The infection dynamics of COVID-19 in Kazakhstan is characterised by a fast growth of cases and deaths since the beginning of July, 2020 and the number of deaths almost doubles every two weeks (1). In this post we analyse the way of measuring and reporting the cases in Kazakhstan in order to have a better view of the recent fast spread of the illness.
The first infected person detected arrived at Almaty airport on 10th of March and by March 15th, 7 more people were officially infected. The next day the government announced the quarantine with restrictions on shopping, entertainment activities, cinemas, theatres, exhibitions and other events involving a large crowd of people as well as the international flights were suspended.
Quarantine measures and restrictions were lifted on May 11th, and the spread of the virus increased by 10 times from an average of 200 newly infected in March-April to almost 2,000 in July, forcing the government to impose a new quarantine on July 5th. However, in Kazakhstan, only those who have symptoms are registered as infected people. Asymptomatic people are recorded separately and are not included in estimation of contagious rate of virus. By mid-July, 53,021 people are officially infected and have symptoms. However, there are other 26,258 infected without symptoms. This registration approach considerably underestimates the infection rate per capita. The total number of confirmed COVID-19 cases per million people with and without symptoms is about 4,255 persons which is twice as much as if only symptomatic cases (2,845 persons) were taken into account. Similar ratios are registered in the UK, Italy, Russia and South Africa(2).
On March 26th, the government officially registered the 1st death from COVID-19 in Kazakhstan from Akmola Region. Taking into account that almost 50% of the infected people are aged 20 to 39 years old(3), a low mortality rate is expected and actually the number of deaths was quite low in April-May. However, it is difficult to estimate the real mortality rate (death from COVID-19 per 1 million people) in Kazakhstan, since mortality statistics due to COVID-19 does not include deaths of infected people who had other severe illnesses. In fact, if a person had any pathologies or chronic illnesses, it is considered that s/he died from a chronic disease rather than from COVID-19. Additionally, there is a problem of identification between pneumonia and COVID-19, which has already been noted by the World Health Organization. “An unexplained pneumonia outbreak in Kazakhstan is likely to be the novel coronavirus, a World Health Organization (WHO) top official said …”(4). In fact, in June 2020, 628 people died from pneumonia in Kazakhstan, which is four times more than in June 2019. The official mortality rate from COVID-19 in Kazakhstan is approximately 14.2 people per 1 million people. This number is three times higher for the age group 50-59 (34 deaths per million of population aged 50-59) and almost ten times higher for the age group after 60 years old (123 deaths). However, if we take into account excessive deaths from pneumonia, which may be erroneously classified, the rate will increase to 47.8 deaths per million (unfortunately, we do not have data to estimate the potential misclassification from other diseases). The similar mortality rate is observed in Norway, Belarus and Argentina.
Early detection and precise monitoring of COVID-19 is critical to control this pandemic due to its rapid spread. Thus, the late detection as well as the misclassification of the illness that occur in Kazakhstan and in most countries, are one of the main causes of the exponential increase in morbidity and mortality. Communicating accurate information about the illness spread to the population is also crucial for the implementation of quarantine measures that must be taken in some cases. The population needs to be aware of the illness severity in order to take seriously the measures implemented by the governments. Misleading counting of cases and underreported deaths have led to the wrong policy measures. For example, the quarantine restrictions were lifted based on the low number of cases officially reported.
Based on official data, there are large regional differences both in infection and mortality rate. The highest infection rate is observed in the Atyrau region, followed by Nur-Sultan city and the West-Kazakhstan region (Map 1). Despite the highest infection rate in Atyrau (almost 4 times higher than the average for the country) the fatality rate is two times lower than the national average.
However, the regions with the highest infection rates do not correspond exactly to the regions with the highest mortality rates (Map 2), indicating also a different fatality rate (number of deaths relative to infected people). The difference in fatality rates can be can be explained by the difference in age structure or disease distribution as well as in government measures with regard to the disease taken in each region. The highest fatality rate (figure 1) is observed in Akmola region, Nur-Sultan city, Pavlodar and Karaganda regions. Approximately 1,05 % of people infected with COVID19 have a fatal outcome in Nur-Sultan. In Pavlodar, fatality rate is almost twice as high as the national average, but it is also true that Pavlodar has the highest share of population over 58 years old, i.e. the age group with the highest fatality rate.
Figure 1: COVID-19 infection and fatality rate by region in Kazakhstan(5)
- Source: https://ourworldindata.org/coronavirus-country-comparisons
- Source: https://ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people
- COVID-19 fatality rate is much higher for elderly population
- Source: https://www.dw.com/en/kazakhstan-pneumonia-coronavirus/a-54135982
- The infection rate is calculated per 100 people instead of 1,000,000 to maintain the same scale than fatality rate in the figure.