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Archive for the ‘General’ Category

Death By Corona: What Are the Numbers?

   This morning, we learned that actor Tom Hanks and his wife have contracted COVID-19 infection. Indeed, 43 famous persons have already been affected by the disease, including six Iranian leaders and four European soccer players. We might speculate that this reflects a single exposure event in Iran…or the fact that European athletes travel frequently in a high-incidence environment. Perhaps similar reasoning can be used to explain the striking variation in coronavirus death rates between countries.

As of March 12, 126,258 cases of COVID-19 had been reported worldwide; and 4,368 died of the disease – a case-fatality ratio (CFR) of 3.6%. This figure varies widely from country-to-country. Indeed, The CFR in Mainland China is 3.9% – vs. 3.2% of all other countries combined. Only 1.0% of infected passengers aboard the Diamond Princess cruise ship died of the disease. Among countries reporting more than 500 cases to date, the CFR (in descending order) is Italy 6.6%, Iran 4.3%, Spain 2.8%, United States 2.8%, Japan 2.5%, France 2.1%, United Kingdom 1.7%, South Korea 0.8%, Netherlands 0.8% and Switzerland 0.7%. Fatal infection is notably rare among the Scandinavian countries: Sweden 0.2%, Norway 0%, Denmark 0%. Finland, which has experienced 109 cases, has reported zero mortality.

The CFR in each country is largely determined by how the disease is identified, defined and reported. The quality, training professionalism and available resources available Health-Care workers will also influence case-finding and treatment; as will Demographic and cultural differences related to age, nutrition, access to local health facilities, lifestyle and exposure to animals. I suspect that much of this variation in CFR for COVID-19 is related to the very definition of “cases”. The death of an infected patient will be obvious and easily documented; while asymptomatic or relatively minor infections could remain undocumented. Indeed, the total number of “cases” used to calculate CFR might only represent those cases who are sufficiently ill to seek medical care. The patient with a mild febrile illness will not be “counted”

These questions can be easily solved using a standard serological survey in relevant communities. Such a survey should include a questionnaire regarding recent symptoms, exposure, occupation, etc. If a large proportion of the general population is found to be seropositive toward SARS-2 virus, we might conclude that the disease is less dangerous than current statistics seem to indicate.

Birds, Pigs and Silent VIP’s

It has become a tragic fact that every year the flu season brings an immense burden on health care services and now has dozens of subtypes cataloged, from ‘swine flu’ to ‘bird flu’ to ‘Asian flu’ and beyond. Typically, between late Fall and early Spring, over the last ten years, the United States alone has suffered hundreds of thousands of hospitalizations and tens of thousands of deaths across all ages [1]. But shortly after the turn of the century the ‘Spanish Flu’ pandemic of 1918 to 1920 was different in the extreme, and like every disease or virus did not discriminate on age, gender, race, even species, or, indeed, fame.

This year makes the centennial anniversary of the pandemics end so along with the estimated 50 million deaths let us remember how we are all equal in the face of such viruses.

Rose Cleveland – sister of President Grover Cleveland, who acted as ‘first lady’ to her bachelor brother – was one of approximately 150 famous people that perished in the ‘Spanish flu’ pandemic. Perhaps the best-known victims at the time were Francisco Rodrigues Alves (Brazilian President-Elect) and Louis Botha (President of South Africa), but no less than ten shining stars of the silent movie era are known to have also died during the deadly outbreak.

True Boardman, who appeared in 137 films in just an 8-year career and his son (also named True Boardman) went on to co-star in films with Charlie Chaplin and Mary Pickford.

William Courtleigh, Jr. who passed at only 26 years of age, after co-starring with Lillian Lorraine and Ann Pennington.

Dark Cloud (Elijah Tahamont), a Canadian Indian and chief of the Abenaki. During his 8 year career, he got to work with Francis Ford and Mary Pickford, appearing in 34 movies.

Myrtle Gonzalez, who is regarded as Hollywood’s first Latin and Hispanic star. She starred in some 78 movies, alongside the likes of William Desmond Taylor and Jean Hersholt.

Shelly Hull, brother of actor Henry Hull who was only just breaking into motion pictures following his success on Broadway, where he starred in plays such as The Amazons, The Cinderella Man and The Land of Promise.

Joseph Kaufman, both an actor and director with over 30 credits in each discipline. He married fellow silent film star Ethel Clayton who went on to star in as many as 180 movies.

Vera Kholodnaya, was the first Russian star of Silent Movies. Unfortunately, most of her films have been lost. Her first film was Anna Karenina and she went on to star in A Life for a Life, The Last Tango and some reported 50 other films. She also has a life-size bronze statue of herself in Odesa, Ukraine.

Julian L’Estrange, husband of Constance Collier, who starred in stage and movie productions on both sides of the Atlantic.

Harold A. Lockwood, was an actor, director, and producer who starred alongside May Allison no less than 23 films and also shared the screen with Mary Pickford (a repeating theme!).

Wayland Trask, Jr., a member of Mack Sennett’s company of actors, and a star of no less than 45 comedies.

Even prior to the recent outbreak, influenza has long contributed to thousands upon thousands of deaths across the globe, naturally including a number of famous names: Juan Peron (Argentina), Francesco Nitti and Paolo Boselli (Italy); performers Angela Baddeley, Lillie Langtree, Tallulah Bankhead, Jean Harlow, and Trevor Howard; baseball legends Dick Bertell and Hack Wilson; movie directors Jules Dassin and Luchino Visconti; and philosopher Bertrand Russell. In fact, three additional Silent Movie stars managed to join the famous-flu-deaths list – 2 shortly after the Spanish flu with Edward J. Connelly (1928) and Henry B. Walthall (1936); and the other as recent as 2018, with the passing of Lassie Lou Ahern, who had a career spanning over 50 years, starring in no less than 30 films including many from the ‘Our Gang’ films.

These lists are abstracted from the hobby of our founder and medical advisor, Dr. Steve Berger, who maintains an extensive database at The site is completely free to use, allowing you to explore and search the medical file of over 20,000 VIPs. Who will you look up?

[1] Figures taken from the CDC:

India: Diphtheria, Pertussis and Tetanus

Although global incidences of Diphtheria, Pertussis and Tetanus declined dramatically during the second half of the twentieth century, relatively high rates for these diseases continue to be reported from India.  India accounted for 17.7% of the total World’s population in 2018, but reported 46% of global Tetanus, 53% of global Diphtheria (and only 10.2% of global Pertussis) that year.  Similarly, 68% of the population of Southeast Asia (SEA) live in India, while that country accounted for 85% of Diphtheria, 75% of Pertussis and 90% of tetanus for SEA in 2018. [1-4]   Trends for these data are charted in the following three graphs. [5]


  1. Berger S. Infectious Diseases of India, 2019. 620 pages , 109 graphs , 6,807 references. Gideon e-books,
  2. Berger S. Diphtheria: Global Status, 2019. 389 pages , 451 graphs , 699 references. Gideon e-books,
  3. Berger S. Tetanus: Global Status, 2019. 561 pages , 816 graphs , 390 references. Gideon e-books,
  4. Berger S. Pertussis: Global Status, 2019. 417 pages , 514 graphs , 1,028 references. Gideon e-books,
  5. Gideon e-Gideon multi-graph tool,

Japanese Encephalitis in Assam State

Since 2008, data regarding Japanese Encephalitis in India have distinguished between Japanese encephalitis [JE] and Acute encephalitis syndrome [AES].  Cases of the latter have been variously ascribed to Chandipura, enteroviral infection, scrub typhus and lychee fruit intoxication.  [1,2]    In 1963, 22% of individuals in Assam (Lakhimpur and Darrang districts) were seropositive toward JE virus.  Surveys conducted during 2006 to 2014 found that Japanese encephalitis was responsible for 30% to 78% of acute encephalitis cases in Assam.  A study published in 2007 found that 19.3% of patients with Japanese encephalitis in Assam State have concurrent neurocysticercosis.  In the following chart, I’ve compared reported incidence for these two conditions in India and in Assam State. [3]


  1. Berger SA. Japanese Encephalitis: Global Status, 2018. 96 pages , 66 graphs , 1,120 references  Gideon e-books,
  2. Berger SA. Infectious Diseases of India, 2018. 585 pages , 96 graphs , 6,487 references. Gideon e-books,
  3. Gideon e-Gideon multi-graph tool,

Note featured on ProMED

Listeriosis in the European Union

A recent series of outbreaks in Europe reflects an increasing incidence of listeriosis in the region.  In the following graph I’ve contrasted disease rates per 100,000 in the European Union with those of the United States [1,2] :



  1. Berger S. Listeriosis: Global Status, 2018. 128 pages, 108 graphs, 1,203 references. Gideon e-books,
  2. Gideon e-Gideon multi-graph tool,

Note featured on ProMED

Norovirus Infection in South Korea

The following background information on Norovirus infection in South Korea was abstracted from Gideon and the Gideon e-book series. [1-3]  A computer-generated parsing program of PubMeD and ProMED identifies 22,521 published Infectious Diseases outbreaks.  735 of these outbreaks specify Norovirus as the disease agent.  South Korea accounts for 0.67% of all outbreaks, and for 1.5% of Norovirus outbreaks.  Details of the individual events are summarized in table 1.

Further analysis of these sources identified 59,774 prevalence / seroprevalence surveys.  745 of these surveys examine the prevalence of viral agents associated with gastroenteritis.  South Korea accounts for 18.6% of all Infectious Disease surveys, and 3.4% of surveys involving viral gastroenteritis. Details of surveys which examine Norovirus prevalence are summarized in table 2.

Primary references are available from the author.


  1. Berger SA. Infectious Diseases of South Korea, 2018. 418 pages, 108 graphs, 2,260 references. Gideon e-books,
  2. Berger SA. Gideon Guide to Outbreaks, 2018. 1,900 pages, 5,246 tables, 50,908 references.
  3. Berger SA. Gideon Guide to Surveys, 2018. 4,028 pages, 10,229 tables, 53,802 references.


Rickettsial Spotted Fever: United States vs. Brazil

A higher case / fatality ratio for reported spotted fever cases in Brazil vs. the United States suggests that the Brazilian strain of Rickettsia rickettsii is more virulent.  In the following charts I’ve compared data for disease incidence and deaths for each of the countries, and contrasted death rates per 100,000 population. [1,2]


  1. Berger S. Infectious Diseases of Brazil, 571 pages, 120 graphs, 5,552 references. Gideon e-books,
  2. Gideon e-Gideon multi-graph tool,

Hand, Foot and Mouth Disease in Hong Kong

Reported rates of severe HFM disease and infection due to Enteroviruses (with the exception of EV-71) in Hong Kong have been increasing for the past ten years. [1,2]


  1. Gideon multi-graph tool,
  2. Berger SA. Infectious Diseases of Hong Kong, 2017. Gideon e-books. 316 pages, 115 graphs, 718 references

Note featured on ProMED



One Health – By the Numbers

Those of us who work in Human and Animal Health encounter zoonotic infectious diseases on an almost daily basis.  But precisely how common are these conditions?  A preliminary overview was undertaken to quantify and collate the impact of relevant diseases.  Data were generated using an interactive tool in Gideon. *

As depicted in the following tables, 59% (209) of all generic infectious diseases affecting mankind are derived from animal reservoirs.  Surprisingly, this percentage varies little when data are analyzed for specific countries selected at random from widely diverse regions.  Similarly, the distribution of diseases from country-to-country varies little, when collated by pathogen class, vector, vehicle and reservoir.

* See video tutorial at  – scroll down to Diseases – Fingerprint

Zoonotic Infectious Diseases – Distribution by Reservoir

Region Diseases Zoonoses   Bird   Dog   Cattle   Rodent   Pig  
Worldwide 354 209 59% 49 14% 64 18% 50 14% 86 24% 39 11%
United States 247 129 52% 30 12% 43 17% 36 15% 52 21% 27 11%
China 253 132 52% 32 13% 47 19% 37 15% 53 21% 30 12%
France 222 106 48% 26 12% 36 16% 32 14% 38 17% 24 11%
Ghana 225 98 44% 22 10% 32 14% 30 13% 33 15% 23 10%
Brazil 257 130 51% 30 12% 42 16% 34 13% 50 19% 29 11%
Australia 220 102 46% 28 13% 31 14% 27 12% 33 15% 23 10%


Zoonotic Infectious Diseases – by Pathogen, Vector or Vehicle

Region Diseases Zoonoses   Virus   Parasite   Bacterium   Arthropod   Food  
Worldwide 354 209 59% 68 19% 72 20% 56 16% 79 22% 71 20%
UnitedStates 247 129 52% 28 11% 46 19% 45 18% 36 15% 51 21%
China 253 132 52% 24 9% 54 21% 47 19% 45 18% 58 23%
France 222 106 48% 19 9% 40 18% 42 19% 26 12% 44 20%
Ghana 225 98 44% 17 8% 36 16% 38 17% 20 9% 41 18%
Brazil 257 130 51% 30 12% 48 19% 42 16% 36 14% 51 20%
Australia 220 102 46% 28 13% 34 15% 41 19% 25 11% 44 20%

Pathogens Associated with Animal Bites

Gideon lists 31 species of bacteria which have been associated with human infection following the bites of animals:
– Bacteroides tectus
– Bergeyella zoohelcum
– Bisgaard’s taxon
– Capnocytophaga canimorsus
– Corynebacterium canis
– Capnocytophaga cynodegmi
– Corynebacterium freiburgense
– Corynebacterium kutscheri
– CDC NO-1
– Erysipelothrix rhusiopathiae
– Fusobacterium canifelinum
– Halomonas venusta
– Kingella potus
– Moraxella canis
– Mycobacterium vulneris
– Neisseria animaloris
– Neisseria canis
– Neisseria weaveri
– Neisseria zoodegmatis
– Pasteurella caballi
– Pasteurella canis
– Pasteurella dagmatis
– Pasteurella multocida
– Pasteurella stomatis
– Psychrobacter immobilis
– Spirillum minus
– Staphylococcus intermedius
– Streptobacillus moniliformis
– Vibrio charchariae
– Vibrio harveyi

Although virtually all literature on the subject advocates administration of tetanus prophylaxis following animal bites, few if any cases of bite-associated tetanus have been documented.