transmission. This decision by the CDC may have some influence in other countries. But in the places with really large surges and relatively low vaccination, some of the stronger social distancing mandates may be needed to keep the death toll from being really large. For most of 2020, we’ve had about 5 million infections per day at the global level. We’re now settling into about 6 million infections per day. COVID is now worse than it was in 2020 – on average at the global level. It is certainly not over.

IHME COVID-19 Resources: 

What We're Reading This Week: 

July 22, 2021

This transcript has been lightly edited for clarity

In this week’s assessment of the pandemic and modeling from the Institute for Health Metrics and Evaluation, I think we’re seeing the continued critical role of the Delta variant driving transmission in many parts of the world. We’re seeing most of North America with substantial surges. For example, surges in the United States were faster than we predicted last week, so surges are accelerating.

(Explore projections for the United States [83].)

In Europe, we’re seeing very large surges in tourist destinations – Spain [84], Cyprus [85], Malta [86], Greece [87]. Also, there are big surges in the Netherlands, and much smaller surges in other parts of Europe. In Central Europe, it really hasn’t started yet. 

We’re seeing a peak in transmission in Russia [88], we think, which is certainly good news because of the large Delta surge there. We’re seeing Delta surges throughout Africa [89]. We’re also seeing Delta surges throughout Southeast Asia, in Thailand [90], Indonesia [91], and Vietnam [92] keep accelerating.

The theme of what we saw last week – which was the theme of Delta surges continuing – we’re also seeing in our forecast models that at the global level, because we’ve made a revision to how we think mobility may evolve, there is no evidence that mobility is declining in response to these surges in most places. We think we’ve taken that into account in this week’s model. So our forecasts for the next four months are up at the global level. It’s particularly true in parts of the world like Southeast Asia [93], but there's much less effect of those revisions in the US or in Europe [94].

Our forecasts have this surge continuing. It goes up at the global level until early September. It comes down a little bit, and then, as the Northern Hemisphere’s late fall/winter surge starts to take off, we expect numbers to start to creep back up again.

It’s quite a complex picture, but one that’s dominated by how the Delta variant evolves. I think the critical question in understanding the hospitalization and death rates that we might expect to see is really how effective are the vaccines, first – vaccine by vaccine – at preventing infection. That’s built into our model, and we’ve done a systematic review of trials and post-vaccination studies. But then the part that’s less understood is the effect of the vaccines on the Delta variant in preventing hospitalizations and deaths. We know quite a lot about preventing symptomatic disease, and that’s built into our modeling. But the studies that focus on hospitalization and death – many of them had too small numbers to have narrow enough uncertainty intervals for us to adjust our predictions on the basis of a difference between symptomatic disease and severe disease leading to death.

That evidence is starting to accumulate in places that have a lot of hospitalization, such as the United Kingdom, and we expect to better reflect that in the future. 

(Explore projections for the United Kingdom [95].)

But to get that data on how good vaccines are against the Delta variant, countries need to be reporting disaggregated data by age, sex, and vaccination status. In some countries that’s happening – the United Kingdom is an example [96] – but it’s not happening in many countries, including the United States, where it’s actually quite difficult to get information on breakthrough infection, and there has actually been guidance from the CDC discouraging the testing of asymptomatic or mildly symptomatic individuals who have been vaccinated unless they end up in the hospital. That’s making it harder to see how much we can rely on the vaccines against the Delta variant for that critical outcome, which is hospitalization, and the more critical outcome which is, of course, death. We hope there will be more reporting of that kind of data in the future. That’ll give us more information on how well we can rely on vaccines as the main management strategy, but also as waning immunity from vaccination and natural infection kicks in, we should expect vaccine efficacy to also be changing. So having good surveillance will just be critical as we manage both the current Delta surge, likely fall/winter surges in the Northern Hemisphere, and the strong prospect that there will be other variants that will emerge which we’ll need to understand quickly so that we can help understand which communities will face major surges from COVID and plan accordingly.

IHME COVID-19 Resources: 

What We're Reading This Week: 

July 15, 2021

This transcript has been lightly edited for clarity

So in this week's update from the Institute for Health Metrics and Evaluation, we are seeing a number of developments around the world that, at the highest level, can be summarized as outbreaks driven by the spread of the Delta variant. Generally speaking, if we go region by region, the good news in South America is that transmission is trending down finally. But in contrast, in Central America – particularly Cuba and many states in Mexico – and 28 states in the United States, transmission is increasing. We think this is largely due to the spread of the Delta variant, although low sequencing rates in Mexico make it hard to be absolutely sure, but the timing and geographic proximity do make it seem that the Delta variant is fueling these increases.

(Explore projections for Cuba [102], Mexico [103], and the United States [104].)

And these increases in transmission are occurring in some places – some of them with 50% of the population or even higher, in the US for example – that are vaccinated. So they are occuring in the unvaccinated and breakthrough transmission in the vaccinated.

(Listen to IHME Professor Ali Mokdad on Twitter [105] share recommendations for vaccinated individuals in the United States.)

Similarly, we are seeing a mixed pattern of Delta surges in select countries in Europe: the Netherlands, Spain, Greece, and Cyprus are having surges that have erupted rather abruptly due to the Delta variant, though we're not seeing yet these same surges in Germany, Italy, or in many other parts of Eastern Europe. We are seeing large Delta variant surges in Russia, Kazakhstan, and other parts of Central Asia.

(Read our COVID-19 policy briefing [15] for the WHO-EURO region.)

Elsewhere, in sub-Saharan Africa, there are many countries with surges. Albeit there have been some that have gone up, like Uganda and Zambia, that have peaked and have started to come down, which holds out the prospect that we'll see less dramatic, sustained surges in other countries in Africa.

(Read our policy briefings for Uganda [106] and Zambia [107].)

Of course, the other big story is the eruption after relatively good control in Southeast Asia. Thailand, Vietnam, Indonesia, and Malaysia have had large COVID-19 surges.

(Explore our projections for Thailand [108], Vietnam [109], Indonesia [110], and Malaysia [111].)

When we look at our models for the next four months, the timing of the Delta surge is absolutely critical, as is the race against the Delta variant in terms of vaccination rates. Our models for the world are certainly an increase in forecasted cases and deaths compared to our last release two weeks ago. But in general, our global forecast is for this current Delta surge to play out, lead to increased numbers between now and early September, a decline globally, and then a return to increasing numbers at the end of our forecasting window in November. When we run the models out farther, we see a Northern Hemisphere surge coming later in the year as well.

(Explore our global projections [2].)

So the main message from this week's analysis is the dominant role of the Delta variant. that even in places with quite substantial vaccination rates like Israel, we are seeing increased transmission rates. There's enough breakthrough transmission that we see enough "susceptibles," or kindling so to speak, that we're seeing transmission expand. This holds out the prospect that we could see Delta surges even in places our model doesn't predict to have surges due to the ingredients being present. Those ingredients are fewer people with previous infection, lower vaccination rates, and behaviors that are going back to pre-COVID levels of interraction, and minimal mask use. I think, moving forward, the recommendation from many public health authorities that it's okay for vaccinated individuals not to wear a mask will probably need to be reconsidered in those settings where there's a major surge due to Delta since we now know that the vaccinated play an important role at least in getting infected, and also are very likely contributing to transmission. 

IHME COVID-19 Resources: 

July 8, 2021

We will not produce COVID-19 forecasts this week as we will be implementing some changes to our modeling framework. 

IHME COVID-19 Resources: 

July 1, 2021

This transcript has been lightly edited for clarity

There’s a lot happening on the COVID front, and I think it’s largely being driven – but not exclusively – by the Delta variant. If we start in Europe where there has been a lot of attention, we’re continuing to see an absolutely explosive surge in the United Kingdom. It’s farther along in Scotland, and now case reports are at the highest levels of the whole pandemic than they’ve been at this point in the pandemic despite moderate levels of vaccination and some number of people who’ve been previously infected. This is spreading to England, Wales, and Northern Ireland as well. 

(Read our COVID-19 policy briefing for the United Kingdom [112].)

On the eastern part of Europe, we see the Russian Federation having the other major surge for COVID. This is happening in a population that has not got high levels of vaccination, but 80% of the population was previously infected. This suggests that the Delta variant is highly transmissible and has a considerable degree of immune escape. The other thing that’s happening in Russia in the case of natural infection is that deaths are tracking up in parallel with cases going up. 

(Read our COVID-19 policy briefing for the Russian Federation [88].)

The surprise in the rest of Europe is that, in aggregate, cases are trending down quite briskly. So even though the variant has been detected in many other countries in Europe, only in Portugal is there is a slow increase in cases – and in Cyprus a faster increase – but in most of the rest of the countries in Europe, although the variant is present in many, we’re not yet seeing things take off. It’ll be important to see how that unfolds. 

(Explore our projections for Portugal [113] and Cyprus [114].)

In Southeast Asia, we’re seeing large increases in Indonesia and we’re also seeing steady increases in Thailand and Cambodia. We expect that these are driven by the Delta variant and we do expect them to continue, and our forecasts therefore have a considerable increase in deaths in a number of countries in Southeast Asia. 

In Bangladesh, the government took off the social distancing measures that brought the surge under control. Now the surge has come back, and the government has re-established stay at home orders. We’re not seeing this yet in India; there are two or three states where the decline in cases has slowed or stopped. We’ll have to wait and see if what has happened in Bangladesh will now happen in India. It’s quite plausible that it could spread to many states in India in the next two or three weeks.

(Read our COVID-19 policy briefings for Bangladesh [115] and India [116].)

In sub-Saharan Africa, there are continued surges in a number of countries, but not all. The glimmer of hope there is that the surge in Uganda, which is in one of the earlier surges in what we think is a Delta-driven wave, has peaked and come down. They have had a number of social distancing measures in place, so it argues that those measures have been effective, and that similar measures elsewhere can help bring surges under control.

(Explore our projections for Uganda [106].)

In Central America, the big news is that the increasing number of states that we see in Mexico where cases have been going down are now going up. Some of the surges are quite brisk. It’s somewhere near half the states in Mexico now showing increasing case numbers. The big question in Mexico is, is this due to the P.1 variant spreading in from South America, or is it due to the Delta variant spreading in from England or India? We don’t know – there’s very limited sequencing in Mexico. It of course makes a really big difference for the next month and into the fall for Mexico if this is P.1-driven and Delta will come after? It’s hard to know what the correct answer is. 

(Read our COVID-19 policy briefing for Mexico [117].)

In South America, the trends are – in aggregate – on the slow and steady increase up, reflecting this experience we see in Ecuador and Peru of flat or slightly increasing case numbers over a prolonged period. We’re seeing similar patterns in some states in Brazil, too, though many countries in the southern cone have started to experience declining cases. 

In the United States, of course concern is high that the Delta variant may lead to something that we’re seeing in Scotland like an explosive exponential growth in cases. We are seeing hospitalizations go up in Missouri, Arkansas, Nevada, Mississippi, and a number of other states. In some of those states, while hospitalizations are trending up, cases are not. We expect the disconnect between cases and hospitalizations is because of CDC guidance to states and health providers to not test vaccinated individuals. While we understand why that guidance was given, to create an incentive for people to get vaccinated and to avoid reports of cases in the vaccinated, it is making it harder to track whether the Delta variant is leading to an increase in transmission. Our models for the US show increases, but not dramatically, over the next two-three months. We expect the more dramatic Delta variant increases to come later in the year as seasonality works against us as well.

(Explore projections for the United States [118].)

That’s the diverse set of trends we’re seeing around the world, clearly at a critical junction in the epidemic where we race to vaccinate as many people as possible while the Delta variant is leading to these outbreaks in many regions around the world. 

IHME COVID-19 Resources: 

What We're Reading This Week: 

Editor's Note

We have made a change in our COVID-19 model visualization tool [2], where we were showing estimates for reported COVID-19 deaths – which is measurements that come through the official measurement systems. Now, you can toggle to looking at estimates from the past and forecasts for the future of total excess mortality related to the pandemic. We had made a change back in May to show total excess mortality in the viz tool first [126], but because people are more familiar with the numbers on reported deaths, we're reverting back to showing that as the first view.

June 24, 2021

Resources: 

June 18, 2021

This transcript has been lightly edited for clarity

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. We now project about 9.2 million deaths from COVID-19 by September 1 globally (our projections [2] run through October 1). Global cases and deaths continue to decline, in large part due to the declines in India. However, there are many differences between countries and regions when it comes to infections and mortality. 

(View policy briefings for India [127].)

In Europe and North America, due to the rise of vaccinations and seasonality, we are seeing a decline in cases. However, in certain locations in Europe, such as Scotland, we see a rise in cases due to premature relaxation of social distancing measures – even with a high vaccination rate – due to the arrival of new escape variants. 

(View policy briefings for the United Kingdom [128].)

Cases are increasing in many Caribbean countries and parts of Mexico in South America due to the circulation of the variant P.1 (first discovered in Brazil) and possibly by the increase in circulation of the variant B.1.617 (first discovered in India). 

In Southeast Asia, a number of locations – Malaysia, Taiwan, and Vietnam – are experiencing a rise in cases mainly due to the arrival of the variant B.1.617 (first discovered in India). 

(View policy briefings for the WHO SEARO region [129].)

In many places in the world, such as Eastern Europe and Southeast Asia, where mask wearing is very low, mobility is very high, and confidence is very low – even with previous high infection rates we are seeing a surge of cases. There is a potential for a surge of cases, especially with new escape variants that are making the vaccines less effective, and of course previous infections do not provide as much immunity against them. In many countries, distribution of the vaccines is still very low and their health systems are unable to contain the surge.

The best strategies to contain the surge in the days to come are improving social distancing measures within the country, limiting the introduction of the virus through control at the airports and through isolations, and asking people to change their behaviors by avoiding gatherings, wearing a mask, and getting the vaccine as soon as possible. 

COVID-19 cases and deaths continue to decline in the United States due to seasonality and the rising vaccination rates. We now estimate that about 170 million Americans will be fully vaccinated by September 1 (our projections run through October 1). About 30% of Americans who are now eligible to receive the vaccine are hesitant and report that they will not take the vaccine. Also, children under the age of 12 are still not eligible to get the vaccine.

(View policy briefings for the United States [130].)

Despite the fact that about 25% of Americans have received the mRNA vaccines, our best vaccines, many people are still susceptible to getting infected by COVID-19 – especially with the new escape variants that are now circulating through many states. We know, for example, that P.1 is circulating in several states and has started replacing B.1.1.7 (first discovered in the UK), which has been circulating in many states. We estimate that about 50% of Americans will remain susceptible to COVID-19 and this may sustain a surge in the winter. The best strategies to prevent such a surge in winter are to address vaccine hesitancy, expedite the rollout of the vaccine, and ask people to wear masks as soon as possible – especially when we start seeing cases going up at the beginning of winter. 

Resources: 

June 10, 2021

This transcript has been lightly edited for clarity

The main findings from this week's analysis are concentrated in several areas. First, I think we're seeing evidence in Scotland particularly, but also England, that even in a moderately vaccinated population the COVID-19 variant B.1.617.2 (Delta variant) has enough immune escape from at least AstraZeneca that we’re seeing rapid expansion of transmission. This is something to watch closely, and may be a marker for other countries that have used AstraZeneca, or have used some of the other vaccines are not as effective as the mRNA vaccines.

(See our vaccine efficacy table [131].) 

The second area that I think is of huge concern is the really rapid increases in select countries. These include Uganda, Zambia, DRC, and some substantial increases in Namibia. These definitely raise questions as to whether these are surges driven by (the Delta variant) B.1.617.2 or – in the case of Namibia – is it just what's happening in neighboring South Africa, where they're hitting a peak of seasonality, and it's still a B.1.351-driven surge.

(View policy briefings for the AFRO Region [132].) 

Elsewhere in India, the pandemic continues to decline. We’re seeing some suggestion that lockdown and other measures is leading to a peaking of transmission in Taiwan, and it’s important because it suggests that the measures we’ve been using throughout the pandemic work – including against (the Delta variant) B.1.617.2. That control in Taiwan is something we want to watch very closely.

(View policy briefings for India [133] and Taiwan [134].)

In Latin America, in Chile, another warning that with high vaccine coverage (80% with one dose) they’re still seeing quite steadily rising cases. That could be quite low efficacy of the vaccine against the variant P.1, which is still what we think to be the major variant in Chile.

(View policy briefings for Chile [135].)

Generally the Southern Hemisphere is starting to decline again as we would expect. In the rest of Europe and to some extent in the US and Canada, I think we’re seeing that seasonality is very strong. We're seeing declines in transmission beyond what we would expect to see with just the scale-up of vaccination, which is markedly different across Europe from east to west. 

Resources: 

June 4, 2021

No video this week. Check the resources below for details on the latest estimates. 

Resources: 

May 28, 2021

This transcript has been lightly edited for clarity

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. We are projecting about 9.2 million deaths globally by September 1. Global cases and deaths continue to decline, in large part due to the declines we see in India. There are differences in countries and regions when it comes to infections and mortality. 

In Europe and Northern America, due to the rise in vaccination and seasonality, we are seeing a decline in cases. However, in certain location in Europe – for example in Scotland – we see a rise in cases due to a premature relaxation of social distancing measures, even with high vaccination rates, especially with the arrival of new escape variants.

Cases are increasing in many Caribbean countries and in parts of Mexico and South America due to the circulation of the P.1 variant, first discovered in Brazil, and possibly by the increase in circulation of B.1.617, first discovered in India.

In Southeast Asia, a number of locations like Malaysia, Taiwan, and Vietnam are seeing a rise in cases mainly due to the arrival of B.1.617.

In many places in the world, such as Eastern Europe and Southeast Asia, where mask wearing is very low, mobility is very high, and confidence in vaccine is very low – even with a previous high infection rate – we’re seeing a surge in cases. There is a potential for a surge of cases, especially with new escape variants that are making the vaccines less effective, and previous infections do not provide as much protection against it. In many of these countries, vaccine distribution is very slow, and they’re not able to contain the surge.

The best strategies to contain the surge in the days to come is improving social distancing measures within the country to contain the spread of the virus, limit the production of the virus through control at airports with isolation, and ask people to change their behaviors: avoid gatherings, wear a mask, and take the vaccine as soon as possible. 

COVID-19 cases and deaths continue to decline in the United States due to seasonality and the rising vaccination rates. We now estimate that about 170 million Americans will be fully vaccinated by September 1. About 30% of Americans who are eligible to take the vaccine remain hesitant and report they will not take the vaccine. Also, children under the age of 12 are still not eligible to get the vaccine. Combine that with the fact that about 25% of Americans who receive the mRNA vaccines are still susceptible to getting infected by COVID-19, especially the new escape variants that are now circulating in the United States. For example, we know that P.1 has started circulating in several states and started replacing B.1.1.7. We believe that about 50% of Americans will remain susceptible to COVID-19, and this percentage will sustain a surge in winter. The best strategy to prevent such a surge in winter is to address vaccine hesitancy, expedite the rollout of the vaccine, and ask people to start wearing masks as soon as possible – especially if we start to see cases going up at the beginning of winter, as we expect. 

May 21, 2021

This transcript has been lightly edited for clarity

Our results are quite similar to last week’s forecasts. There are some important points to notice in what we’re seeing develop around the world. As expected and as forecasted for the last 4-5 weeks, cases have peaked in India and deaths and are now peaking as we expected. We should see by next week, we believe, deaths going down at the national level. There is some variability across states, but good news in a very dark story that at least currently the death toll is started to come down. 

(View projections for India [137].)

Elsewhere around the world, places where there is a continued marked increase in cases include Japan. The steady rise in cases and deaths certainly are going to cause considerable concern and discussion around the Olympics because now we’re at a point where the epidemic is the worst it has been in Japan in the course of the pandemic.

(View projections for Japan [138].)

Another important area is the slow, steady decline in cases and deaths in the United States as well as in most of Europe. This raises the question as we expect continued scale-up of vaccination and the low level of seasonality in the summer should keep transmission steadily going down. Even what we expect to be quite a considerable drop in mask use because of the CDC guidelines in the US haven’t really changed our US forecasts very much. I think this points out that in a period of low seasonality and rising vaccine coverage, mask use may not be the critical driver that it will be later in the year.

(View projections for the United States [139] and Europe [140].)

So we expect that there isn’t a critical challenge in sustaining high levels of mask use over the summer in the Northern Hemisphere. We do believe, as we look out into the winter, when seasonality starts to kick back in and as new variants threaten to spread that have immune escape, that mask use may come back to be a critical part of our strategy in controlling the pandemic. 

Other good news in Brazil is that cases and deaths in aggregate are starting to trend down, suggesting that despite seasonality intensifying in Brazil, we’re seeing some reasonable amount of control around the P.1-driven epidemic there.

(View projections for Brazil [141].)

With seasonality intensifying, social distancing and maintaining mask use are absolutely critical for the control of COVID-19 in the southern part of South America in the face of escape variant P.1. 

Additional Resources: 

May 14, 2021

This transcript has been lightly edited for clarity

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. IHME is projecting about 9.2 million deaths globally by September 1.

(View projections at the global level [142].)

Cases globally are declining but mortality is stagnant. Still, the detection rate of COVID-19 infections is very low, about 7% globally. Based on the seroprevalence surveys that we track at IHME, we estimate about 24% of the public have been infected, so it means that many people are still susceptible out there. Effective R is above 1 in 63 countries, indicating that cases will increase in the coming weeks in these locations.

(View projections for India [143].)

In India, cases are coming down. Mortality peaked and is also starting to come down. This isn't true for every state in India, but at the national level, mortality and cases are declining.

The next phase of the pandemic will be determined by three main factors:

  1. Vaccines, and how fast countries can vaccinate their populations given the worldwide vaccine shortage and how well they can deal with vaccine hesitancy, which is still high in many countries.
  2. Seasonality is still high in the Southern Hemisphere where variants like P.1 are circulating. Cases will likely increase in this part of the world, and it will be incumbent on social distancing measures to help prevent transmission
  3. Spread of B.1.617, a variant first identified in India. We're seeing reports that this new escape variant is circulating in the UK and Mexico, and the outcome depends on how countries are able to handle it in their own communities with travel restrictions.

​​To control the pandemic, strategies remain the same: social distancing mandates, mask-wearing, and rolling out the vaccine as soon as possible.

In the United States, we project 947,000 cumulative deaths by September 1. This represents an additional 35,000 deaths from May 10 – September 1. We are expecting that daily deaths will keep declining through September 1. The epidemic continues to decline in the US with the exception of three states where we are seeing evidence of stagnant or slightly increasing transmission. Those states are Alabama, Montana, and New Mexico. These declines in the United States are due to a combination of vaccination rates and declining seasonality.

(View projections for the United States [144].)

B.1.1.7 remains the dominant variant circulating in the United States right now, but there is evidence of sustained increases and the prevalence of the escape variants B.1.351, B.1.617, and P.1. Vaccinations continue declining as the US approaches the limit of the adults who are willing to take the vaccine, increasing the threat of escape variants – especially later in the year due to seasonality. Every effort should be made right now to increase vaccination. Mask use in the vaccinated continues declining, and we expect with the new CDC guideline on mask use indoors for vaccinated people, that mask-use will drop more drastically in the United States than what we have assumed in our models and we will adjust for that in our future release. Our reference scenario and our worse scenario do suggest that infection will increase in July and August in the US, although mortality will not increase – but we will start seeing a rise in cases. We in the United States are not out of danger, simply because of future seasonality in the winter and the arrival of the new variants.

Additional Resources: 

May 6, 2021

Latest Model Results

This transcript has been lightly edited for clarity

In this week’s release from IHME, we have changed our key metric from reported deaths to the total number of COVID-19 deaths [145]. That means that up until present, the number of deaths that COVID-19 has caused in the world is about 6.9 million – so all the numbers that we are now forecasting are total COVID-19 deaths, corrected for underreporting.

(View projections at the global level [146].)

COVID-19 is the number one cause of death in the world this week, and the number of deaths that we are observing so far – up until present – is about 30,000 deaths per day from COVID-19. Now if we look around the world, the main area driving the epidemic is in India. There also seems to be an epidemic unfurling in Nepal, spreading perhaps into other countries in Southeast Asia, but primarily the global epidemic is being driven by what’s happening in India. Our model suggests that infections may be at a peak in India this week. Because there are so few people left in many states that have not been infected, we’re starting to observe some breaks in transmission due to the small fraction of the population that remains susceptible. That means, unfortunately, we expect the death toll in India to continue rising probably for the next two to three weeks, and we expect that death toll to get much higher. So the epidemic, as it unfolds in India, is the primary global concern.

(View projections for India [147].)

In Brazil, and countries around Brazil, the P1 epidemic in aggregate may have reached its peak. There are data to suggest that in many parts of South America, cases are actually flat or maybe even coming down, and deaths are likely to follow suit. 

(View projections for Brazil [148].)

We’re seeing in Europe and in North America that while there are some countries wherein transmission is still intensifying – in aggregate – the developments we’ve been seeing for many weeks now, like expanded vaccination and declining seasonality, are pushing down transmission, bringing down cases, hospitalizations, and deaths. It does suggest that in the Northern Hemisphere, excluding India, we can expect to reach quite low levels of transmission in the summer. In India, we expect the peak to decline, but we still anticipate that cases and deaths will continue for many weeks into the summer. 

In aggregate, by September 1, we are expecting at the global level to see 9.4 million cumulative deaths from COVID-19. That’s an extra nearly 2.5 million deaths from now until September 1.

Total COVID-19 Mortality (Methods Update Explanation)

Related Resources: 

This transcript has been lightly edited for clarity

In this week’s release from IHME, we have made a major change in how we think about the number of deaths that have occured from COVID-19. We have completed an analysis of all-cause mortality for 59 countries and 198 states and provinces within countries. Using that data, we have looked at excess mortality, and then we have tried to relate excess mortality as a metric to get closer to the true number of COVID-19 deaths. There are clearly other things that go into excess mortality. For example, people have avoided health care, so that might’ve raised mortality for some causes. There’s an increase of depression and drug use in some countries, and that has potentially raised deaths. We know injuries are down, perhaps by about five percent globally, due to reductions in mobility. We know that flu deaths and RSV deaths are down globally because of lockdowns. And we also know that when there was an intense death rate from COVID-19 in the months afterwards, some frail individuals who died from COVID didn’t die from heart disease and chronic lung disease. When you put all of that together, we conclude that the closest estimate for the true COVID-19 death is still excess mortality.

Once we completed this analysis, our understanding of the magnitude of COVID to date has been much worse than what we have been thinking so far. We have estimated that 6.9 million people have died from COVID globally to date. 

Additional Resources: 

April 30, 2021

No video this week. Explore COVID-19 model resources below:

April 23, 2021

This transcript has been lightly edited for clarity

In this week’s IHME analysis of the pandemic, the main focus is on the extraordinary surge in India and other parts of South Asia. The exponential rise in cases and deaths continues in India, and our analysis of seroprevalence surveys is telling us that the infection-detection rate is below 5% – maybe even around 3-4%. This means that the number of cases that are being detected needs to be multiplied by 20 or more to get the number of infections that are occurring in India. The number of infections right now is extraordinarily large. There are more infections happening in India than what occurred globally two weeks ago. 

Our latest projections show that the number of infections driven by the surge in India (and perhaps also driven by the surges in Bangladesh and Pakistan) will be reaching 15 million a day globally. The huge epidemic is likely to continue at least into the second week of May, but given the extraordinary volume of infections in India, COVID-19 may run out of people to infect pretty soon. Our models are suggesting that transmission may start to decline in India as we get into the latter half of May. Meanwhile, the surge in India is now spreading to Nepal. 

(View projections for Bangladesh [150] and Pakistan [151].)

(View projections at the global level [3] and for India [152].)

Cases elsewhere in South Asia have peaked and started to come down – particularly in Bangladesh – but we think that might be a reporting artifact from the Ramadan period, where fewer people may be seeking to be tested, and/or there may be lags in the data. So we’ll watch very closely the trends in Bangladesh and Pakistan. 

In South America, where the epidemic is really fundamentally driven by P1, we’re seeing rising cases and deaths, but nowhere near as explosively as the South Asian epidemic. It’s important to consider what the variant is in the South Asian epidemic. We think it’s mostly related to B.1.617, although sequencing data in the public domain are quite sparse for India and there is certainly plenty of B.1.351 and also B.1.17 sequenced in India. But given the explosive increase in South Asia compared to Latin America and given the high prevalence of previous infection in some states like Delhi, which was already 75% infected before this started to happen, it’s clearly an escape variant, and that makes it most likely that it’s B.1.617. 

In Europe, aggregate cases and deaths seem to have come down slightly in the past week, but there are certainly a number of countries, like Spain and the Netherlands and a few others, where cases are going up but deaths are either constant or even declining slightly. So we’re perhaps seeing continued transmission related to behavioral relaxation but effective vaccination is enough to keep the death rate constant or declining. 

(Read the WHO EURO region policy briefing [153].)

In North America, we’re seeing continued growth of the epidemic in Canada, particularly in Ontario. Some suggestion of the B.1.1.7-fueled increase in Michigan is reaching its peak, and thus our forecasts for the US are down. We’ve also introduced this week an important change to our analysis of past infections by correcting seroprevalence data that we used to get the infection-detection rate and infection-fatality rate for waning antibody sensitivity over time (read about this change here [154]). This change has increased the number of people who have been previously infected in the US to near 30%, up from previous estimates in the low 20s, and that makes a difference to our forecasts, along with steady progress on vaccination. 

(View projections for Canada [155], Ontario [156], Michigan [157], and the United States [118].)

Those are the main areas of development in this week’s assessment. But just to reiterate, what’s happening in South Asia is overwhelmingly driving our assessment of the global pandemic. 

Additional Resources: 

April 16, 2021

Dr. Ali Mokdad is in for Dr. Christopher Murray this week. 

The surge in Michigan is slowing and our results indicate a decline in United States cases until the winter months. The US is experiencing a decline in deaths due to increase in vaccination, reduced spread of the B.1.1.7 variant compared to Europe, and relatively high rates of immunity due to previous infection.

(Read the COVID-19 policy briefing for the United States [158] and Michigan [159].)

Vaccine hesitancy is on the rise, fueled by the pausing of the Johnson & Johnson and AstraZeneca vaccines. Come May and June, there may be more vaccines in the US than people willing to take them. 

Projections and Scenarios for the United States:

  • In our reference scenario, which represents what we think is most likely to happen, our model projects 618,000 cumulative deaths on August 1, 2021. This represents 58,000 additional deaths from April 12 to August 1. Daily deaths are expected to decline from a peak around May 1 and then decline to low levels by August 1. Daily infections are expected in the reference scenario to decline steadily over the next months. 
  • By August 1, we project that 52,600 lives will be saved by the projected vaccine rollout.
  • If universal mask coverage (95%) were attained in the next week, our model projects 13,000 fewer cumulative deaths compared to the reference scenario on August 1, 2021.
  • Under our worse scenario, which includes faster reductions in mask use and faster increases in mobility, our model projects 679,000 cumulative deaths on August 1, 2021, an additional 61,000 deaths compared to our reference scenario. In the worse scenario, daily infections remain remarkably stable over the next four months, declining only slightly by August 1.
  • At some point from April through August 1, 12 states will have high or extreme stress on hospital beds and four states will have high or extreme stress on ICU capacity.

Globally, we see a rise in cases and mortality. We are paying particular attention to hotspots in Asia: Pakistan, Bangladesh, Iran, and India, where we see the spread of a new variant, B.1.617. Social distancing mandates should be imposed to help contain the virus in those locations, in addition to scaling up vaccinations globally. 

(Read the COVID-19 policy briefing for Pakistan [160], Bangladesh [115], Iran [161], and India [162].)

Global Projections and Scenarios:

  • In our reference scenario, which represents what we think is most likely to happen, our model projects 4,677,000 cumulative deaths on August 1, 2021. This represents 1,275,000 additional deaths from April 12 to August 1 (Figure 19). Daily deaths are expected to peak in early to mid-May and then decline to nearly 5,000 by August 1. Daily infections are expected to peak in the reference scenario in early May and then decline to 2 million by August 1.
  • By August 1, we project that 393,200 lives will be saved by the projected vaccine rollout.
  • If universal mask coverage (95%) were attained in the next week, our model projects 286,000 fewer cumulative deaths compared to the reference scenario on August 1, 2021.
  • Under our worse scenario, in which mask use declines faster and mobility increases faster, our model projects 5,051,000 cumulative deaths on August 1, 2021, an additional 374,000 deaths compared to our reference scenario. Daily deaths will remain over 10,000 through to August 1. 
  • In the worse scenario, daily infections increase through to mid-May and the decline to 5 million by August 1. 
  • At some point from April through August 1, 86 countries will have high or extreme stress on hospital beds. At some point from April through August 1, 96 countries will have high or extreme stress on ICU capacity.

(Read the global [163] COVID-19 policy briefing.)

Additional Resources: 

April 8, 2021

This transcript has been lightly edited for clarity 

In this week’s COVID-19 update from IHME, we see that the global epidemic is really not improving at all. New to our model is the expansion of estimates out to August 1 (they previously expanded to July 1). And like last week, there’s four key centers of ongoing transmission. 

First and foremost on the list of concerns is what’s unfolding in South Asia. There are rapid increases in cases Bangladesh, Pakistan and India. We’re seeing this in states such as Deli, where seroprevalence surveys suggest 65-70% have been infected. This makes us quite convinced that the outbreak in South Asia is driven by a so-called escape variant, which is where previous infection doesn’t necessarily protect you from the new variants (also known as the escape variants). And where vaccines are likely to be less effective, particularly the AstraZeneca vaccine. So the outbreak in India continues to increase very rapidly, and I think we can expect that to continue growing for quite some time.

(Read the COVID-19 policy briefing for Bangladesh [115], for India [164], and for Pakistan [160].)

The second area is the ongoing P1 epidemic in Brazil. New sequencing data was released from São Paulo this week that suggests P1 had spread into São Paulo much earlier than the data had previously expected, making the case that the general outbreak in the entire country is driven by the P1 variant. For those looking at the numbers, the seeming flattening of case numbers in the last few days around Easter is likely a data artifact. When there’s holidays, there’s usually lags in reporting.

Projections and Scenarios for Brazil:

  • In our reference scenario, which represents what we think is most likely to happen, our model projects 592,000 cumulative deaths on August 1. This represents 256,000 additional deaths from April 5 to August 1. Daily deaths will peak at 3,480 on April 24, 2021.
  • We expect that 152.65 million will be vaccinated by August 1.
  • If universal mask coverage (95%) were attained in the next week, our model projects 60,000 fewer cumulative deaths compared to the reference scenario on August 1.
  • Under our worse scenario, our model projects 654,000 cumulative deaths on August 1, an additional 62,000 deaths compared to our reference scenario. 
  • By August 1, we project that 99,500 lives will be saved by the projected vaccine rollout.

(Read the COVID-19 policy briefing for Brazil [165], which includes detailed information about our projections.)

Third area of concern is in Europe, where cases are increasing slowly despite increasing social distancing mandates. Cases are increasing more rapidly in eastern countries where mask use is lower. The good news is that this holds out the prospect that further increases in vaccination in Europe, as long as mask use doesn’t drop too much, will really be the main strategy to remedy rising cases and deaths. 

We do see in the vaccine confidence data that in Eastern Europe particularly, vaccine confidence is really low. So there are countries where less than 30% of people are willing to be vaccinated. So there is a prospect for B.1.17 to continue expanding in those settings. Although, for the region overall, our reference scenario in our model projects that daily deaths will start to go down in May.

Projections and Scenarios for Europe: 

  • In our reference scenario, which represents what we think is most likely to happen, our model projects 1,566,000 cumulative deaths on August 1, 2021. This represents 303,000 additional deaths from April 5 to August 1.
  • Daily deaths will peak at about 5,620 in late April, and then start declining.
  • If universal mask coverage (95%) were attained in the next week, our model projects 55,000 fewer cumulative deaths compared to the reference scenario on August 1, 2021.
  • Under our worse scenario, in which mask use declines faster and mobility increases faster, our model projects 1,629,000 cumulative deaths on August 1, 2021, an additional 63,000 deaths compared to our reference scenario. Daily deaths remain above 1,000 on August 1 in this scenario.
  • By August 1, we project that 103,500 lives will be saved by the projected vaccine rollout. This does not include lives saved through vaccinations that have already been delivered.
  • Daily infections in the reference scenario drop below 100,000 in mid-June but remain above 200,000 through to August 1 in the worse scenario. 

(Read the COVID-19 policy briefing for Europe [166], which includes detailed information about our projections.)

The last area of focus or concern is in Canada and the United States. We’re seeing the largest outbreak in Michigan, that surge is really very impressive. Numbers are shooting up, and we’re finally seeing deaths creep up as well as cases and hospitalizations. Cases have gone up 500% in a month, and there’s no end in site so far. The challenging part for Michigan for us is that the increase there is not easily explained. There’s a lot of B.1.1.7 in Michigan, but mask use and mobility aren’t unusual in Michigan. And there’s more B.1.1.7, at least according to the data, in Maryland  – but a much bigger surge in Michigan. So they only way we can put all this together is to expect that the sequencing data is sort of out of sync in Michigan, and perhaps B.1.1.7 showed up there sooner, and there’s more transmission. If not, there’s some other factor that’s going on in Michigan.

(Read the COVID-19 policy briefing for Michigan [167], which includes detailed information about our projections.)

Across the border from Michigan, we’re seeing upticks in Ontario and Quebec [168] as well, and we’re starting to see bigger increases in transmission in adjacent states like Minnesota as well. Clearly, there’s a cluster of increasing transmission in that part of Canada and the US, and everybody is watching this very closely. The question is, is this a marker of what may happen in other parts of these countries?

Projections and Scenarios for the United States:

  • In our reference scenario, which represents what we think is most likely to happen, our model projects 619,000 cumulative deaths on August 1, 2021. This represents 64,000 additional deaths from April 5 to August 1. Daily deaths are expected to decline steadily until August 1.
  • If universal mask coverage (95%) were attained in the next week, our model projects 14,000 fewer cumulative deaths compared to the reference scenario on August 1, 2021.
  • By August 1, we project that 78,200 lives will be saved by the projected vaccine rollout.
  • Under our worse scenario, in which mask use declines more rapidly and mobility increases more quickly, our model projects 698,000 cumulative deaths on August 1, 2021, an additional 79,000 deaths compared to our reference scenario. In the worse scenario, daily deaths would increase until the beginning of June and then decline but remain over 750 a day on August 1.
  • At some point from April through August 1, nine states will have high or extreme stress on hospital beds. At some point from April through August 1, three states will have high or extreme stress on ICU capacity.

(Read the COVID-19 policy briefing for the United States [169], which includes detailed information about our projections.)

Overall, for the United States, it’s really this balance of the scale up vaccination, past infections, and how quickly do people re-open as to whether the variant spread of B.1.1.7 will tip us into a surge like Michigan elsewhere, or like what our reference scenario suggests, which is that things won’t be that bad and numbers will start to go down in May. Now it’s very easy, and our worse scenario demonstrates that, to see death numbers rising into June with only slightly lower mask use and slightly increase mobility. We’re on that knife edge of transmission where small changes can really shift us to an R-effective below 1 or R-effective over 1. This really puts enormous importance on people remaining cautious, not taking risks in terms of transmission, trying to get vaccinated as soon as possible and when they’re eligible, and hopefully we will win that race in terms of this spring surge. 

Additional Resources: 

April 2, 2021

This transcript has been lightly edited for clarity 

In this week’s release of the IHME models for COVID-19, I think it’s important to look at four different areas of the world that are driving the global epidemic right now.

  1. First and most concerning is the P1-driven surge in Brazil and some neighboring states, such as Peru and Ecuador. In this week’s model, we have very substantially revised upwards our forecasts until July 1st, and this in part is due to much more in-depth analysis of what combinations of cross-variant immunity – between ancestral variants and P1 – and increased transmissibility of P1 can account for what we observed in Amazonas state in December and January. So when we put all that together, we find a much more alarming forecast for Brazil and neighboring countries.
     
  2.  The second great area of concern right now is the surge that we’re now seeing in South Asia, in Bangladesh, in Pakistan, and many states in India. We had been going through a very long period of declining cases and deaths, and now we are in a very rapid expansion in some places – Punjab is an example, and Bangladesh is having particularly sharp increases. Now when you look within India at a state like Delhi, where 65% of the population had been infected already – both from a seroprevalence survey and our own modeling – and now you’re seeing this big upsurge starting. It strongly suggests that the epidemic unfolding in South Asia is also related to one of the escape variants. Because sequencing is not as strong there, we’re not 100% sure, but there have been reports, for example, of mutations that look like escape variants that are accounting for this transmission.
     
  3. The third area of concern globally in terms of what’s happening is the continued expansion of daily cases in Europe, and now daily deaths going up at a much slower rate, but still going up. This is happening despite considerable vaccination underway in Europe and a very strong set of social distancing mandates in place. So the B.1.1.7 variant is driving increased transmission despite a lot of brakes on transmission that we would expect would be protecting them from continued expansion. In our models, despite this very concerning set of trends, we do think that the B.1.1.7-driven epidemic in Europe will peak sometime in late April and start to come down because, eventually, vaccination and declining seasonality will be enough to overwhelm an increased transmission from B.1.1.7. As we have forecasted for a number of weeks, we expect many countries – and we have now seen France do this – put tighter restrictions in place to help in putting the brakes on B.1.1.7.
     
  4. The last area of concern is in the United States and Canada, where we are seeing some places like Ontario, Michigan, Minnesota, and New Jersey with increasing case numbers. Some local communities, such as King County in Washington as well, where cases and hospitalizations are going up, and we expect deaths to follow soon as well despite vaccination. That is not as dramatic as these other three areas of concern, but certainly given what we’ve seen in Europe, this is enough of a concern that we should be monitoring this closely.

In all of these areas that we are speaking about, the three core strategies are still the same: 

Wherever you can, accelerate vaccination – of course that’s hard to say for places that don’t have access to vaccination – but for those that do, continue delivering vaccines as fast as possible. Next, maintaining mask use, even after vaccination. Finally, maintaining social distancing mandates and strengthening them when daily cases and hospitalizations begin to rise.

Additional Resources: 

Links
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[2] https://covid19.healthdata.org/
[3] https://covid19.healthdata.org/global
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[6] http://www.healthdata.org/sites/default/files/files/Projects/COVID/2021/44563_briefing_African_Region_33.pdf
[7] http://www.healthdata.org/sites/default/files/files/Projects/COVID/2021/44564_briefing_Region_of_the_Americas_35.pdf
[8] http://www.healthdata.org/sites/default/files/files/Projects/COVID/2021/102_briefing_United_States_of_America_37.pdf
[9] https://apnews.com/article/business-science-health-coronavirus-pandemic-coronavirus-vaccine-ffdc3c1ce4a9622a064a672ce8aee543
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[18] http://www.healthdata.org/covid/faqs
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[113] https://covid19.healthdata.org/portugal
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