Gov. Andrew Cuomo and Dr. Anthony Fauci are the most trusted leaders in America on the coronavirus right now

Gov. Andrew Cuomo and Dr. Anthony Fauci are the most trusted leaders in America on the coronavirus right now. Trump is not!

In an article by Grace Panetta (Mar 26, 2020, 12:12 PM) in Business Insider it seems that Americans trust Gov. Andrew Cuomo and Dr. Anthony Fauci when it comes to the so-called CoronaVirus (COVID-19).

• Americans trust Dr. Anthony Fauci, the nation's top infectious-disease expert, and New York Gov. Andrew Cuomo the most when it comes to official guidance on the COVID-19 outbreak, a new Insider poll showed.

• We asked respondents: "When it comes to the official advice regarding coronavirus, please rate how much you trust the following messengers on a scale on 1 to 5."

• Fauci and Cuomo received the highest marks, and President Donald Trump and Treasury Secretary Steve Mnuchin got the lowest average scores. 

Americans trust Dr. Anthony Fauci, the nation's top infectious-disease expert, and New York Gov. Andrew Cuomo the most for official information and guidance on the COVID-19 outbreak, a new Insider poll showed. 

Insider asked poll respondents to rate 10 top Trump administration officials and governors on trustworthiness. 

We asked respondents: "When it comes to the official advice regarding coronavirus, please rate how much you trust the following messengers on a scale on 1 to 5."

According to our poll, 1 means strongly distrust, 2 means somewhat distrust, 3 means neither trust nor distrust, 4 means somewhat trust, and 5 means strongly trust. Participants were asked to mark "NA" if they were unfamiliar with the person. 

Fauci and Cuomo received the highest marks, and President Donald Trump and Treasury Secretary Steve Mnuchin got the lowest:

• Respondents gave Fauci an average score of 3.84 out of 5 for trustworthiness. He received a top score of 5 from 40% of respondents, which is nearly double what the next highest-rated person got, and 86% gave him a 3 or higher, which is vastly higher than anyone else. 
• Cuomo received an average score of 3.29 out of 5. Three-quarters of respondents gave Cuomo a score of 3 or higher, and 22% gave him 5 out of 5.
• Global-health Ambassador Deborah Birx, the response coordinator of the coronavirus task force, got a score of 3.14 out of 5. About three in four respondents gave Birx a score of three or higher. 
• California Gov. Gavin Newsom got an average score of 2.97 out of 5. Just shy of 70% of people gave Newsom a score of 3 or higher. 
• Former Vice President Joe Biden, the front runner for the 2020 Democratic nomination, got an average score of 2.76 out of 5. About 31% of respondents rated Biden a 4 or 5, 27% a gave him a 3 of 5, and 42% answered with a 1 or 2. 
• Vice President Mike Pence was rated a 2.65 out of 5 on average for trustworthiness. About one-third of respondents rated him a 1.
• Secretary of Health and Human Services Alex Azar was rated 2.62 out of 5. 
• President Donald Trump scored 2.56 out of 5 on average. Forty-four percent of respondents rated Trump a 1 out of 5, compared with 20% who rated him a 5 out of 5. The largest group of people — 55% — rated Trump as a 1 or 2.
• Treasury Secretary Steve Mnuchin got the lowest score out of the 10 officials, with a rating of 2.52 out of 5 on average. 

Fauci, a prominent figure in public health and the director of the National Institute of Allergies and Infectious Diseases, has served under six presidents, starting 1984, in various capacities and was one of the leading doctors on the front lines of the AIDS crisis.

Fauci has consistently been one of the most public-facing and trusted voices on the coronavirus crisis — often appearing at odds with the White House's more optimistic messaging in the process.

But Fauci's blunt explanation of the strict scientific facts, calm but no-nonsense demeanor, and subtle sense of humor both in White House briefings and in congressional hearings have garnered him rave reviews from the public and made him a household name.


And while Cuomo was previously considered a somewhat divisive figure in New York politics and known for his incessant feuding with New York City Mayor Bill de Blasio, respondents felt he's risen to the occasion during the pandemic.

As the governor of one of the hardest-hit states, Cuomo has been praised for massively expanding New York's testing capacity, aggressively combating the virus with business closures and social distancing, and his daily PowerPoint pep talks to New Yorkers in his press conferences.

In Cuomo's daily coronavirus press briefing on Thursday, Cuomo said that he speaks frequently to Fauci about the crisis facing New York, describing him as "brilliant" and "kind."


"Dr. Fauci has been so kind and helpful to me," Cuomo said. "Dr. Fauci is brilliant at this and he is so personally kind. I call him late at night, I call him in the middle of the night, he's really been a friend to me personally and the state of New York." 

SurveyMonkey Audience polls from a national sample balanced by census data of age and gender. Respondents are incentivized to complete surveys through charitable contributions. Generally speaking, digital polling tends to skew toward people with access to the internet. SurveyMonkey Audience doesn't try to weigh its sample based on race or income. A total of 1,136 respondents were collected on March 25 with a margin of error plus or minus 3 percentage points and a 95% confidence level.

Improving Your Health By Using Your Mind

By Dane Calloway

12 Science-Backed Ways To Improve Your Health By Changing Your MindBy David DiSalvo

Action starts with a thought. Not necessarily much thought, it might only last a few seconds, but typically how we think sets the stage for what comes next. When it comes to improving health, challenging our mindset can result in significant benefits if we can commit to the challenge of following through. Here are 12 changes in mindset that science suggests can lead to physical health benefits when action follows.

1. Change your “vacation can wait” mindset.

Many of us go months, sometimes years, saying “we need a vacation” without taking one. This is a mindset issue, since with few exceptions the workplace will do just fine without us for a couple of weeks. Recent research underscores the importance of using our personal days by showing that taking vacations may lower risk of developing metabolic syndrome, a condition strongly linked to type 2 diabetes, heart disease and stroke.

2. Shift your breathing focus.

Focusing more closely on our breathing comes with a list of science-backed health benefits, including lower heart rate and blood pressure, reduced stress response, and even a boosted immune system, according to some research. This change is all about mindset, because it’s about shifting mental focus onto something we’re already doing, and choosing a simple technique to do it more effectively (like “box breathing” for example).

3. Think about getting outside.


Mounting evidence suggests that spending time outside is good for our physical health and mental well being. And it doesn’t even take a lot of time to get the benefits, according to the latest research, just a couple of hours a week. The mindset challenge here is to blend outside time into your day in such a way that it’s not really a separate thing, the way going to the gym requires its own separate block of time. One method to get there is to tie outside time with the next item.

4. Rethink your schedule to work in walking.


Walking has several well-substantiated health benefits that are available to most of us if only we’d do more of it, including improved cardiovascular and brain health. A straightforward mindset change to get us there is rethinking how we schedule time throughout the day to work in walking breaks. That can be as simple as putting reminders in your scheduling software to “get up and walk.”

5. Get strategic about socializing.

Over the last few decades we’ve gained solid scientific understanding of the importance of social interdependence. Doses of socializing have been linked to better stress management, which is in turn linked to benefits touching cardiovascular health, cognitive health (particularly in older adults), and lower rates of anxiety and depression. The mindset challenge here is to think more strategically about working social time into the day. Sitting in an office with the door closed for hours on end, even if it feels ultra-productive, deprives us of a great resource. Pair this one with walking (above) and it’s a two-fer.

6. Adjust your attention reactions.

In the “attention economy” our time and attention are commodities with a price tag. That’s simply a reality at this point and there’s little use in complaining. We can, however, reconsider how we allocate our attention, and that can lead to longer-term health benefits. Most especially, managing our reactions (to our smartphones most of all) may help manage unhealthy levels of stress hormones like cortisol and adrenaline that can take a toll over time. The takeaway is simply that we can decide to manage our reactions. It’s a difficult mindset adjustment in light of the forces vying for our attention, but it’s still in our court.

7. Decide to work less.

A new study just found a link between working fewer hours and lower risk of stroke (the study was observational, not clinical, but the correlation was significant). Previous studies have found similar links and they all point to the same genre of health takeaways. This is a mindset challenge because often we spend more time in the office without really thinking about it, and we have to force the issue into mental decision space to make a change. Not all jobs allow for making this change, but if we can, the science suggests we probably should.

8. Reconsider doing lunch.

Going out for lunch is convenient, delicious, and gets you out of the office – but it comes with loss of control over what you eat. The mindset change here is to rethink the default mindset of doing the easiest thing. Then invest some thinking into making healthier meals for lunch that put the control back in your hands. The difference could be significant in just about every nutrient category. As an example, consider your control over which cooking oils you use and how much sodium is in your food – two things that are notoriously hard to track when eating out.  Pair this one with getting outside during lunch and it's another double tap.

9. Focus on purpose. 

Allowing a sense of purpose to guide us is a direct challenge of mindset, and plenty of research points to health benefits of taking it on. Most recently, research linked having a sense of purpose to lower levels of inflammation, which is in turn linked to decreased risk of cardiovascular disease and a variety of other conditions and disorders, from diabetes to depression.

10. Beware restraint bias.

Restraint bias is the mental miscue that occurs when we think we’ve reached a certain level of success and can therefore take pressure off the mental brakes and expose ourselves to more temptation. It’s the decrease in vigilance everyone who has ever dieted felt just before the yo-yo starts yo’ing. Apart from offering good reasons to rethink dieting (another topic), the mindset change here is to boost awareness that restraint bias is always lurking, and will undermine health benefits from whatever diet or exercise program you’re trying if you don’t see it coming and act to avoid it.

11. Think laughter.

It’s true, laughter is terrific medicine with health benefits, as plenty of research attests, but it’s not always easy to come by.  The mindset challenge here is to rethink the sometimes stifling seriousness of a stressful, responsibility-filled life and intentionally find ways of laughing more. One strategy is to really attend to those times when you need to laugh and expose yourself to something funny (a go-to movie or TV show, etc.) instead of doing something unhealthy, like grabbing comfort food or alcohol. Consider it a humor prescription.

12. Let your mind let things go.


Finally, one big mindset change that serves to decrease the cumulative stress response is to develop the discipline of letting things go. The unmanaged stress response is sort of like biochemical baggage that keeps weighing us down more and more with time, and eventually the weight compromises other parts of our health. Dwelling, ruminating, holding onto those things that can’t be changed is a major trigger for an exacerbated stress response, and it’s a vicious cycle that keeps refueling itself. That earwormy song has it right– Let it go.

Confirmed cases of coronavirus disease (COVID-19) Updated 3/23/2020

Cuomo Orders All Hospitals To Add Beds As New York Confirms 20,000 Coronavirus Cases

New York Gov. Andrew Cuomo says that in his state — the U.S. epicenter for the coronavirus — the wave of new cases is still going up. Here, commuters wearing masks pass through New York City's Penn Station on Monday.

Global coronavirus cases cross 350,000, death toll passes 15,000 as pandemic takes hold

PUBLISHED MON, MAR 23 20208:46 AM EDT UPDATED 2 HOURS AGO
William Feuer@WILLFOIA

KEY POINTS

• COVID-19 has now infected more than 350,536 people, according to Johns Hopkins University, and killed at least 15,328 people.
• Global cases have more than doubled in the past week, according to the World Health Organization, and worldwide deaths have nearly tripled.
• Outside of China, where the virus emerged in December, Italy has the most confirmed cases with nearly 60,000.

WHO launches global megatrial of the four most promising coronavirus treatments

By Kai Kupferschmidt, Jon CohenMar. 22, 2020 , 3:28 PM

Could any of these drugs hold the key to saving coronavirus disease 2019 (COVID-19) patients from serious harm or death? On Friday, the World Health Organization (WHO) announced a large global trial, called SOLIDARITY, to find out whether any can treat infections with the new coronavirus for the dangerous respiratory disease. It’s an unprecedented effort—an all-out, coordinated push to collect robust scientific data rapidly during a pandemic. The study, which could include many thousands of patients in dozens of countries, has been designed to be as simple as possible so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate.

With about 15% of COVID-19 patients suffering from severe disease and hospitals being overwhelmed, treatments are desperately needed. So rather than coming up with compounds from scratch that may take years to develop and test, researchers and public health agencies are looking to repurpose drugs already approved for other diseases and known to be largely safe. They’re also looking at unapproved drugs that have performed well in animal studies with the other two deadly coronaviruses, which cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
Drugs that slow or kill the novel coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could save the lives of severely ill patients, but might also be given prophylactically to protect health care workers and others at high risk of infection. Treatments may also reduce the time patients spend in intensive care units, freeing critical hospital beds.

Scientists have suggested dozens of existing compounds for testing, but WHO is focusing on what it says are the four most promising therapies: an experimental antiviral compound called remdesivir; the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir; and that same combination plus interferon-beta, an immune system messenger that can help cripple viruses. Some data on their use in COVID-19 patients have already emerged—the HIV combo failed in a small study in China—but WHO believes a large trial with a greater variety of patients is warranted.

Enrolling subjects in SOLIDARITY will be easy. When a person with a confirmed case of COVID-19 is deemed eligible, the physician can enter the patient’s data into a WHO website, including any underlying condition that could change the course of the disease, such as diabetes or HIV infection. The participant has to sign an informed consent form that is scanned and sent to WHO electronically. After the physician states which drugs are available at his or her hospital, the website will randomize the patient to one of the drugs available or to the local standard care for COVID-19.

“After that, no more measurements or documentation are required,” says Ana Maria Henao-Restrepo, a medical officer at WHO’s Department of Immunization Vaccines and Biologicals. Physicians will record the day the patient left the hospital or died, the duration of the hospital stay, and whether the patient required oxygen or ventilation, she says. “That’s all.”

The design is not double-blind, the gold standard in medical research, so there could be placebo effects from patients knowing they received a candidate drug. But WHO says it had to balance scientific rigor against speed. The idea for SOLIDARITY came up less than 2 weeks ago, Henao-Restrepo says, and the agency hopes to have supporting documentation and data management centers set up next week. “We are doing this in record time,” she says.

It will be important to get answers quickly, to try to find out what works and what doesn’t work. We think that randomized evidence is the best way to do that.

Ana Maria Henao-Restrepo, World Health Organization
Arthur Caplan, a bioethicist at New York University Langone Medical Center, says he likes the study’s design. “No one wants to tax the frontline caregiver who’s overwhelmed and taking risks anyway,” Caplan says. Hospitals that aren’t overburdened might be able to record more data on disease progression, for instance by following the level of virus in the body, Caplan suggests. But for public health, the simple outcomes WHO seeks to measure are the only relevant ones for now, says virologist Christian Drosten of the Charité University Hospital in Berlin: “We don’t really know enough about this disease to be sure what it means when the viral load decreases in the throat, for instance.”

On Sunday, INSERM, the French biomedical research agency, announced it will coordinate an add-on trial in Europe, named Discovery, that will follow WHO’s example and will include 3200 patients from at least seven countries, including 800 from France. That trial will test the same drugs, with the exception of chloroquine. Other countries or groups of hospitals could organize add-on studies as well, Heneo-Restrepo says. They are free to do additional measurements or observations, for instance on virology, blood gases, chemistry, and lung imaging. “While well-organized additional research studies of the natural history of the disease or of the effects of the trial treatments could well be valuable, they are not core requirements,” she says.

The list of drugs to test was first put together for WHO by a panel of scientists who have been assessing the evidence for candidate therapies since January, Heneo-Restrepo says. The group of selected drugs that had the highest likelihood of working, had the most safety data from previous use, and are likely to be available in supplies sufficient to treat substantial numbers of patients if the trial shows they work.

Here are the treatments that SOLIDARITY will test:

Remdesivir
The new coronavirus is giving this compound a second chance to shine. Originally developed by Gilead Sciences to combat Ebola and related viruses, remdesivir shuts down viral replication by inhibiting a key viral enzyme, the RNA-dependent RNA polymerase.

Researchers tested remdesivir last year during the Ebola outbreak in the Democratic Republic of the Congo, along with three other treatments. It did not show any effect. (Two others did.) But the enzyme it targets is similar in other viruses, and in 2017 researchers at the University of North Carolina, Chapel Hill, showed in test tube and animal studies that the drug can inhibit the coronaviruses that cause SARS and MERS.

The first COVID-19 patient diagnosed in the United States—a young man in Snohomish county in Washington—was given remdesivir when his condition worsened; he improved the next day, according to a case report in The New England Journal of Medicine (NEJM). A Californian patient who received remdesivir—and who doctors thought might not survive—recovered as well.

Such evidence from individual cases doesn’t prove a drug is safe and effective. Still, from the drugs in the SOLIDARITY trial, “remdesivir has the best potential to be used in clinics” says Jiang Shibo of Fudan University, who has long worked on coronavirus therapeutics. Jiang particularly likes that high doses of the drug can likely be given without causing toxicities.

However, it may be much more potent if given early in an infection, like most other drugs, says Stanley Perlman, a coronavirus researcher at the University of Iowa. “What you really want to do is give a drug like that to people who walk in with mild symptoms,” he says. “And you can’t do that because it’s an [intravenous] drug, it’s expensive and 85 out of 100 people don’t need it.”

Chloroquine and hydroxychloroquine
At a press conference on Friday, President Donald Trump called chloroquine and hydroxychloroquine a “game changer.” “I feel good about it,” Trump said. His remarks have led to a rush in demand for the decades-old antimalarials. (“It reminds me a little bit of the toilet paper phenomenon and everybody’s running to the store,” Caplan says.)

The WHO scientific panel designing SOLIDARITY had originally decided to leave the duo out of the trial, but had a change of heart at a meeting in Geneva on 13 March, because the drugs “received significant attention” in many countries, according to the report of a WHO working group that looked into the drugs’ potential. The widespread interested prompted “the need to examine emerging evidence to inform a decision on its potential role.”

The available data are thin. The drugs work by decreasing the acidity in endosomes, compartments inside cells that they use to ingest outside material and that some viruses can coopt to enter a cell. But the main entryway for SARS-CoV-2 is a different one, using its so-called spike protein to attach to a receptor on the surface of human cells. Studies in cell culture have suggested chloroquines have some activity against SARS-CoV-2, but the doses needed are usually high—and could cause serious toxicities.

Encouraging cell study results with chloroquines against two other viral diseases, dengue and chikungunya, didn’t pan out in people in randomized clinical trials. And nonhuman primates infected with chikungunya did worse when given chloroquine. “Researchers have tried this drug on virus after virus, and it never works out in humans. The dose needed is just too high,” says Susanne Herold, an expert on pulmonary infections at the University of Giessen.

Results from COVID-19 patients are murky. Chinese researchers who report treating more than 100 patients with chloroquine touted its benefits in a  letter in BioScience, but the data underlying the claim have not been published. All in all, more than 20 COVID-19 studies in China used chloroquine or hydroxychloroquine, WHO notes, but their results have been hard to come by. “WHO is engaging with Chinese colleagues at the mission in Geneva and have received assurances of improved collaboration; however, no data has been shared regarding the chloroquine studies.”

Researchers in France have published a study in which they treated 20 COVID-19 patients with hydroxychloroquine. They concluded that the drug significantly reduced viral load in nasal swabs. But it was not a randomized controlled trial and it didn’t report clinical outcomes such as deaths. In guidance published on Friday, the U.S. Society of Critical Care Medicine said “there is insufficient evidence to issue a recommendation on the use of chloroquine or hydroxychloroquine in critically ill adults with COVID-19.”

Hydroxychloroquine, in particular, might do more harm than good. The drug has a variety of side effects and can in rare cases harm the heart. Because people with heart conditions are at higher risk of severe COVID-19, that is a concern, says David Smith, an infectious disease physician at the University of California, San Diego. “This is a warning signal, but we still need to do the trial,” he says. What’s more, a rush to use the drug for COVID-19 might make it harder for the people who need it to treat their rheumatoid arthritis or malaria.

Ritonavir/lopinavir
This combination drug, sold under the brand name Kaletra, was approved in the United States in 2000 to treat HIV infections. Abbott Laboratories developed lopinavir specifically to inhibit the protease of HIV, an important enzyme that cleaves a long protein chain into peptides during the assembly of new viruses. Because lopinavir is quickly broken down in the human body by our own proteases, it is given with low levels of ritonavir, another protease inhibitor, that lets lopinavir persist longer.

The combination can inhibit the protease of other viruses as well, specifically coronaviruses. It has shown efficacy in marmosets infected with the MERS virus, and has also been tested in SARS and MERS patients, though results from those trials are ambiguous.

The first trial with COVD-19 was not encouraging, however. Doctors in Wuhan, China, gave 199 patients two pills of lopinavir/ritonavir twice a day plus standard care, or standard care alone. There was no significant difference between the groups, they reported in NEJM on 15 March. But the authors caution that patients were very ill—more than one-fifth of them died—and so the treatment may have been given too late to help. Although the drug is generally safe it may interact with drugs usually given to severely ill patients, and doctors have warned it could cause significant liver damage.

Ritonavir/lopinavir and interferon-beta
SOLIDARITY will also have an arm that combines the two antivirals with interferon-beta, a molecule involved in regulating inflammation in the body that has also shown an effect in marmosets infected with MERS. A combination of the three drugs is now being tested in MERS patients in Saudi Arabia in the first randomized controlled trial for that disease.

But the use of interferon-beta on patients with severe COVID-19 might be risky, Herold says. “If it is given late in the disease it could easily lead to worse tissue damage instead of helping patients,” she cautions.

Thousands of patients
The design of the SOLIDARITY trial can change at any time. A global data safety monitoring board will look at interim results at regular intervals and decide whether any member of the quartet has a clear effect, or whether one can be dropped because it clearly does not. Several other drugs, including the influenza drug favipiravir, produced by Japan’s Toyama Chemical, may be added to the trial.

To get robust results from the study, several thousands of patients will likely have to be recruited, Henao-Restrepo says. Argentina, Iran, South Africa, and several other non-European countries have already signed up. WHO is also hoping to do a prevention trial to test drugs that might protect health care workers from infection, using the same basic protocol, Henao-Restrepo says.

The trial’s European counterpart, Discovery, will recruit patients from France, Spain, the United Kingdom, Germany, and the Benelux countries, according to an INSERM press release today. The trial will be led Florence Ader, an infectious diseases researcher at the University Hospital Center in Lyon.

Doing rigorous clinical research during an outbreak is always a challenge, Henao-Restrepo says, but it’s the best way to make headway against the virus: “It will be important to get answers quickly, to try to find out what works and what doesn’t work. We think that randomized evidence is the best way to do that.”

Posted in: HealthCoronavirus
doi:10.1126/science.abb8497

Location	Confirmed cases	Cases per 1M people	Recovered	Deaths

Worldwide 372,147 52.81 101,069 16,310 China 81,093 60.53 72,703 3,270 Italy 63,928 1059.86 7,432 6,078 United States 42,161 135.31 187 508 Spain 33,089 708.04 3,355 2,206 Germany 28,914 347.74 453 118 Iran 23,049 277.09 8,376 1,812 France 19,856 296.26 2,200 860 South Korea 8,961 173.30 3,166 111 Switzerland 8,249 962.53 131 107 United Kingdom 6,650 98.45 140 335 Netherlands 4,768 273.63 — 214 Austria 3,924 440.77 — 21 Belgium 3,743 325.03 350 88 Norway 2,570 478.80 — 10 Portugal 2,060 200.46 14 23 Sweden 2,046 198.00 16 25 Canada 2,020 53.44 18 24 Australia 1,717 67.33 88 7 Brazil 1,629 8.10 2 25 Denmark 1,572 280.58 — 24 Malaysia 1,518 46.32 159 14 Israel 1,238 136.04 37 1 Czechia 1,236 116.06 6 1 Turkey 1,236 15.07 0 30 Japan 1,101 8.61 235 41 Ecuador 981 59.87 3 18 Ireland 906 184.09 5 4 Luxembourg 875 1425.33 6 8 Pakistan 875 4.88 6 6 Chile 746 42.45 11 1 Thailand 721 10.47 52 1 Finland 700 126.78 10 1 Greece 695 64.54 19 17 Poland 692 18.03 1 8 Iceland 588 1614.23 51 1 Indonesia 579 2.35 30 49 Romania 576 29.69 73 6 Saudi Arabia 511 14.93 18 0 Singapore 509 90.27 152 2 Qatar 501 189.65 37 0 India 468 0.36 34 9 Philippines 462 4.87 18 33 Slovenia 442 211.07 — 3 Russia 438 3.04 17 0 South Africa 402 6.84 2 0 Bahrain 377 264.53 164 2 Peru 363 11.06 1 5 Hong Kong 356 50.34 101 4 Estonia 352 264.99 4 0 Egypt 327 3.57 56 14 Mexico 316 2.61 4 2 Croatia 315 77.28 5 0 Panama 313 77.59 1 3 Lebanon 267 44.45 8 4 Argentina 266 5.92 27 4 Iraq 266 7.15 62 23 Serbia 249 34.29 2 3 Dominican Republic 245 22.82 0 3 Colombia 235 4.87 3 2 Algeria 201 4.67 65 17 United Arab Emirates 198 20.63 41 2 Taiwan 195 8.20 29 2 Armenia 194 66.33 2 0 Bulgaria 190 27.14 3 3 Kuwait 189 40.89 30 0 Slovakia 185 33.94 7 0 Latvia 180 93.75 1 0 San Marino 175 5248.32 4 20 Hungary 167 17.09 21 8 Lithuania 154 55.11 1 1 North Macedonia 136 65.47 1 2 Uruguay 135 39.20 0 0 Costa Rica 134 27.59 2 2 Morocco 134 3.77 3 4 Bosnia and Herzegovina 128 36.45 2 1 Vietnam 122 1.35 17 0 Andorra 112 1470.26 1 1 Jordan 112 10.76 1 0 Malta 107 216.79 2 0 Albania 104 36.15 3 4 New Zealand 102 20.48 0 0 Burkina Faso 99 4.92 5 4 Cyprus 95 81.19 3 1 Moldova 94 35.05 2 1 Brunei 91 205.70 2 0 Sri Lanka 91 4.20 3 0 Tunisia 89 7.59 1 3 Cambodia 86 5.63 2 0 Belarus 81 8.53 22 0 Venezuela 77 2.63 15 0 Ukraine 73 1.74 1 3 Azerbaijan 72 7.18 10 1 Senegal 67 4.35 5 0 Oman 66 14.92 17 0 Kazakhstan 62 3.36 0 0 Georgia 61 16.38 8 0 Palestine 59 11.68 17 0 Cameroon 56 2.39 2 0 Trinidad and Tobago 50 36.66 0 0 Liechtenstein 46 1193.04 0 0 Uzbekistan 46 1.36 0 0 Afghanistan 40 1.24 1 1 Democratic Republic of the Congo 36 0.53 0 2 Nigeria 36 0.21 2 1 Cuba 35 3.12 0 1 Bangladesh 33 0.20 3 3 Kosovo 31 17.12 0 0 Bolivia 27 2.36 0 0 Honduras 27 2.96 0 0 Côte d'Ivoire 25 1.05 1 0 Ghana 24 0.77 0 1 Macao 24 43.19 10 0 Mauritius 24 18.96 0 2 Monaco 23 600.52 1 0 Montenegro 22 34.85 0 1 Paraguay 22 3.08 0 1 Guernsey 20 305.00 0 0 Guatemala 19 1.10 0 1 Jamaica 19 6.57 2 1 Rwanda 19 1.69 0 0 Togo 18 2.26 0 0 Barbados 17 62.06 0 0 Jersey 16 163.50 0 0 Kenya 16 0.34 0 0 Kyrgyzstan 14 2.19 0 0 Maldives 13 33.12 3 0 Madagascar 12 0.48 0 0 Tanzania 12 0.22 0 0 Ethiopia 11 0.13 0 0 Mongolia 10 3.05 0 0 Equatorial Guinea 9 7.37 0 0 Seychelles 7 74.29 0 0 Gabon 5 2.53 0 1 Guyana 5 6.36 0 1 Isle of Man 5 60.00 0 0 Suriname 5 8.95 0 0 Eswatini 4 3.52 0 0 Guinea 4 0.32 1 0 The Bahamas 4 10.22 0 0 Cape Verde 3 5.56 0 0 Central African Republic 3 0.65 0 0 El Salvador 3 0.47 0 0 Fiji 3 3.24 0 0 Liberia 3 0.62 0 0 Namibia 3 1.15 0 0 Republic of the Congo 3 0.59 0 0 U.S. Virgin Islands 3 — 0 0 Zambia 3 0.18 0 0 Zimbabwe 3 0.19 0 1 Angola 2 0.04 0 0 Benin 2 0.18 0 0 Bhutan 2 2.70 0 0 Haiti 2 0.18 0 0 Mauritania 2 0.47 0 0 Nepal 2 0.07 1 0 Nicaragua 2 0.32 0 0 Niger 2 0.10 0 0 Saint Lucia 2 11.24 0 0 Sudan 2 0.05 0 1 The Gambia 2 0.97 0 1 Antigua and Barbuda 1 9.90 0 0 Belize 1 — 0 0 Chad 1 0.07 0 0 Djibouti 1 1.13 0 0 Dominica 1 — 0 0 Eritrea 1 0.17 0 0 Grenada 1 — 0 0 Mozambique 1 — 0 0 Papua New Guinea 1 0.12 0 0 Saint Vincent and the Grenadines 1 9.12 0 0 Somalia 1 0.09 0 0 Syria 1 — 0 0 Timor-Leste 1 — 0 0 Uganda 1 0.02 0 0 Vatican City 1 — 0 0 American Samoa 0 — 0 0 Northern Mariana Islands 0 — 0 0