Some COVID-19 vs. Malaria Numbers: Countries with Malaria have Virtually no Coronavirus Cases Reported

March 18th, 2020 by Roy W. Spencer, Ph. D.

…and countries with many COVID-19 cases have little to no malaria.

This subject has been making the rounds in recent days, much more in social media and lesser-known news outlets and not so much the mainstream media…

There is now considerable evidence from several countries (China, S. Korea, France, others?) that anti-malarial drugs, especially chloroquine, is effective at greatly reducing COVID-19 symptoms, and possibly preventing infection in the first place.

I downloaded the latest COVID-19 reported cases by country from the WHO as well as the incidence of malaria cases as of 2017. I calculated the COVID-19 incidence as the number per million total population, while the malaria numbers are reported per 1,000 “population at risk”.

It took a few hours to line everything up in Excel because of differences in naming of a few countries, no malaria data for countries where malaria has been essentially eradicated, and many countries where no COVID-19 cases have been reported.

I only have time to give some interesting bottom-line numbers. I encourage others to investigate this for themselves to see if the relationships are real.

If I sort all 234 countries by incidence of malaria, and compute the average incidence of malaria and the average incidence of COVID-19, the results are simply amazing: those countries with malaria have virtually no COVID-19 cases, and those countries with many COVID-19 cases have little to no malaria.

Here are the averages for the three country groupings:

Top 40 Malaria countries:

212.24 malaria per thousand = 0.2 COVID-19 cases per million

Next 40 Malaria countries:

7.30 malaria per thousand = 10.1 COVID-19 cases per million

Remaining 154 (non-)Malaria countries:

0.00 malaria per thousand = 68.7 COVID-19 cases per million

I tried plotting the individual country data on a graph but the relationship is so non-linear (almost all of the data lie on the horizontal and vertical axes) that the graph is almost useless.

This is based upon the total number of COVID-19 cases as of March 17, 2020 as tallied by the WHO.


121 Responses to “Some COVID-19 vs. Malaria Numbers: Countries with Malaria have Virtually no Coronavirus Cases Reported”

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  1. Steve Case says:

    those countries with malaria have virtually no COVID-19 cases, and those countries with many COVID-19 cases have little to no malaria.

    Do I have choice? If so I’d rather have COVID-19

    Other than that smart remark:

    There is now considerable evidence from several countries (China, S. Korea, France, others?) that anti-malarial drugs, especially chloroquine, is effective at greatly reducing COVID-19 symptoms, and possibly preventing infection in the first place.

    There’s probably already a run on chloroquine, wherever it’s available

    • Michael Lakher says:

      It is pretty obvious to every reasonable person with some pertinent background, but not to FDA.

    • Jack Werbicki says:

      I think the reduced/nonexistence cases of covid 19 in malarial countries is due to the use of hydroxychloroquine to treat the malaria. In my view this is where the study should start.

  2. Andrew S says:

    You can compare the wintertime climate of the two places where there has been the highest death rates. The Po Valley of northern Italy, and Wuhan on the Yangtze river. Both places where cold air can stagnate under a temperature inversion in winter with reduced sunshine and very poor air quality. This leads to a lack of vitamin D that is important for the immune system, and reduced lung capacity from pollution.

  3. Snape says:

    Dr. Spencer

    Not saying you are wrong, but keep in mind the youthfulness of the populations that have a malaria problem.

    For example, the median age in Nigeria is 17.9 years. 18.8 years in the Congo.

  4. Roy W. Spencer says:

    An obvious confounding factor is the fact malaria is mostly in poor countries, and they probably have little testing and reporting of these cases.

    • nisssc says:

      is correlation, causation?

    • michael hart says:

      Indeed, Roy.
      And most Malarial countries are poorly served with transport infrastructure, meaning that the virus is just taking longer to spread in such countries.

      • Ganesan says:

        I’m from India. Not only is transport infrastructure good enough for internal mobility, but also, the density of population is very high. So, social distancing is inherently extremely weak. Yet, the numbers infected (668 as on 26th March) and mortality due to Covid-19 (17) are very low.

        I think the correlation that Dr Roy points out is too strong to be explained away by other factors.

        • Nighat says:

          Comparing the no of infected population and the death rate in the countries with malaria epidemic
          In the past strongly suggest an immmunity built in to fight covid19.This clearly suggest to explore
          into existing anti malaria cocktail medicine for preventive and treatment purposes.
          The most recent directive by the Japan PM to use their own version of anti malaria dug and also to supply 20 other countries in Europe and Asia makes the case even stronger for a vast clinical trial. The drugs on their are already tested and approved,just not for covid 19 , it can make it little easier and faster.

    • Right, that was my first thought too.

      There is actually only one rich country in the malaria zone, and that is Singapore.

      Singapore is one of the few countries with no deaths from Covid19, so that is an important evidence that supports the hypothesis.

      • Jason says:

        Evidence should be used to falsify a hypothesis, so it can be modified or rejected.

        Evidence does not “prove” a hypothesis.

        Check out Karl Popper and falsification.

        • I think you are confusing statistical hypotheses with explanatory hypotheses. For the former, yes, your statement holds. But for the latter, scientific data obtained from objective experiments and quasi- and non-experimental investigations be used to support the hypothesis. Also, science does not really “prove” anything. It is based on probability theory and therefore there is always some definable level of error in decision making.

          • Sriram Narasimhan says:

            Singapore is an interesting case.

            Initial wave (Early feb to 3rd week) was all from Chinese tourists (SG gets 3million visitors from china every month)
            The infections came down dramatically when SG curbed China travel

            The infections again increased around 15th March times as travellers from west started arriving, mostly UK. Local transmission clusters had anywhere 10-15cases.
            SG MRTs and buses are still full, people are in parks and also in malls. The local transmission could have been similar to Italy but not.

    • Rosemary Voltz says:

      I’m curious that if a study could be done on people who have had the malaria drugs in the past or are on them now vs. their infection rate. I was in Uganda on a mission trip a few years ago and had the malaria meds for almost a month. It would be an interesting study to see if it helped on a number of viruses.

      • Hilary says:

        I was actually curious about the same thing. I was in the Peace Corps in the 70’s and took choloroquin for almost 2 years and was wondering if it would still be able to help fight Covid even so many years later.

  5. bernie1815 says:

    Intriguing. To test out the role of confounding factors we/you should be able to find countries/regions that have endemic malaria but are developed health care systems/relative rich. Singapore? Sri Lanka? Northern Territory? Queensland?

    • Roy W. Spencer says:

      Yes, I’m sure there is more that can be done. Only a couple hundred points, though, so confidence with multiple variables will be limited.

  6. curious says:

    https://clinicaltrials.gov/ct2/show/NCT04303507

    Chloroquine Prevention of Coronavirus Disease (COVID-19) in the Healthcare Setting (COPCOV)

    Brief Summary:
    The study is a double-blind, randomised, placebo-controlled trial that will be conducted in health care settings. After obtaining fully informed consent, the investigator will recruit healthcare workers, or other individuals at significant risk who can be followed reliably for 5 months. 10,000 participants will be recruited and the investigator predict an average of 200 participants per site in 50 sites.

    The participant will be randomised to receive either chloroquine or placebo (1:1 randomisation). A loading dose of 10mg base/kg, followed by 150 mg daily (250mg chloroquine phosphate salt) which will be taken for 3 months or until they are diagnosed with COVID-19. Subsequent episodes of symptomatic respiratory illness, including symptomatic COVID-19, clinical outcomes, and asymptomatic infection with the virus causing COVID-19 will be recorded during the follow-up period.

    • Michael Lakher says:

      I hope politics will not interfere and the chloroquine study in US will not be botched on purpose. Then we, the world, will never know.

  7. Steve Fitzpatrick says:

    A paper in 2008 by a mostly Dutch/Belgian group shows chloroquine effective against a common human coronavirus strain (which causes many instances of the common cold). The drug was effective at completely inhibiting virus growth in cell cultures at relatively low concentrations (cytotoxic levels of chloroquine are hundreds of times higher). The same paper showed newborn mice were protected from an otherwise fatal dose of live human coronavirus if their mother was given a modest level of chloroquine in her food… the chloroquine passes to the pups in their mothers milk.

  8. Pat Michaels says:

    Hi Roy,

    I’m wondering if there is confounding because malarial countries tend to be high-humidity places and coronavirus doesn’t like that–swells up and dies. It’s one reason why flu is seasonal.

    Really nice work, though!

  9. Bindidon says:

    One more time, a comment is kept off the blog by one of the most stoopid scanners ever experienced…

    Here is what I couldn’t manage to post:

    https://drive.google.com/file/d/15bFA4Dd7dNlooZcPy-ru2z56EVLZXSX1/view

    Best regards from Germany
    J.-P. Dehottay

    • Roy W. Spencer says:

      Bindidon:

      Beside the fact that your post (the comments in the link) are pretty offensive on multiple levels, are you not aware of the studies already done in China, S. Korea, and France showing the huge reduction in symptoms and length of illness for most of those given chloroquine? If there is quantitative evidence of benefit, and there will not be a vaccine for 6 months to 1 year, why would you use hand-waving arguments to suggest the drug should not be used? Are you part of Big Pharma?

      • Bindidon says:

        Roy Spencer

        ” Beside the fact that your post (the comments in the link) are pretty offensive on multiple levels… ”

        Well, Sir: what about comparing my comment with those of harsh insulting people a la Robertson, Flynn aka Amazed, etc etc?

        My comment indeed is offensive. This is due to the fact that you do not seem, from the far Alabama, to really understand what happens here in Europe.

        Again: we are not in China here. We live, like the US, in democracies, and not in a brute force dictature which bypassed the imaginable, by enrolling by force Xinjiang Muslims to work in Hubei during the infection’s and death toll peak.

        *
        ” If there is quantitative evidence of benefit, and there will not be a vaccine for 6 months to 1 year, why would you use hand-waving arguments to suggest the drug should not be used? ”

        Where did I ‘suggest’ that, please?

        I just showed to all of you the evidence that in Europe, it is a bit too late to introduce chloroquine, due to the speed of the disease’s development, the hospitals moving into trash mode everywhere, etc.

        Your home country soon will experience what happens here, and we will see how chloroquine will help you of getting rid of the virus.

        I think that you underestimate the fundamental difference between Europe and USA: In contrast to us here,

        – a huge amount of people in the US do not enjoy social protection or health insurance;
        – there is in the US a visceral resistance against authority.

        *
        ” Are you part of Big Pharma? ”

        Was that question really needed? I’m a retired engineer, point final.

        Rgds
        J.-P. Dehottay

        • argus says:

          Bindidon, the US is indeed staring at a catastrophe but the why can be studied later. Social nets don’t matter to anything. You pay for it now, you pay for it later.

          The real why is why so few deaths in Germany compared to everywhere else? Did the German government get wind of the pandemic and corner the ventilator market, or is this an old stat not being updated?

          • Bindidon says:

            argus

            You made a good point here. I don’t understand why the death toll in Germany is so low compared with France let alone with Italy.

            I’m not a German but live here since over 50 years. Please believe me: there is no way to dissimulate such things in Germany.

            Of course: there is some hierarchy, there is a government, and Federal Chancelor Merkel is something between a President and a Prime Minister.

            But below that you have not only 16 federal regions; you have an incredible network of competences no one here can muzzle: that is only possible in dictatures like China, Russia (or the defunct German ‘Democratic’ Republic).

            J.-P. D.

          • Bindidon says:

            argus (ctnd)

            I just looked at worldometers’ SARS-CoV2 stat, and see, for the cases/million:
            – Germany: 147 (similar to France with 140);
            – USA: 28.

            Hmmmh?

        • Gerald Machnee says:

          RE:**I think that you underestimate the fundamental difference between Europe and USA: In contrast to us here,**

          I think we see a fundamental difference between Europe and North America.
          See below:

          **More than 340,000 electricity customers across Germany have their power cut off each year for failing to pay bills. A new proposal from one political party aims to change this.

          Figures from 2017 show that there were 343,865 cases of people having their electricity shut down off due to not paying a bill, an increase of 14,000 from the previous year.**

        • Jim says:

          If JP’s engineering gravitated towards structural, I would recommend staying away from his bridges even if it means a significant detour.

        • Jim says:

          ‘Alabama’??? Do you mean where George Washington Carver did most of his significant work? So now you are dabbling with racism as well as nativism. Remember the ‘throwing rocks in glass houses’ bit? AH, is that you?

        • Michael Lakher says:

          Guys, lets look at different European countries, may be we can learn something there.
          Denmark – one death per about 3000 cases. What do they do right? May be they let physicians to treat patients (and not the computers)?

    • Tim S says:

      I agree that your rant is not just insulting, but very bigoted. The USA is a very diverse and progressive country. With due respect, you should get out more and learn about places you want to criticize.

    • Jim says:

      Your self referencing is astonishing. You criticize politicization of the crisis with politics. You admonish admittedly careless pastors inviting folks to dangerous gatherings while ignoring supposedly educated students gathering in much larger numbers for spring break. Now, for something completely different and perhaps just as ‘stoopid’ for a narrow perspective such as yours. Germany has an adequate supply of ventilators compared to Italy, maybe you and your friends could volunteer to drive across the frontier with a couple to help your Italian neighbors.

  10. Bindidon says:

    For those who are really interested in having a look at SARS-CoV2’s very first steps in Europe and the US, here are

    – the situation on 19.03.20:

    https://drive.google.com/file/d/1YTPpuW82vgJ_9lRhTCVmr6IeN_JCUspf/view

    – the situation on 18.03.20:

    https://drive.google.com/file/d/1hnq32N1w5AFZwe21YJT0mrb5ddPiVXjc/view

    Some might think: so what? Never heard of the Swine Flu, or of the Spanish Flu (which in fact was born in the French Etampes, moved by ship to Boston, MA and spread out worldwide from there) ?

    That is definitely their problem.

    J.-P. D.

  11. Strop says:

    It seems a factor in the spread is tourism / movement of people. Could it be that high Malaria areas are not attractive to tourists and the people who reside in those areas can’t afford international travel?

    • Bindidon says:

      Strop

      + 100 for your unpretentious and intelligent comment.
      It is as simple as that.

    • Bamavic says:

      Isn’t India one of the countries with low COVID infection rate? Thought they had a few tourists coming by.

      • Regine Le Nestour says:

        I agree with you.
        In fact, China and Africa have developed big commercial partnership since a lot of years. China and Africa are building big infrastructures in Africa. A lot of Africans students are studying in China.
        The frequency of flights between Africa and China have increased by 600 % in the last few years.
        Africa didn’t stop flights between China and Africa at the end of January like a lot of others countries did.
        The most affected countries by covid19 in Africa are Algeria,Egypt and south Africa.
        There is no more malaria in Algeria.
        China was declared free of malaria in 2019.

        • Strop says:

          It would be interesting to see which parts of Africa have teh chinese travel relationship that you mention. Africa is a large continent with many countries.
          Sengal 36 and Burkina Farso 26 are Malaria areas but have a number of cases and are two of the safest tourist destinations in that portion of Africa.
          Sth Africa 116 , Morocco 49, Egypt 196 where cases are higher are big tourist destinations.

      • Strop says:

        India is not broadly affected by Malaria and particularly the main tourist areas are not notably affected by Malaria.

  12. Stevek says:

    My understanding is chloroquine is fairly safe drug. It can cause eye damage or blindness but must be used for years, and the damage can be monitored so the drug can be stopped if damage starts.

    it seems then to me that someone in higher risk group should immediately be put on chloroquine if they test positive for covid-19. It seems like an best treatment, at least until more data comes out and proper studies are done.

    The issue is we do not have the time to do full human trials. So anecdotal evidence and our understanding of human cells and viral replication must be used, along with in vitro or animal studies. All these point to chloroquine being effective.

    I do worry about the drug being generic and cheap so FDA will not approve it for covid 19. Appears because of their close ties to pharmaceutical companies there is conflict of interest to them being impartial.

    • bernie1815 says:

      Sagan said it well: “Extraordinary claims require extraordinary evidence” though I think LaPlace’s quote has a bit more bite: “The weight of evidence for an extraordinary claim must be proportioned to its strangeness.” But, if the climate wars have taught us anything, I guess anything is possible!

      • John Moore says:

        The chloroquine claims are not extraordinary, as long as nobody is calling it a miracle cure. In the experiments so far, it is apparently helpful.

        There are in vitro experiments showing good action. There are plausible biological reasons – more than one – for it to be useful in people. What we don’t yet have is blinded clinical trials.

    • Michael Lakher says:

      If you think of it, a lot of major medical advances started as simple observations: wash hands before you touch patients (Semmelweis), do not put your patients next to latrine (Florence Nightingale), do not use contaminated water (cholera epidemics in London). And, every single time, medical establishment was against the obvious. Right now, it is both medical establishment and the politicians. Both like bow ties. History did not teach them.

  13. Stevek says:

    One thing I do not understand is why cases in China are not expected to grow once they start reopening businesses, restaurants, schools.

    It is my understanding that once quarantines are removed if some still have virus it will start to spread exponentially again.

    To stop growth herd immunity is needed or vaccine needed or some other external force must lower r0 ( weather, or behavioral changes like social distancing )

    • Bindidon says:

      Stevek

      ” It is my understanding that once quarantines are removed if some still have virus it will start to spread exponentially again. ”

      Yeah. So is mine.

      And… I don’t trust in the Chinese Communist Party.

  14. Cris Streetzel says:

    In the same vein, I would think poor countries have less international travellers. A more effective metric would be how the infection growth rate in those countries compares, but it will still be confounded by underreporting.

  15. BunyipBill says:

    Well said. Unfortunately like the ‘Warming Alarmists’, the people making the loudest and most often incorrect statements about Corona 19 are among the most scientifically and mathematically challenged in society. Too much time going to protests or gluing themselves to the road to go to the boring lectures.

    • Bindidon says:

      BunyipBill

      ” … the people making the loudest and most often incorrect statements about Corona 19 are among the most scientifically and mathematically challenged in society. ”

      Oh, how interesting! Feel free to show me such ‘statements’.

      Rgds
      J.-P. D.

  16. David L Hagen says:

    Roy Potentially very important as a cheap treatment. Data now coming out on effectiveness of Chloroquine with an antibacterial. eg see:
    Gautreta et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID 19: results of an open label non randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949

    Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.
    Conclusion: Despite its small sample size our survey shows that hydroxychloroquine treatment is
    significantly associated with viral load reduction/disappearance in COVID-19 patients and its
    effect is reinforced by azithromycin.
    Key words: 2019-nCoV; SARS-CoV-2; COVID-19; hydroxychloroquine; azithomycin;
    clinical trial

    An Open Data Clinical Trial for COVID-19 Prevention

    PS Please check Iran. The WUWT Tweet map included Iran. However it had high interaction with China and now has a very high Chronavirus infection rate.

    Johns Hopkins Chronovirus Map

    #CoronaVirus country cases
    81,137 China
    35,713 Italy
    17,361 Iran
    14,769 Spain
    12,327 Germany
    9,345 US
    9,054 France …

    • David L Hagen says:

      Iran Coronavirus Update posted:

      March16:Death toll of #Coronavirus exceeds 5500 in 186 cities across #Iran
      with new #COVID19 deaths reported in following Provinces
      Babol:+250
      Ilam:+120
      E.Azerbaijan:+150
      Tehran:750
      Gilan:681
      Khorasan Razavi:457
      Yazd:80
      situation in Mazandaran is critical w/70deaths in past 24hrs

    • Hug says:

      Unfortunately Dr Raoult and his team are working in Marseille, in the south of France and Dr Raoult looks a little bit like a hippie with his long hair: https://www.youtube.com/watch?v=n4J8kydOvbc
      In the “scientific” committee held in Paris to help the government to manage the crisis, he feels like an extra-terrestrial among the other “experts” dresses in suits and ties who are parisians in majority and probably feels ridiculed by this guy who comes from an “exotic” city but is in fact probably the only one or one of the very few actual experts on communicable deseases of this committee.
      So his results doesn’t seem to be welcome with so much enthusiasm that it should. Maybe the fact that Chloroquine is very cheap is also a reason to be reluctant…
      We are also told that the medicine could also have negative secondary effects even though it has been prescribed for many years in the past without having negative effects…
      Moreover, to be rigorous, the medecine needs another trial by another laboratory and then follow a long process in the administration before being definitely accepted…within 3 or 4 weeks at best when the crisis will be behind us…
      No matter, the medicine has already proven his efficacity in China, South Korea or Iran, these countries are considered as scientifically underdevelopped countries by the parisians “experts”.
      I wish you pleasants weeks without being confined at home as we are and good care with chloroquine for those who get the virus.
      A non-expert parisian.

  17. Stephen Taylor says:

    Anti malarial drug oxy chloroquine, an anti viral, is being investigated as treatment for Covid19. It stops the replication of viral mRNA by increasing intracellular zinc.

  18. Aaron S says:

    Posted this link to a paper showing humidity and temperature decrease flu and Corona virus rates last article. I will share again with a different comment. Warm humid conditions are apparently slowing the spread of Corona virus and traditionally have reduced spread of influenza. So how does IPCC factor these sort of positives to society into their assessments. Globally we are no where near the fatality number from this Corona as an average flu year in the US alone. Point is the flu is a real killer and we are just used to it. This corona is not likely as severe and seems more fatal but much less likely to spread. Although it does require respirators and currently can overwhelm medical infrastructure. After it passes I am confident it will be minor compared to flu except the CNN click bait hysteria.

    https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767

    • skeptikal says:

      Aaron S says:”Globally we are no where near the fatality number from this Corona as an average flu year in the US alone.”

      You’re comparing a few weeks of a Coronavirus (which has yet to peak in most of the world) to a full YEAR of flu… and you don’t see a problem with that comparison?

      Can you point me to the last flu season where hospitals were over-run with patients?… and when was the last flu season when there weren’t enough ventilators to go around?

      Globally there’s 10,000 dead already from 250,000 cases. That’s a 4% fatality rate…. AND… this virus is far from done.

      This is going to be so much worse than the average flue year.

      • Robert Wallbridge says:

        Your 4% figure is not true. WHO estimates 86% of victims do not seek medical attention as their symptoms are mild, leaving only 14% to be included in stats. So the “real” infected total is nearer 1.5 million not 250,000 and the fatality rate is closer to 0.6%.

      • Lee L says:

        They have flu in China..every year.
        Do they lock down cities of 10 million people every year for flu?

  19. Rolf says:

    We can get the same result by mapping countries Chinese people travel to. Compare that with Wuhan-Covid-19 infections we see the same tendency.

    We can also map All airlines flights from Wuhan with cities around the world and compare this with the virus spread.

    We ‘know’ chloroquine seem to work well. BUT, is Italy deprived of Chloroquine, Hydroxychloroquine and antivirals ? Or they have no Zink at all in their bodies ? Something seem very strange. That spike in cases and deaths should slow down by now.

    Maybe time to try Melatonin. (Plenty in kids 0-20 and they have no symptoms).

  20. Bindidon says:

    ConUSians

    Don’t lose time in thinking about chloroquine: rather look at Italy.

    The incredible amount of new cases there is so tremendous that medicine staff in hospitals lack time even to count the deaths, let alone to check wether or not chloroquine would be helpful.

    Staffs are working there over 12 hours a day, get infected because they lack protection clothes ans masks…

    At night, truck convoys full of dead people move off some cities together with the Italian army, because there is no way anymore to cremate them there.

    No: this is no joke, no fake news, no alarmism. This is simple reality.

    Be careful (but I’m afraid you won’t).

    J.-P. D.

    • Robert Wallbridge says:

      Italy has special factors affecting the spread of the disease – I have family there so I understand the society a bit.
      Northern Italy has a high elderly population (around 23%) who are the highest risk group. Many worked in heavy industry and have compromised health. They generally are smokers and thus already have respiratory/circulatory problems. They (like Spain) socialise in large family groups compared to north western countries. In addition there is a possibility that the high chinese presence created multiple “seeding” sites across the region.
      The latest data I have seen from Italy is that 99% of deaths in this region are in the 80yrs+ group, of which 75% had heart/circulatory problems and 30% had diabetes.
      Note Spain has similar social patterns and also has a rapidly rising infection/fatality rate.
      We need cool calm heads and joined up thinking, not emotion led panic.

      • Bindidon says:

        Robert Wallbridge

        This is know here in Germany even to people having no contact to Italy (On March 15th 35.6 percent of those infected in Italy were between 70 and 79 years old, 42.7 percent between 80 and 89 and 9.6 percent 90 and older).

        No emotion, no panic here: it was just a hint on how serious things may become if you don’t care early enough.

        The age of all these Italians can’t be the unique cause of the death toll there: France has in many regions similar social structures (old persons, high rate of heavy smokers).

        Italy reacted by far too late to CoVid19.

        We will see how the daily rate: (new cases / old cases) develops here and there.

        To look at the death tolls only is not very meaningful, as is shown in Germany, France, Spain and Italy, because the harsh new case increase brings hospitals into greatest difficulties.

        Rgds
        J.-P. D.

  21. Dr Rob Brook says:

    I think the theory about linking chloroquine and low incidence of Covid-19 is an interesting one. The correlation shown on the map appears to be compelling. However, in my experience the locals in these countries rarely take any malaria prophylaxis, and in any case there is widespread resistance in the malaria parasite to chloroquine nowadays, so it is little used.

    I have another theory which may be a bit off the wall. But here goes. As has been shown in numerous studies, bats are significant reservoirs of a wide range of coronaviruses, and in most tropical countries I’ve visited and lived in, tree roosting fruit bats are common even in cities. Is it possible that people who live in these low incidence countries have acquired some degree of immunity from contact with related coronaviruses shed by bats? I have walked numerous times under colonies of fruit bats roosting in trees above Madang market in Papua New Guinea, and their sneezing and coughing must surely result in a constant rain of virus particles upon any humans in the vicinity. Our immune system will respond to such challenges, and I postulate that this is where the immunity has come from. I’ll certainly volunteer for antibody testing once it becomes available.

    It has been argued that the low incidence countries don’t get many foreign visitors. In 2018 [the most recently available stats), Kenya had 230,000+ visitors from China. Number of confirmed Covid-19 cases there, so far? Just 7.

    Finally, have a look at this article – https://theconversation.com/coronavirus-origins-genome-analysis-suggests-two-viruses-may-have-combined-134059

  22. Phil Salmon says:

    I think if you regressed the number of international flights per person per year, between countries, you would find an even stronger correlation with CV19 incidence than the (negative) correlation with malaria incidence. Malaria countries are poor, people fly less.

    • Bindidon says:

      James

      Thanks, really impressing graph.

      The problem with PotUSes like Trump is that they simply lack time neccessary for presidence.

      He is 110% busy with his reelection, and is therefore every day more a candidate than a president.

      Rgds
      J.-P. D. in Germoney

    • Bindidon says:

      Unfortunately, the graph was removed by Instagram…
      Hmmmh.

  23. old bloke says:

    Thank you Dr. Roy, that was an interesting post. I suspect that the Wuhan Zombie Virus may seemingly be lower in the malaria infected countries is because of poor / non-existent testing regimes in those countries. How many zillions of Zimbabwe dollars would a test kit cost?

    Nevertheless, I can’t order chloroquine online without a doctor’s prescription, and that ban applies to all countries around the world.

    So, I’ll sit here and enjoy a gin & tonic, or a gin & bitter lemon, as both tonic and bitter lemon drinks contain quinine, the active ingredient in chloroquine.

  24. Freddaktari says:

    Malaria prone countries Have the most amazing and magical tourist attraction sites. Same them. It’s in these areas that you will find the rarest breads of wild animals and plants.

    Come one folks.

  25. Darville Risdorf says:

    If you are responding to Jan Kjetil Andersen, he used the word “support,” not “prove.”

  26. R Otterness says:

    Wikipedia notes approx 5 million prescriptions for hydroxychloroquine in the US in 2017. Presumably the same order of use this past year for lupus or rheumatoid arthritis.

    It would be interesting to know how many of the recipients have been diagnosed with C-19 although maybe not enough general exposure among our population so far.

  27. Rehema Parmena says:

    I think it’s a bit of a generalisation to state that “poor countries have little capacity for testing and reporting”……I’m Kenyan and live in Nairobi and I can assure you that our testing and reporting capacity is equal of not better to a number of “rich countries”. Secondly we have no transport issues – there is an abundance of public transport which is used by the average Kenyan both within Nairobi and outside of the capital. Third, whilst Kenya and a number of other “poor” countries as you seem to refer to them, do have malaria cases, chloroquine is rarely used- in fact, even 20 years ago I recall that doctors had stopped prescribing it and governments, at least here in Kenya had withdrawn it for various safety and side effect reasons. Finally, malaria is not something that your average Kenyan gets on a regular basis, I believe it’s more a concern for tourists. In fact, on this final point I’ve taken chloroquine only once in my life whilst residing in Uganda and got quite unwell and was asked by my various doctor friends why I’d take such an antiquated drug! That was more than 20 years ago. Reading through these posts I notice there’s quite a degree of ignorance, negative stereotyping and misinformation about so called “poor” countries. Do a little more research, particularly on Kenya- we now have 15 reported cases and a possibility of community spread which may see numbers go up. I’d also suggest that you read up on our testing capabilities, KEMRI. You’ll be surprised to note that we are possibly a global leader in this respect.

  28. Rehema Parmena says:

    It may be inaccurate to lump all “poor countries” together when speaking of poor reporting. Kenya might fall within your category of “poor” but both our reporting and testing capacities are quite impressive. Other factors worth looking into are average age of the populations in these countries, the impact of temperature in our largely tropical climates, etc. NB- I’m a lawyer not a doctor but I definitely needed to put my two cents into this ongoing dialogue!

    • Dr Rob Brook says:

      I’m glad you agree with me that no one takes chloroquine these days. I last took it in the early 1990s and I still got malaria! I also agree with your comments about health services in developing countries. We’ve just returned from Costa Rica where the health service (private) is excellent and the public one isn’t too bad either. Here in the UK the national health service is hopelessly under-resourced. We have no idea how many people are infected because the testing regime is so poor.

      But the correlation that Dr Roy Spencer points out is interesting even if it’s not due to chloroquine taking. See my post above – what do you think of the idea about exposure to various coronaviruses from fruit bats? Something must account for the lower rate of infection. I guess that we’ll only know for sure if someone conducts widespread testing for antibodies in a population.

  29. Daniesh says:

    Also we should consider the fact that not all countries test all the suspected cases

  30. Wirawan says:

    I’d like to share a similar observation by Prof. Bodmer from Univ. of Kent, UK.

    =====
    Malaria versus non-malaria countries and covid-19

    I have done an analysis using human population data by country and covid-19 infections. The results are astonishingly clear: Non-malarial countries have almost 100 times more infections than malarial countries.

    I took the most populous top 30 countries and divided them into 1) countries with malaria and 2) countries without malaria. Malarial countries have 3.136 billion people and non-malarial countries have 2.772 billion people. However, malarial countries only have 4,329 infections and non-malarial countries as of 23/03/2020 have 272,585 infections or 98% of infections (p>0.00001, Chi2 59741).

    Why are malarial countries showing low infection rates?

    Temperature: malarial countries are warmer and in tropical regions. However, temperature tests on the virus shows that it survives in warm temperatures and you basically need to toast it to kill it.
    Malarial countries are not reporting cases, because of a weak public health system and cases are going unreported. If this was the case one would expect many deaths occurring, and these would be reported, but they are not. It looks like these countries are very low in infections.
    Infections have not reached malarial countries. But why would these countries have so few arrivals and infections compared to non-malarial countries. It is not really spreading in any malarial region, and one would expect that at least one malarial area would have an epidemic, but there are none.
    People treat malaria with quinines, often cloroquine or hidroxicloroquine. These malarial medicines stay in the body for long periods of time and this might be protecting the malarial countries from the pandemic. There have been reports in the news, from China and from the US about labs and doctors’ reports suggesting positive signs of cloroquine in infected people. It might be that cloroquine is acting as a prophylactic that protects people from infection in malarial countries, since many people at some point in the past have taken cloroquine, thus stopping the virus from becoming an epidemic.

    Prof Richard Bodmer
    DICE
    University of Kent
    Canterbury, Kent
    UK

  31. Thiru Reddy says:

    Wondering if ethnicity data for US and European covid19 deaths/intensive care cases data is available? And if there is a correlation to India or Africa immigrant status? To correlate to the malaria acquired immunity benefit towards covid19.

  32. Thiru Reddy says:

    We can take away the under-testing or low-transmission rate variables out of the equation by looking at the confirmed cases in these countries.

    If you look at the death rate or cases in critical care in India (today 600+ confirmed cases but zero in critical care!), they are relatively very low. Same with Indonesia – zero critical cases today of the 700+ confirmed cases, none are classified as critical.

  33. gary fedak says:

    I have seen an article in Voltaire where the incidences of Malaria
    in Italy matches the incidences of Covid19. This would seem counter
    to this stream of thought.I don’t know how reliable. But what information is reliable on this.

  34. AJ says:

    Interesting, Russia seems to be an enigma. No Malaria, no Covid.

  35. Muntasir says:

    Surprising enough. Malaria is very common in Bangladesh and I think there is a good number of our population had to take quinine once in our life. So, there could be a link between two even if its not 100%. Telling my own experience, once i was having severe fever, lost a lot of bodyweight and finally I could recovered with Avloquine. A medicine cost only BDT 2 (BDT 86 = US$1)

    Social distancing is vague in any country like Bangladesh. It’s just simply not possible physically and number of ICU beds is as low as 1000 only.

    There is no evidence of why the virus dint come to india/nepal while both of the countries have land borders. Or even Bangladesh where hundreds of thousands of travelers were traveling during the month of January and till now! So the probability was higher to spread the virus in South Asia than Europe.

    Chances of spreading are way higher in Bangladesh than anywhere else. There must be something. Prof Richard Bodmer has stated very rationally. In practicality- we have not got an abnormal death case in Bangladesh yet but considering the timeline, we would have got it by now.

    Yes, we are not testing mass but there ain’t mass death either.

    I really hope things will be fine soon.

  36. N.Ravi Shankar says:

    Sir,
    Is there any way we can analyse the ethnicity of the corona infected people like how many Indians/Africans/malaria infected country origins are getting infected by corona?
    That might make things a bit more clearer.

  37. N.Ravi Shankar says:

    What I mean is among the infected people in non malarial countries, the indians, Africans etc who are infected by covid-19.

  38. N.Ravi Shankar says:

    Sir,
    What I mean is in non malarial countries like USA, Germany, France etc., the number or percentage of indians, Africans etc who are infected by covid-19.

  39. Mrudul Mudotholy says:

    The data points of Malaria is on a different base (Risk per 1,000) with respect to Covid19 (Confirmed cases). We are comparing probability of occurence (P=0.x% to 99.x%) with occurence (P=1). Hence the random anomaly we see on the map.

    Malaria has a high probability of occurrence in humid-hot conditions. Thus, the higher risk in countries close to earth’s equator.

    Whether COVID19 spreads here – one needs to wait and watch as most of these countries, with exception of Singapore have poor data reporting capabilities.

  40. Anon says:

    A question: could a genetic mutation in the hemoglobin cells in the populations of Africa, South Asia and other tropical countries with high prevalence of malaria, thought to provide protection against the disease (as a consequence of evolution and natural selection) somehow be protecting these same countries against the high rates of coronavirus positives as well as coronavirus deaths as shown in populations not known to have this mutation – namely HbS, HbE, HbC?

    https://en.m.wikipedia.org/wiki/Human_genetic_resistance_to_malaria

  41. Subathra Dhanasingh says:

    On march 28th the cases in india is close to 900.. it is growing exponentially..

    Is theory of herd immunity because of malaria still works?

  42. PRASHANT KUMAR says:

    Well done 👍 great work sir I know this may be scientifically unproven/wrong but satitically huge difference in data somehow prove some hidden corealation.we are looking upon your country.amreica is great we pray they and we overcome this chinnees virus very soon.INDIA AMERICA GREAT AGAIN

  43. Mark says:

    Seasonal flu infection rates are estimates done by the government. If you used only confined cases of seasonal flu identified through testing the death rate would be close tho 10%

  44. Marty says:

    Seasonal flu death rates are based off of estimates of total infections not infections confirmed through testing. If you used only confirmed cases the death rate is close to 10%.

  45. c1ue says:

    Interesting, but not clear this is conclusive.
    For one thing, I’d bet the malaria countries are also much younger on average – and we know nCOV is basically a non-factor if under 20. The entire continent of Africa – average age is 18?

  46. Lee says:

    I spent my childhood in Africa, had malaria at 5 years old, and then took chloroquine tablets weekly until I was 18 years old. Perhaps it is too soon to determine if the chloroquine dosing 40 plus years ago had the potential to create immunity to the Covid-19 virus. Your data comparison of countries with malaria and Covid-19 is the closest research I could locate about my query.

  47. Faraz says:

    Poorer countries may not be testing that much but in this age of social media, deaths are hard to conceal. I think this argument does carry weight.

  48. chuck says:

    two divisions of usa gi”s in korea 1962 1963 I was there close to the dmz had to take malaria pills every week . they gave them to us in the chow hall when we ate lunch . they were yellow , bitter and about a nickel in size . It would be interesting to see how many gi’s today that have gotten covid 19 today that were there taking the pill.

  49. Az şah says:

    😂😂😂😂

  50. Ken says:

    Populations in most Malaria prone countries have also been vaccinated with the BCG vaccine, which essentially trains the immune system to effectively fight off most pathogenic microorganisms. This additional fact combined with a history of chloroquine usage may account for the low incidences of COVID-19 infection in these countries.

  51. Zack says:

    But the infection rate in population is never known. Until 100% reliable testing is done on 100% of popultaion, only hospitalizations and case outcomes should be discussed. Countries have different protocols for listing cause of death and for who they test. The data is not uniformly collected and cant be uniformly compared.

    But the broad understanding should be easy to see. This is a primarily a culling disease of the old and infirm. A disease of substitution, shortening lives already compromised by underlying morbidities.

    4/3, So far, INVERSE is still apparent: highly malarial countries don’t show high death covid data.

    But the correlation could just be bad denominator data, or suggest that a malarial exposure = immunity/resistance, un-correlated to chloroquine use.

  52. Jide says:

    Michael and Roy , I also agree that the level of testing and transport infrastructure are the real reasons we are seeing weal covid results from malaria prone countries

  53. Jorge Lanese says:

    during my active duty service in the United States Marine Corps in the late 70s I contracted malaria overseas. I spent eight days( which I barely remember) in the ship’s Hospital. With the recent news of this anti-malaria pill I did some quick numbers and made the connection mentioned in this article. I never really thought about the fact that year in and year out people around me get the flu and I never do, and if I do I never show any symptoms . this past year was the first time in 30 years I got a flu shot at the VA Hospital. could there be a connection?

  54. Kevin says:

    The reason is that Chinese have gotten a way of getting people to recover through their Mahuang herbal treatments. Just people in malaria streaked nations have the possibility of contracting malaria daily but have a way of remedy or cure through a drug. While the Chinese and Koreas have given recommendations to the West on how to curb infection rate, they are yet to disclose how they are achieving so high a recovery rate among old people and those with underlying health issues. As of today China cases of infection vs recovery is 83000 vs 7700. Recovery is pretty high and proves they have a proven way to handle the infected cases selectively based on patient internal landscape using mainly their traditional herbs.

  55. Infection magnet says:

    Very interesting. I had severe malaria in 1997 (Gambia). I live in Finland. Can it be that I could be immune to Covid-19? I have other health problems and I am in risk group. Possible immunity would be huge relieve…even slight hope for it.

  56. Infection magnet says:

    Jorge this is very interesting. I am Finn and had severe malaria and 42⁰C+ in 1997 (Gambia). Since then I have had proper fever only once 2 years ago, when I got influenza from a friend visiting my home. My temperature regulation seems to be broken. Very rarely I get proper symptoms of flues. However, a bit sore throat often. Other infections are piling up though

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  60. Mary says:

    I have Rheumatoid Arthritis and I re-started plaquenil (anti-malarial) in hopes of avoiding covid-19.

  61. Ruth B says:

    Apart from immunity from prior bouts of malaria and/or chloroquine usage over time, could it be that the genetic adaptation in red blood cells of folks from malaria regions (sickle cell, Thalessema etc) could be conferring immunity against COVID-19?
    This could be investigated by studying the blood groups of those who have contracted COVID-19 in malaria prone areas.
    If this hypothesis is correct, they would largely belong to the A.A. group which has no genotypical adaptation against malaria
    Apologies if this sounds bonkers- I am a humanities person just reading around!

  62. Jon says:

    Chloroquine’s already been bought out in most chemist’s in Kenya where it’s an over the counter drug

  63. RobUK says:

    I am just an old guy in the UK looking for answers and I keep coming back to Africa.

    Nigeria has had 6 deaths associated with Covid-19, the majority of the population still take Chloroquine to fight Malaria as it is affordable and readily available, 6 deaths out of 220 million.

    Covid-19 is most dangerous for the elderly.

    In Nigeria the elderly would have been taking this drug for most their lives, because of this it is possible that this group has built up an immunity to this type of virus.

    Lupus and rheumatoid Arthritis sufferers who are also long term users of this medication also appear to show immunity as according to Dr Daniel Wallace (a world expert on these two medical issues) Quote out of over 1000 Covid-19 patients only (1) had Lupus, this was most surprising he stated. He also said none of his Lupus patients had contracted Covid-19.

    Start at 7.00

    https://www.youtube.com/watch?v=xFTMya2ybso&feature=youtu.be

    Thousands of doctors the breadth of the US are using this drug in combination with Zepac and zink sulfate , they are I believe achieving phenomenal success.

    According to Oxford University the drug is safe.
    The UK part of the EU trial is enrolling only the most sick patients and is only treating those patients with HYDROXYCHLOROQUINE alone, when they are fully aware that the drug is most effective when used early and in combination with zepac and zink sulphate.Oxford receives millions of £`s from Drug companies,it appears Oxford do not want this dirt cheap drug HYDROXYCHLOROQUINE to perform well in this trial, see next.

    Italy Finally Starts Mass Treatment with Hydroxychloroquine

    Referring to the European Discovery trial in which UK is taking part with only 800 patients, Perronne says:

    “I refused to participate because this study provides for a group of severely ill patients who will only be treated symptomatically and will serve as control witnesses against four other groups who will receive antivirals. It is not ethically acceptable to me.
    We could perfectly well, in the situation we are in, evaluate these treatments by applying a different protocol. In addition, the hydroxychloroquine group (which was added to this study at the last minute), should be replaced by a hydroxychloroquine group plus azithromycin, the current reference treatment according to the most recent data.”

    The previous paragraph verifies the involvement and lobbying by the drug companies.

    The EU added hydroxychloroquine because your President Trump suggested it might be usefull, they are trying to kill 2 birds with one stone.

    https://www.trustnodes.com/2020/03/29/italy-finally-starts-mass-treatment-with-hydroxychloroquine

    The French article link, with English translation below.

    https://www.parismatch.com/Actu/Sante/A-propos-de-la-chloroquine-et-de-l-inimaginable-penurie-des-masques-en-France-1680312

    “Pr Christian Perronne.

    I refused to participate because this study provides for a group of severely ill patients who will only be treated symptomatically and will serve as control controls against four other groups who will receive antivirals. It is not ethically acceptable to me. We could perfectly well, in the situation we are in, evaluate these treatments by applying a different protocol. In addition, the hydroxychloroquine group (which was added to this study at the last minute), should be replaced by a hydroxychloroquine group plus azithromycin, the current reference treatment according to the most recent data. Finally, the protocol model chosen will not provide results for several weeks. Meanwhile, the epidemic is galloping. We are in a hurry, we are at war, we need quick assessments.”

    ” In the USA Dr. Zev Zelenko who works in two hospitals of the Orthodox Jewish communities in the New York region (where the infection rate is high), has administered since March 19, to 500 people, without PCR test beforehand (so as not to waste time), the combination of Pr Raoult to which he added zinc which slows down viral replication. Patients treated were: adults of all ages with early signs (cough, fever, body aches…) with associated comorbidity (diabetes, obesity, pulmonary, cardiovascular disease, cancer, immunosuppression) – adults of all ages with signs beginners, no co-morbidity – anyone, regardless of age, with pulmonary signs (shortness of breath or more). Only young subjects with early signs but no co-morbidity were not treated. As of March 26, none of the people who received this therapy had been hospitalized, none had progressed to a severe form requiring resuscitation, none had died. This is not a study, of course, but these results have significant indicative value. On the sidelines of this initiative comm
    In France, Professor Christian Perronne is one of the best specialists in infectious and tropical diseases. He is also the president of the CSMT (Commission Spécialisée Maladies Transmissibles) and of the sub-section of the CNU (National Council of Universities), as well as of the French Federation of Infectious Diseases (FFI) since 2010. This man is also responsible to teach courses on infectious and tropical diseases at the University of Versailles-Saint-Quentin, while being the head of the infectiology department at the Raymond Poincaré University Hospital in Garches. Full member of the World Health Organization, he co-chairs a working group on vaccine policy in the Europe zone since 2009. Pr. Christian Perronne is also a diligent researcher and the fruits of his research have made the subject of numerous publications worldwide.”

    https://www.cebm.net/covid-19/chloroquine-and-hydroxychloroquine-current-evidence-for-their-effectiveness-in-treating-covid-19/

    Side Effects of Chloroquine are minimal, see below.

    Both CQ and HCQ have been in clinical use for several years, thus their safety profile is well established (18). Gastrointestinal upset has been reported with HCQ intake (21). Retinal toxicity has been described with long-term use of CQ and HCQ (22, 23), and may also be related to over-dosage of these medications (23, 24). Isolated reports of cardiomyopathy (25) and heart rhythm disturbances (26) caused by treatment with CQ have been reported. Chloroquine should be avoided in patients with porphyria (27). Both CQ and HCQ are metabolised in the liver with renal excretion of some metabolites, hence they should be prescribed with care in people with liver or renal failure (27, 28). In a letter to the editor, Risambaf et al (27) raise concerns about reports of COVID-19 causing liver and renal impairment, which may increase the risk of toxicity of CQ/HCQ when it is used to treat COVID-19.

    CHLOROQUINE | Drug | BNF content published by NICE
    HYDROXYCHLOROQUINE SULFATE | Drug | BNF content published by NICE

    To make this drug HYDROXYCHLOROQUINE more secure we need to know how many covid positive Lupus and rheumatoid Arthritis sufferers died in nursing homes + how many contracted or died from covid-19 within the overall community.

    The drug companies appear intent in stopping the use of HYDROXYCHLOROQUINE, there are millions of £-$ to be made for them if they find a yearly vaccine and convince the gullible public to allow it to be injected into them, consider statins, now there is a story to be told regarding drug company data, Prof Sir Rory Collins (the keeper of that data) and Oxford University. This Oxford study is flawed from start to finish.

    Sorry about the length, comments appreciated,

  64. Dr. Alok Mohta says:

    Even in India the Malaria endemic zones have zero or least number of cases and least to zero deaths.
    Same pattern can be seen worldwide with tropical countries viz. South Asia,central Africa, Caribbean Latin America have low cases n deaths as compared to Temperate zone countries.
    The Inherent Immunity against Malaria might be providing Cross immunity against COVID19 !! Needs more Research as plasma samples of such people from Malaria endemic zone may give some clue?

  65. Chendri says:

    My hypothesis is immunity, people who are living in malaria endemic, dengue ,yellow fever or other viral or parasite infection have very strong imunne to detect this covid-19, they get infectee but their body right way clean the virus. I do not agree to get rid off malaria or dengue other viral infection which we know the vector is mosquito. Our immune system needs the infection disease to get traine become a strong immune. You are living clean without any exposure viral infection and when your body get infected here it is dumb immune system which could not detect the infection.

  66. Rubi says:

    Have you looked at the potential relationship of Thalassemia anemia people and their genetic resistance to malaria? Could that also provide immunity to covid?

  67. huldah1776 says:

    Simple. Malaria preventive = HCQ

  68. Dave Taylor says:

    Dr. Spencer,

    Have you reevaluated this data more recently?

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