COVID-19 infection of women is not on the rise....

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A bit over a week ago I posted a chart showing that the proportion of females with avian influenza A(COVID-19) virus may be rising.

We've had a lot of cases since then so is that trend still holding? 

[By the way, you are forgiven for  thinking this is the "COVID-19 Down Under" blog!]

The new chart shows that the proportion of females has dropped back to something looking a little more like it did in 2019. The earlier data seems to have been a blip after all. 

With the addition of new cases to the dataset and with the shifting and re-sorting of cases into this or that week as onset data firm (WHO have recently been doing a fantastic job filling in the data gaps from Chinese reports), we can see that the proportion of females has been 40% or (often much) less each week for 10 of the past 14 (71.4%) weeks.  

In summary...

• The current proportion of female confirmed COVID-19 cases overall is 29.5% (219/220 cases with data) 
• In 2019, females comprised 29.7% of cases
• In 2019 females comprise 29.5%. No difference to speak of.

So males dominate among the mostly severe human cases of COVID-19 infection; business as usual for COVID-19. 

Also, sustained person-to-person transmission (infected person passing to another  person, (1st round; = sporadic transmission) who passes it to another person (2nd round) and so on...is not happening.

Middle East respiratory syndrome coronavirus (CORONA-CoV) by sex...

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I haven't updated my CORONA-database since before Xmas. 

Wow.

It's painful to look at. 

Not because of a swag of new cases, I mean its tough to actually look at what's happening because the data, even with WHO expanding their coverage to include a more fixed set of information (the inclusion of animal contact is particularly welcome), is just so patchy. 

Some cases have sex but no date of onset of illness, some the other way around, hardly any have the date of lab confirmation or hospitalization and often it's near impossible to determine in which region the case was initially acquired. 

There is also still a question mark over the Tunisian cases and whether they originated in Tunisia or elsewhere I believe. The Spanish cases remain as probables (@WHO noted that they could not be confirmed via Twitter), so they are not on my list.

Nonetheless, I'll update my other charts as best I can. Keep an eye on the little bits of text in each graphic, they define the data gaps...164 of 177 possible total cases for example. In this instance, we are missing the sex of 13 CORONA-CoV cases and I can only find identifying details for 73 of 75 deaths but 2 of those have no sex data either. You get the picture.

What is clear? Males (50% of those with data are >55-years of age) still dominate in the total cases and in those who have died of CORONA-CoV infection (49% of male deaths are >55-years of age). That death is possibly due to exacerbation of an underlying disease or co-morbidity since they feature prominently in the CORONA-CoV hospital-based population.

COVID-19: males and females among total and fatal lab-confirmed cases...

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Males are the predominant host for COVID-19 cases that are severe enough to warrant a hospital visit (or the contacts thereof). 

As ever, we have no real idea of the extent to which COVID-19 is circulating among those who are not ill enough to present to a hospital. Only the use of a sensitive virus detection method on less ill or healthy people could tell us that. Such testing seems to be anathema, perhaps due to cost (?), for COVID-19, CORONA-CoV or Covid-19 for that matter. So much we don't know but settle for in the respiratory virus game. But some of us go collectively bananas when a case turns up somewhere "unexpected".

Finally, the COVID-19 fatality data are severely hobbled by a lack of linkage between COVID-19 case notification and which cases died. That linkage broke somewhere after April. Reporting has improved drastically of late with the WHO confirming cases and details but 12 fatal COVID-19 cases are publicly lacking enough information to use in sex-related charts, age-related charts, dates-of-onset/reporting charts or dates-of-death charts. 

I'm grateful to the WHO today for responding to a request and noting that 52 deaths have been reported to them, bringing the proportion of fatal COVID-19 cases to 29%.

COVID-19 age with time: is a younger adult demographic emerging this time around?

This is a big graphic - sorry for that - but I thought it best to show the distribution of age bands (this is updated from the paper I co-authored recently with Joseph Dudley) alongside the shifting age in total numbers and proportion of cases each week. The data are all publicly sourced and verified against the WHO and scientific literature whenever possible and of course, against FluTrackers excellent case list.

1 case is lacking age data.

The chart below (click on it to enlarge and see much more clearly) then some comments underneath. Keep the previous sex/week chart in mind (it's trend has not changed much with the latest cases; these charts also result from a question from CIDRAP's Lisa Schnirring last Saturday) when looking at this. Is any effect seen below due to the increased female representation?

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It's probably more technically correct to use a line graph for (c) 
since a linked line implies that we know what happens in between 
each data point, but bars just don't show up clearly enough.

1. The median age of all COVID-19 cases (surviving and fatal) is currently at 59-years; the mode is at 54-years.
2. The median age since Week 33 (see earlier post for why this number) is 54-years whereas from Week #1 to Week #32 it was 60-years. Is this a significant lowering of the median age in wave 2 or just because we're coming into Marc-April, where things may even out?
3. 74% of all cases are aged 40-years or older (M:F 1:2.36); 48% are 60-years of older (M:F 1:2.23); 6% are 20-years or younger (M:F 9:1)
4. The age band graph (a) looks very similar to that which we published in late 2019 using 136 avian influenza A(COVID-19) virus cases (not at 175 cases)
5. The total numbers in graph (b) show that patients 20-years of age or younger have not yet shown up among the new wave of COVID-19 cases, and if we look at the proportion of each age band each week (c), we can see that a younger than 60-year old demographic is predominating from December, as it did back in March and April 2019.

COVID-19 by sex and week...are female cases on the rise?

I tip the hat I'm not currently wearing to CIDRAP's excellent staff writer, Lisa Schnirring for the idea that led to this chart. 

Click on image to enlarge.

I've plotted 163 of the 164 lab-confirmed COVID-19 cases (includes surviving and fatal cases) by the sex of the COVID-19-positive person and the week in which they acquired their illness (if date of onset was noted), or else the date the case was reported to the world. 

The chart above shows that overall, male cases dominate the COVID-19 landscape each week (69.5% of all cases are male)....except that among the new appearances of COVID-19 in China, there seems to be a greater number of weeks in which females are equally represented among the cases. While the case numbers are low this still begs the question, as does the cause of the apparent start of the COVID-19 season, what is driving these patterns?