Internacionales

Biden: ‘Paxlovid Rebound’ Raises Questions Over How Long Treatment Should Last, World Covid Stats

Alberto Ardila Olivares

Some experts have called for studies into extending Paxlovid treatments to be prioritized, as early research has suggested that Paxlovid rebound could occur due to insufficient exposure to the drug. Researchers from the University of California, San Diego School of Medicine  said last month that the drug may not be reaching enough infected cells in the allotted time

Advertisement – by Joseph Choi The Hill President Biden testing positive for COVID-19 again days after completing a course of Paxlovid has raised the question of whether the length of the antiviral treatment should be reconsidered.

Just days after he completed a five-day round of Pfizer’s COVID-19 antiviral treatment, Biden’s physician, Kevin O’Connor, said in a letter on Saturday that the president had tested positive once again. As of Wednesday, Biden is  still testing positive for COVID-19

This phenomenon has come to be known as “Paxlovid rebound,” when a person tests positive for the coronavirus again even after initially testing negative following a round of treatment with the antiviral. A recent  preprint study  found that Paxlovid rebound occurred among 3.5 percent and 5.4 percent of coronavirus infections at the seven-day and the 30-day mark after treatment respectively.   Biden’s chief medical adviser, Anthony Fauci, also experienced Paxlovid rebound after contracting the virus and started a second round of treatment.

Some experts have called for studies into extending Paxlovid treatments to be prioritized, as early research has suggested that Paxlovid rebound could occur due to insufficient exposure to the drug. Researchers from the University of California, San Diego School of Medicine  said last month that the drug may not be reaching enough infected cells in the allotted time.

Paxlovid, under an emergency use authorization issued by the Food and Drug Administration, is administered in two doses taken daily over the course of five days. Physicians are not permitted to prescribe longer rounds of treatment, and clinical data on courses lasting more than five days has yet to be completed.

Earlier this year, Fauci said the National Institutes of Health was in talks with Pfizer about  studies looking into longer courses  of Paxlovid, though any updates on these possible trials have not been disclosed.

“I’m actually still flabbergasted that we have not set up a clinical trial to figure this out. It’s an easy thing to do,” Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco, told The Hill.

“Wouldn’t cost that much to be able to accumulate enough patients in a week or two and follow them for a few weeks so we could have an answer,” Wachter said, adding that the data needed to potentially extend the length of a round of Paxlovid could have been collected already if trials had been started just a few months ago.

According to Wachter, there aren’t any ​ similar antiviral “analogies”   to compare Paxlovid to. Viral rebound isn’t usually tested for, and other antiviral treatments aren’t administered in the same manner.

Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, noted that viral rebound has rarely been studied as much as it is now in the context of COVID-19. ​However, Toner said instances of viruses or bacterial infections still lingering after treatment do occur.

Instances of viral rebound of coronavirus are also not unique to Paxlovid. Cases of rebound with molnupiravir, the COVID-19 antiviral created by Merck and Ridgeback, have been observed as well.

People who experience cases of antiviral rebound are still at risk of transmitting COVID-19 to other people. Michael Charness, a researcher from the Veterans Administration Medical Center in Boston, recently told CNN  that he and his colleagues had observed at least two instances of people infecting others after their symptoms reoccurred. Both cases involved people who tested positive again after taking Paxlovid.

People tend to have much milder symptoms that resolve fairly easily on their own after testing positive again, Toner said. For this reason, he said a second round of treatment, even in cases of Paxlovid rebound, is probably unneeded. O’Connor, Biden’s physician, has provided regular updates on the president’s health but has not disclosed whether he has started a second course of Paxlovid, like Fauci did.

While the need for and feasibility of longer Paxlovid rounds remains uncertain, the U.S. may find itself relying on antivirals more going forward as new variants of COVID-19, more infectious and better at evading immune protection, continue to crop up.

“If we do see more variants and they’re more evasive and we have more people with infections who are at risk of a serious outcome, then antivirals will become increasingly important,” Wachter said, though he added, “As far as we know, none of that is really true.”

He noted that even with subvariants like BA.5 spreading and causing more infections, the current vaccines are still offering strong protection against severe cases, hospitalizations and deaths.

Researchers have previously said that it would be difficult, but not impossible, for COVID-19 to become resistant to Paxlovid treatment, as the drug targets a part of the virus that does not change easily.

Climate change causing poorer fitness in children: study Meta took down Russian troll farm that supported country’s invasion of Ukraine When reached for comment, a Pfizer spokesperson pointed to a health advisory from the Centers for Disease Control and Prevention released earlier this year that stated a brief return of COVID-19 symptoms following the completion of Paxlovid treatment “may be part of the natural history of SARS-CoV-2.”

While further evaluation is needed, we have not seen any viral resistance emerge to date in patients treated with PAXLOVID, and we continue to monitor data from our ongoing clinical studies and post-authorization safety surveillance,” said the spokesperson. “We remain very confident in PAXLOVID’s clinical effectiveness at preventing severe outcomes from COVID-19 in patients at increased risk.”

The spokesperson for Pfizer did not comment on the possibility of longer Paxlovid courses.

=================================================

WORLD COVID STATS Coronavirus Cases: 587,015,153 view by country Deaths: 6,431,196 Recovered: 557,093,018 # Country, Other Total Cases New Cases Total Deaths New Deaths Total Recovered New Recovered Active Cases Serious, Critical Tot Cases/ 1M pop Deaths/ 1M pop Total Tests Tests/ 1M pop Population World 587,015,153 +485,929 6,431,196 +616 557,093,018 +474,817 23,490,939 43,869 75,309 825.1 1 USA 93,739,666 1,057,811 88,700,969 3,980,886 4,717 1,074,632,797 2 India 44,107,588 526,600 43,445,624 135,364 698 31,320 374 876,760,536 622,562 1,408,310,338 3 France 33,993,930 152,457 32,666,444 1,175,029 869 518,400 2,325 271,490,188 4,140,162 65,574,769 4 Brazil 33,964,494 679,594 32,643,157 641,743 8,318 157,453 3,150 63,776,166 295,655 215,711,507 5 Germany 31,178,705 144,717 29,455,400 +89,900 1,578,588 1,445 369,667 1,716 122,332,384 1,450,420 84,342,745 6 UK 23,368,899 185,052 22,807,656 +24,564 376,191 146 340,506 2,696 522,526,476 7,613,686 68,629,899 7 Italy 21,213,559 172,729 19,865,536 1,175,294 392 351,938 2,866 238,136,571 3,950,741 60,276,425 8 S. Korea 20,273,011 +112,857 25,191 +47 18,762,912 +26,265 1,484,908 320 394,714 490 15,804,065 307,704 51,361,209 9 Russia 18,672,422 +18,555 382,651 +47 18,019,883 +9,817 269,888 2,300 127,836 2,620 273,400,000 1,871,770 146,064,968 10 Turkey 15,889,495 99,341 15,487,468 302,686 975 184,263 1,152 162,743,369 1,887,263 86,232,463 11 Japan 13,598,290 +253,392 33,159 +183 11,586,379 +188,460 1,978,752 556 108,207 264 64,104,711 510,107 125,669,125 12 Spain 13,245,996 110,719 12,707,465 427,812 339 283,079 2,366 471,036,328 10,066,482 46,792,547 13 Vietnam 11,189,968 43,094 9,948,174 1,198,700 112 112,841 435 85,826,548 865,486 99,165,741 14 Australia 9,586,984 +32,580 12,201 +82 9,224,255 350,528 155 367,076 467 76,745,533 2,938,509 26,117,164 15 Argentina 9,560,307 129,369 9,313,797 +5,665 117,141 456 207,558 2,809 35,716,069 775,408 46,061,000 16 Netherlands 8,347,295 22,510 8,188,138 136,647 54 484,915 1,308 21,107,399 1,226,180 17,213,950 17 Iran 7,426,030 142,290 7,091,232 192,508 1,398 86,113 1,650 53,322,294 618,330 86,235,950 18 Mexico 6,821,746 +18,556 328,128 +122 5,982,348 +18,211 511,270 4,798 51,774 2,490 17,777,962 134,928 131,758,912 19 Colombia 6,278,998 141,075 6,096,946 40,977 342 120,717 2,712 36,086,570 693,781 52,014,387 20 Indonesia 6,229,315 157,060 6,021,549 50,706 2,771 22,283 562 103,952,029 371,844 279,557,933 21 Poland 6,084,876 116,628 5,335,855 632,393 2,389 161,145 3,089 36,698,610 971,887 37,760,169 22 Portugal 5,356,285 24,656 5,209,885 121,744 61 528,509 2,433 43,527,258 4,294,868 10,134,714 23 Ukraine 5,023,710 108,713 4,911,468 +156 3,529 177 116,327 2,517 19,521,252 452,027 43,185,997 24 Austria 4,776,787 +6,271 19,177 +12 4,669,036 +7,966 88,574 73 524,138 2,104 193,830,947 21,268,325 9,113,597 25 DPRK 4,772,813 74 4,772,739 0 183,468 3 26,014,475 26 Malaysia 4,697,213 36,003 4,613,676 47,534 52 141,350 1,083 62,628,338 1,884,625 33,231,189 27 Taiwan 4,696,969 +21,869 9,136 +54 4,231,381 +25,237 456,452 196,471 382 22,996,312 961,920 23,906,685 28 Thailand 4,600,978 +2,253 31,529 +34 4,548,339 +2,483 21,110 1,496 65,573 449 17,270,775 246,144 70,165,297 29 Israel 4,594,568 11,399 4,544,809 38,360 310 492,662 1,222 41,373,364 4,436,346 9,326,000 30 Greece 4,474,616 31,377 4,298,606 +19,440 144,633 115 433,717 3,041 89,320,544 8,657,688 10,316,905 31 Belgium 4,425,201 32,263 4,242,894 +9,861 150,044 108 378,389 2,759 35,042,202 2,996,383 11,694,836 32 Chile 4,274,613 59,698 3,975,681 239,234 165 219,678 3,068 42,263,427 2,171,974 19,458,534 33 Canada 4,056,133 42,681 N/A N/A N/A 195 105,539 1,111 62,586,673 1,628,482 38,432,524 34 South Africa 4,004,555 101,982 3,897,607 4,966 192 65,790 1,675 25,975,203 426,741 60,868,811 35 Czechia 3,996,433 +2,149 40,544 +5 3,934,243 +4,469 21,646 35 371,747 3,771 55,789,495 5,189,518 10,750,419 36 Switzerland 3,953,866 14,066 3,787,559 +20,778 152,241 67 449,985 1,601 21,877,329 2,489,835 8,786,659 37 Peru 3,940,482 214,480 3,602,373 123,629 241 116,135 6,321 33,232,447 979,437 33,930,141 38 Philippines 3,790,309 60,773 3,695,323 34,213 733 33,655 540 31,587,125 280,465 112,624,069 39 Romania 3,098,268 66,117 2,915,542 116,609 283 163,323 3,485 24,161,343 1,273,650 18,970,156 40 Denmark 3,067,138 6,700 3,043,190 17,248 17 525,668 1,148 128,003,663 21,938,165 5,834,748 41 Sweden 2,545,671 19,402 2,503,116 23,153 16 248,828 1,896 18,775,827 1,835,256 10,230,633 42 Iraq 2,449,440 25,322 2,401,993 22,125 28 58,174 601 19,096,631 453,540 42,105,689 43 Serbia 2,148,615 16,319 2,040,372 91,924 35 247,994 1,884 10,296,026 1,188,370 8,663,990 44 Bangladesh 2,006,646 29,300 1,945,829 31,517 1,228 11,936 174 14,630,751 87,030 168,112,481 45 Hungary 1,987,321 46,886 1,898,374 42,061 19 206,814 4,879 11,394,556 1,185,796 9,609,201 46 Slovakia 1,821,908 +947 20,248 +6 1,790,176 +1,009 11,484 39 333,368 3,705 7,235,238 1,323,885 5,465,157 47 Singapore 1,742,874 1,531 1,645,378 95,965 17 293,101 257 24,265,502 4,080,753 5,946,329 48 Jordan 1,715,296 14,083 1,696,674 4,539 56 164,703 1,352 17,018,240 1,634,098 10,414,456 49 Georgia 1,698,020 16,869 1,637,293 43,858 427,368 4,246 16,920,079 4,258,553 3,973,199 50 New Zealand 1,647,826 +5,492 2,338 +17 1,603,836 +7,881 41,652 329,427 467 7,406,030 1,480,584 5,002,100 51 Ireland 1,647,605 7,662 1,604,869 35,074 30 326,074 1,516 12,546,832 2,483,114 5,052,861 52 Pakistan 1,557,984 +750 30,505 +2 1,517,492 9,987 164 6,779 133 29,651,107 129,007 229,841,331 53 Norway 1,456,672 3,623 1,449,807 3,242 20 264,384 658 11,002,430 1,996,929 5,509,676 54 Hong Kong 1,371,938 9,527 1,233,912 128,499 7 179,953 1,250 54,352,132 7,129,205 7,623,870 55 Kazakhstan 1,362,647 +2,579 13,666 1,320,732 +2,555 28,249 24 70,804 710 11,575,012 601,446 19,245,293 56 Morocco 1,262,082 16,250 1,242,896 2,936 293 33,368 430 12,268,725 324,369 37,823,328 57 Finland 1,218,216 5,251 1,160,081 +6,608 52,884 21 219,156 945 11,237,850 2,021,679 5,558,672 58 Bulgaria 1,214,925 37,424 1,151,182 26,319 56 177,636 5,472 10,294,585 1,505,187 6,839,408 59 Croatia 1,191,079 16,365 1,164,965 9,749 27 293,913 4,038 5,062,571 1,249,250 4,052,488 60 Lebanon 1,181,614 10,540 1,087,587 83,487 186 174,751 1,559 4,795,578 709,225 6,761,717 61 Tunisia 1,134,660 29,105 N/A N/A N/A 29 93,955 2,410 4,863,059 402,684 12,076,625 62 Cuba 1,108,492 8,529 1,099,441 522 23 97,991 754 13,997,964 1,237,422 11,312,198 63 Lithuania 1,089,998 +973 9,218 1,038,300 42,480 7 412,387 3,488 10,069,350 3,809,612 2,643,143 64 Slovenia 1,089,921 6,705 1,058,993 24,223 17 524,118 3,224 2,705,662 1,301,091 2,079,534 65 Bolivia 1,056,378 +4,348 22,083 +3 960,401 +3,512 73,894 220 87,993 1,839 2,705,422 225,354 12,005,235 66 Guatemala 1,051,398 19,082 985,475 46,841 5 56,505 1,026 5,374,814 288,859 18,607,025 67 Costa Rica 1,005,223 8,720 860,711 135,792 52 193,641 1,680 4,659,757 897,632 5,191,164 68 UAE 995,777 2,335 974,601 18,841 98,206 230 178,234,096 17,577,818 10,139,717 69 Belarus 994,037 7,118 985,592 1,327 105,269 754 13,646,641 1,445,184 9,442,841 70 Nepal 988,821 11,969 971,250 5,602 32,710 396 5,828,708 192,811 30,230,211 71 Ecuador 975,234 35,811 904,368 35,055 759 53,578 1,967 2,470,170 135,709 18,202,020 72 Uruguay 971,728 7,415 962,545 1,768 18 277,729 2,119 6,114,822 1,747,671 3,498,841 73 Panama 954,369 8,425 938,038 7,906 16 214,153 1,891 6,772,690 1,519,739 4,456,481 74 Mongolia 951,735 2,179 N/A N/A N/A 192 280,877 643 4,030,048 1,189,353 3,388,438 75 Latvia 871,181 +1,605 5,901 +1 845,554 19,726 2 472,765 3,202 7,439,689 4,037,304 1,842,737 76 Saudi Arabia 810,583 9,257 796,701 4,625 113 22,551 258 43,929,393 1,222,125 35,945,076 77 Azerbaijan 800,478 9,755 787,839 2,884 77,492 944 7,058,973 683,358 10,329,837 78 Paraguay 707,109 19,220 676,279 11,610 6 96,661 2,627 2,646,163 361,728 7,315,331 79 Sri Lanka 666,232 16,574 648,164 1,494 30,843 767 6,486,117 300,276 21,600,531 80 Bahrain 661,570 1,511 656,045 4,014 4 362,507 828 10,186,122 5,581,480 1,824,986 81 Kuwait 653,730 2,559 647,555 3,616 5 148,496 581 8,282,574 1,881,401 4,402,343 82 Dominican Republic 631,040 4,383 625,024 1,633 17 56,979 396 3,597,292 324,816 11,074,864 83 Myanmar 614,158 19,434 592,943 1,781 11,132 352 8,559,637 155,148 55,170,720 84 Palestine 598,019 5,368 584,777 7,874 17 111,803 1,004 3,078,533 575,551 5,348,841 85 Estonia 591,058 2,628 524,990 63,440 4 444,941 1,978 3,468,756 2,611,236 1,328,396 86 Cyprus 562,911 1,115 124,370 437,426 60 459,259 910 9,572,310 7,809,706 1,225,694 87 Venezuela 537,487 5,766 526,664 5,057 36 19,014 204 3,359,014 118,828 28,267,936 88 Moldova 532,187 11,608 504,142 16,437 49 132,569 2,892 3,216,305 801,189 4,014,413 89 Egypt 515,645 24,613 442,182 48,850 122 4,848 231 3,693,367 34,725 106,361,471 90 Libya 505,350 6,433 490,973 7,944 101 71,516 910 2,477,219 350,571 7,066,238 91 Ethiopia 492,412 7,569 470,440 14,403 20 4,073 63 5,151,378 42,607 120,905,038 92 Honduras 444,152 10,940 132,498 300,714 105 43,403 1,069 1,458,053 142,482 10,233,279 93 Réunion 434,924 838 418,572 15,514 10 478,653 922 1,603,660 1,764,899 908,641 94 Armenia 426,799 8,635 412,661 5,503 143,472 2,903 3,109,931 1,045,427 2,974,795 95 Qatar 412,137 681 404,665 6,791 2 146,783 243 3,765,510 1,341,087 2,807,805 96 Oman 395,737 4,260 384,669 6,808 2 73,590 792 25,000,000 4,648,913 5,377,601 97 Bosnia and Herzegovina 387,076 15,888 N/A N/A N/A 119,532 4,906 1,819,216 561,786 3,238,275 98 Kenya 337,768 5,672 331,669 427 1 6,006 101 3,827,700 68,057 56,242,531 99 Zambia 330,575 4,015 325,321 1,239 1 16,989 206 3,642,327 187,187 19,458,177 100 North Macedonia 330,016 9,387 316,490 4,139 158,418 4,506 2,101,653 1,008,860 2,083,196 101 Botswana 325,724 2,772 322,758 194 1 132,911 1,131 2,026,898 827,071 2,450,695 102 Albania 315,337 3,554 301,444 10,339 109,826 1,238 1,869,495 651,110 2,871,244 103 Luxembourg 279,354 1,108 265,463 12,783 431,617 1,712 4,362,918 6,740,950 647,226 104 Algeria 267,902 6,877 179,788 81,237 6 5,888 151 230,861 5,074 45,503,155 105 Montenegro 262,808 2,753 253,737 6,318 6 418,330 4,382 2,555,520 4,067,797 628,232 106 Nigeria 261,473 3,147 254,953 3,373 11 1,206 15 5,441,162 25,098 216,799,566 107 Zimbabwe 256,444 5,581 250,426 437 12 16,745 364 2,453,554 160,213 15,314,344 108 Uzbekistan 243,232 1,637 240,478 1,117 23 7,054 47 1,377,915 39,961 34,481,234 109 China 230,135 +222 5,226 223,286 +147 1,623 1 160 4 160,000,000 111,163 1,439,323,776 110 Mozambique 229,674 2,216 227,192 266 11 6,942 67 1,370,614 41,430 33,082,474 111 Martinique 215,140 1,017 104 214,019 8 574,230 2,714 828,928 2,212,492 374,658 112 Laos 211,643 +106 757 N/A N/A N/A 28,235 101 1,233,207 164,519 7,495,833 113 Brunei 211,132 225 205,773 5,134 3 473,159 504 717,784 1,608,595 446,218 114 Iceland 202,502 179 N/A N/A N/A 3 585,498 518 1,986,628 5,743,974 345,863 115 Kyrgyzstan 201,329 2,991 196,406 1,932 131 29,832 443 1,907,195 282,599 6,748,776 116 El Salvador 190,818 4,206 172,310 14,302 8 29,113 642 2,456,913 374,845 6,554,475 117 Afghanistan 187,037 +187 7,752 167,226 +53 12,059 1,124 4,589 190 1,036,084 25,421 40,757,536 118 Guadeloupe 186,380 971 2,250 183,159 19 465,639 2,426 938,039 2,343,533 400,267 119 Maldives 184,485 307 163,687 20,491 25 329,198 548 2,213,831 3,950,399 560,407 120 Trinidad and Tobago 172,267 4,061 161,837 6,369 18 122,267 2,882 796,122 565,050 1,408,941 121 Uganda 169,396 3,628 100,431 65,337 3 3,474 74 3,012,408 61,787 48,755,027 122 Namibia 169,253 4,065 164,813 375 64,186 1,542 1,062,663 402,995 2,636,913 123 Ghana 168,127 1,457 166,507 163 2 5,185 45 2,490,032 76,791 32,426,229 124 Jamaica 146,695 3,199 94,156 49,340 49,093 1,071 1,149,550 384,706 2,988,127 125 Cambodia 136,959 +22 3,056 133,640 +13 263 7,962 178 3,024,329 175,816 17,201,719 126 Rwanda 132,276 1,466 45,522 85,288 9,710 108 5,677,519 416,787 13,622,107 127 Cameroon 120,215 1,931 117,791 493 13 4,305 69 1,751,774 62,732 27,924,550 128 Malta 113,120 795 110,728 1,597 4 254,777 1,791 2,023,313 4,557,052 443,996 129 Angola 102,301 1,912 97,149 3,240 2,923 55 1,499,795 42,852 34,999,407 130 Barbados 93,559 496 90,202 2,861 324,735 1,722 731,869 2,540,250 288,109 131 French Guiana 92,989 407 11,254 81,328 3 295,358 1,293 650,106 2,064,910 314,835 132 DRC 92,173 1,390 50,930 39,853 968 15 846,704 8,890 95,242,523 133 Channel Islands 88,529 195 87,553 781 499,582 1,100 1,252,808 7,069,783 177,206 134 Malawi 87,547 2,670 83,973 904 67 4,342 132 603,849 29,951 20,161,327 135 Senegal 87,513 1,968 85,342 203 4,954 111 1,140,607 64,570 17,664,545 136 Ivory Coast 85,601 811 84,587 203 3,086 29 1,584,736 57,126 27,741,134 137 Suriname 80,982 1,380 49,599 30,003 135,513 2,309 238,565 399,206 597,598 138 French Polynesia 75,654 649 N/A N/A N/A 7 266,111 2,283 284,295 139 Eswatini 73,294 1,417 71,842 35 11 61,840 1,196 1,041,330 878,593 1,185,225 140 New Caledonia 70,937 314 68,254 2,369 9 243,582 1,078 98,964 339,821 291,224 141 Guyana 70,009 1,271 68,225 513 88,120 1,600 677,998 853,398 794,469 142 Fiji 67,805 874 65,732 1,199 74,511 960 613,582 674,269 909,996 143 Belize 67,309 680 66,308 321 6 163,099 1,648 576,016 1,395,763 412,689 144 Madagascar 66,491 1,408 64,782 301 6 2,279 48 497,804 17,062 29,176,303 145 Sudan 63,074 4,958 N/A N/A N/A 1,372 108 562,941 12,242 45,985,365 146 Mauritania 62,631 992 61,242 397 12,770 202 918,852 187,343 4,904,656 147 Cabo Verde 62,191 410 61,671 110 23 109,378 721 401,622 706,352 568,586 148 Bhutan 60,530 21 60,434 75 76,685 27 2,303,734 2,918,579 789,334 149 Syria 56,453 3,150 52,861 442 3,070 171 146,269 7,955 18,387,666 150 Gabon 48,511 306 47,693 512 20,773 131 1,609,218 689,081 2,335,309 151 Burundi 46,275 38 N/A N/A N/A 3,664 3 345,742 27,375 12,629,687 152 Andorra 45,793 154 45,401 238 14 590,702 1,987 249,838 3,222,760 77,523 153 Seychelles 45,540 168 45,230 142 457,151 1,686 99,617 154 Curaçao 45,127 282 44,720 125 3 272,682 1,704 496,693 3,001,293 165,493 155 Papua New Guinea 44,798 663 43,982 153 7 4,817 71 249,149 26,788 9,300,634 156 Aruba 42,217 226 41,663 328 2 391,943 2,098 177,885 1,651,487 107,712 157 Mauritius 39,535 1,013 37,576 946 30,979 794 358,675 281,056 1,276,170 158 Mayotte 39,344 187 N/A N/A N/A 137,303 653 176,919 617,413 286,549 159 Togo 38,145 280 37,674 191 4,393 32 771,532 88,850 8,683,553 160 Tanzania 37,865 841 N/A N/A N/A 7 598 13 63,284,174 161 Isle of Man 37,794 114 26,794 10,886 439,608 1,326 150,753 1,753,513 85,972 162 Guinea 37,408 445 36,419 544 8 2,696 32 660,107 47,572 13,876,030 163 Bahamas 36,776 822 35,425 529 91,692 2,049 241,422 601,925 401,083 164 Faeroe Islands 34,658 28 N/A N/A N/A 5 703,716 569 778,000 15,796,954 49,250 165 Lesotho 34,040 702 24,155 9,183 15,631 322 431,221 198,019 2,177,677 166 Haiti 32,464 838 30,070 1,556 2,776 72 132,422 11,325 11,692,538 167 Mali 31,232 739 30,404 89 1,455 34 721,594 33,613 21,467,827 168 Cayman Islands 29,419 29 8,553 20,837 1 436,924 431 222,773 3,308,575 67,332 169 Saint Lucia 28,062 386 27,456 220 151,377 2,082 209,716 1,131,289 185,378 170 Benin 27,316 163 25,506 1,647 5 2,136 13 604,310 47,264 12,785,725 171 Somalia 27,020 1,350 13,182 12,488 1,607 80 400,466 23,811 16,818,368 172 Congo 24,775 386 20,178 4,211 4,270 67 347,815 59,953 5,801,470 173 Timor-Leste 22,980 133 22,836 11 16,763 97 271,855 198,313 1,370,838 174 Solomon Islands 21,544 153 16,357 5,034 1 29,838 212 5,117 7,087 722,028 175 Burkina Faso 21,128 387 20,439 302 956 18 248,995 11,267 22,099,191 176 Gibraltar 19,999 106 16,579 3,314 593,971 3,148 534,283 15,868,221 33,670 177 San Marino 19,983 118 19,617 248 4 586,356 3,462 157,634 4,625,411 34,080 178 Grenada 18,822 234 18,514 74 4 165,671 2,060 174,451 1,535,512 113,611 179 Liechtenstein 18,776 86 18,533 157 1 489,519 2,242 102,174 2,663,834 38,356 180 Nicaragua 18,491 225 4,225 14,041 2,724 33 6,788,992 181 Tajikistan 17,786 125 17,264 397 1,781 13 9,984,604 182 South Sudan 17,780 138 15,630 2,012 1 1,550 12 410,280 35,778 11,467,530 183 Bermuda 17,356 148 17,012 196 280,851 2,395 971,291 15,717,191 61,798 184 Equatorial Guinea 16,741 183 16,459 99 5 11,167 122 358,620 239,214 1,499,158 185 Djibouti 15,690 189 15,427 74 15,413 186 305,941 300,538 1,017,977 186 Samoa 15,405 29 1,605 13,771 4 76,579 144 177,396 881,848 201,164 187 Dominica 14,852 68 14,554 230 205,254 940 210,195 2,904,891 72,359 188 CAR 14,772 113 6,859 7,800 2 2,951 23 81,294 16,243 5,004,971 189 Monaco 14,104 57 13,913 134 4 354,176 1,431 77,770 1,952,941 39,822 190 Tonga 12,554 12 12,423 119 116,032 111 535,009 4,944,905 108,194 191 Gambia 12,149 368 11,591 190 4,749 144 155,686 60,855 2,558,324 192 Greenland 11,971 21 2,761 9,189 4 210,110 369 164,926 2,894,708 56,975 193 Yemen 11,895 2,152 9,117 626 23 381 69 265,253 8,503 31,196,528 194 Vanuatu 11,723 14 11,672 37 36,393 43 24,976 77,536 322,120 195 Saint Martin 11,667 63 1,399 10,205 7 291,369 1,573 112,382 2,806,603 40,042 196 Caribbean Netherlands 10,888 35 10,476 377 407,302 1,309 30,126 1,126,964 26,732 197 Sint Maarten 10,765 87 10,658 20 10 245,261 1,982 62,056 1,413,834 43,892 198 Eritrea 10,095 103 9,870 122 2,767 28 23,693 6,493 3,648,828 199 Niger 9,115 311 8,628 176 1 350 12 254,538 9,777 26,034,987 200 Antigua and Barbuda 8,773 144 8,597 32 1 88,064 1,445 18,901 189,729 99,621 201 Guinea-Bissau 8,440 174 8,151 115 6 4,087 84 145,231 70,328 2,065,048 202 Comoros 8,329 160 7,933 236 9,170 176 908,250 203 Sierra Leone 7,736 125 N/A N/A N/A 930 15 259,958 31,262 8,315,441 204 Liberia 7,538 294 5,747 1,497 2 1,421 55 139,824 26,354 5,305,704 205 Chad 7,437 193 4,874 2,370 427 11 191,341 10,991 17,409,288 206 British Virgin Islands 7,131 63 N/A N/A N/A 1 232,651 2,055 105,790 3,451,437 30,651 207 St. Vincent Grenadines 7,098 115 6,641 342 63,559 1,030 100,720 901,903 111,675 208 Micronesia 6,507 +216 12 +1 59 +7 6,436 8 55,361 102 21,923 186,518 117,538 209 Saint Kitts and Nevis 6,470 46 6,396 28 119,850 852 108,021 2,000,982 53,984 210 Turks and Caicos 6,328 36 6,263 29 4 158,955 904 549,243 13,796,609 39,810 211 Cook Islands 6,122 1 6,038 83 347,880 57 19,690 1,118,877 17,598 212 Sao Tome and Principe 6,115 75 6,023 17 26,861 329 29,036 127,547 227,650 213 Palau 5,308 6 5,221 81 1 290,467 328 63,229 3,460,053 18,274 214 St. Barth 5,138 6 N/A N/A N/A 516,901 604 78,646 7,912,072 9,940 215 Nauru 4,603 1 4,600 2 419,752 91 17,889 1,631,315 10,966 216 Anguilla 3,620 10 3,595 15 4 236,880 654 51,382 3,362,256 15,282 217 Kiribati 3,430 13 2,703 714 3 27,824 105 123,273 218 Saint Pierre Miquelon 3,112 1 2,449 662 1 542,633 174 24,848 4,332,694 5,735 219 Falkland Islands 1,835 N/A N/A N/A 497,155 8,632 2,338,662 3,691 220 Montserrat 1,068 8 1,032 28 213,685 1,601 15,134 3,028,011 4,998 221 Macao 791 6 777 8 1,184 9 7,850 11,755 667,803 222 Wallis and Futuna 761 7 438 316 70,274 646 20,508 1,893,804 10,829 223 Diamond Princess 712 13 699 0 224 Marshall Islands 68 58 10 1,133 60,023 225 Niue 56 30 26 33,960 1,649 226 Vatican City 29 29 0 36,025 805 227 Western Sahara 10 1 9 0 16 2 627,981 228 MS Zaandam 9 2 7 0 229 Tuvalu 8 8 661 12,096 230 Saint Helena 2 2 0 327 6,115 Total: 587,015,153 +485,929 6,431,196 +616 557,093,018 +474,817 23,490,939 43,869 75,308.6 825.1 – Advertisement