Coronavirus: How UK death toll compares with rest of world
Britain has the fourth deadliest major coronavirus outbreak in the world and has now suffered more deaths per million people than France, according to statistics.
As the UK this week began including people who died in care homes in its official statistics, its death rate rose above that of France, which had already done so.
The Department of Health now says 27,510 people have been officially confirmed as victims of the COVID-19 outbreak, a rate of approximately 394 per million people in a population of around 67million.
In France, where 24,376 people had died by yesterday, the rate is 373 per million, according to a project led by University of Oxford researchers.
Spain remains the worst-hit large country in the world, with a death rate of 525 coronavirus victims per million population, while Belgium – which has a population of just 11million, has experienced a surge in deaths recently and its rate has hit 655.
Scientists say that accurately comparing countries is difficult and unreliable because each government records death and disease differently, making like-for-like comparisons impossible.
But looking at even raw numbers shows the UK is doing worse than its neighbours, experts say, and can give a broad view of what is happening globally.
The UK now appears to have the fourth highest number of deaths per million out of any country with a large coronavirus outbreak
The true death rate of the coronavirus – the percentage of patients infected who die – is still unknown but is believed to be somewhere between 0.1 and 1 per cent.
How many people die of the virus per million people in the population cannot reveal the fatality rate of the disease unless the entire population is infected.
Professor David Leon, an epidemiologist at the London School of Hygiene & Tropical Medicine, said the data could only amount to ‘simplistic comparisons’.
Differences in how countries record data – and not knowing exactly what those differences are – make the numbers unreliable, Professor Leon said.
Understanding the failings in UK’s gathering of data – only recently including people from care homes or those who die at home, and only counting people who have officially tested positive – gives an insight into why other countries’ data may be unreliable.
The Government’s statistics show that the UK has one of the highest numbers of COVID-19 deaths in the world, but not all record equally
WHY HAS BELGIUM’S DEATH RATE SOARED?
According to the Our World in Data project, Belgium now has the highest number of COVID-19 deaths per person, at a rate of 655 per million.
As of May 1, the country had recorded 7,703 deaths from the coronavirus in its population of approximately 11million.
The country’s officials say the reason its death rate is so high is because it is so good at recording them, Bloomberg reported.
Almost half (43 per cent) of the country’s intensive care beds were still available at the peak of the outbreak.
Officials in Brussels are counting care home deaths based on the patient’s symptoms and how likely they are to have had COVID-19, rather than only including those officially tested, as the UK does.
Other nations, meanwhile, are having to go back over their data and edit it to add in cases that weren’t accurately counted at the time they happened.
This was illustrated by the UK’s death count surging by almost 4,000 on Wednesday this week when it announced non-hospital deaths for the first time.
Statistics across Europe are suggesting that as many as half of a country’s total coronavirus deaths will happen in care homes, meaning countries not recording these accurately may be missing off thousands of unrecorded fatalities.
‘When you have a good surveillance system, you report a lot of cases,’ said Steven Van Gucht, head of the viral disease division in the country’s public health institute. ‘It’s the countries that are not reporting or that are reporting very low numbers, you should be more worried about.’
Statistics suggest the true death toll in the UK is already in excess of 40,000 – 50 per cent higher than it appears to be.
But more detailed statistics may take weeks or months more to become available.
Raw rolling data, in the meantime, may go some way to show how badly a country has been affected and how well authorities there have coped with it.
Germany, for example, has been praised as having one of the best responses to the outbreak of anywhere in the world and as a result relatively few people have died.
More than 163,000 people testing positive for the virus while 6,623 of those have died. That figure represents approximately 75 deaths per million people in its population of 83million.
The country has been credited for quickly starting a massive testing regime which, for the past month, has carried out an average 400,000 tests per week.
This has enabled the country to better track and suppress outbreaks of the disease, and on March 6 it became one of the first nations in Europe to start telling people to self-isolate if they became ill.
China also has a remarkably low death rate per million, although there are concerns about the validity of its data. Official figures show 4,633 people died there – 3.2 per million people in its population, which is 90 per cent lower than the global average.
The country had gone into a drastic lockdown in which people were required to stay at home by martial law and all transport was stopped and roads blocked.
Data cannot show for sure that countries hit harder by the virus, however, were worse affected because they didn’t respond as well to outbreaks.
The University of Bath’s Dr Kit Yates, a senior lecturer of mathematical biology and the author of The Maths of Life and Death, told MailOnline: ‘There’s nothing that you can conclusively draw [from data like this] because countries are testing in different ways and it’s comparing apples with oranges.
He added: ‘You can look at it for a broad view but the whole picture isn’t going to be clear for a long time afterwards.
‘You can say that Germany is doing well. Clearly Germany’s got far fewer cases and deaths than the UK, which is in part attributable to testing rigorously.
‘But it’s really difficult to say whether the UK is doing better or worse than Spain because Spain’s not reporting deaths in the community. Both countries have both under-reporting and over-reporting.’
Dr Yates said that raw data was enough to see generally which countries had suffered the most and the least in the pandemic.
Italy, for example, is known to have had a particularly high death rate because it was caught off-guard by a devastating outbreak in the north of the country.
The country, where almost 28,000 people have died, had scaled back protective measures after banning all flights into the country from China.
But a cluster of cases in the Alps in the north of the country, near Milan, spread fast and hit a population with a high average age and where many people lived in rural areas without fast access to big city hospitals.
WHY IS GERMANY’S DEATH RATE SO LOW?
Germany has appeared to escape the global pandemic lightly in comparison to its neighbouring countries.
These are some of the reasons why Germany’s death toll is lower than that of nearby countries:
This has been put down to Germany’s decision to implement widespread testing of people suspected as having the coronavirus.
Some 400,000 people are being tested per week, according to the Robert Koch Institute, its centre for disease control.
Germany is able to acquire tests from domestic manufacturers while Britain is having to import them.
Germany is home to a strong network of biotech and pharmaceutical companies, including Landt, which has made and helped distribute four million COVID-19 tests, Bloomberg reported.
It’s believed Germany will also lead the way with the highly sought-after antibody testing, which can see if a person has already had the virus and built immunity.
Such checks could potentially allow people to be issued with certificates saying they are safe to go back to work, allowing the economy to get started again.
Private labs nationwide have been free to offer tests. But in the UK, Public Health England have been reluctant to expand testing facilities outside its own 12 centralised labs.
Germany had already established testing by mid-February, epidemiology professor Nathan Grubaugh, at Yale School of Public Health, told Business Insider.
As of April 2, private labs in Germany had already helped the country test one million people for COVID-19.
The age of infected people
The average age of its patients is lower than in countries like Italy, which has a particularly old population, meaning they are less likely to die.
The majority – 80 per cent – of all people infected in Germany are younger than 60, official figures from Robert Koch Institute show.
There is speculation the first cluster of cases stemmed from ‘super spreaders’ who returned from skiing trips in Austria and Italy, who may have been fitter and younger.
The robust healthcare system
Hospitals in Germany have been better prepared, Wired reports.
The country had the most intensive care beds per person than any country in Europe.
A study in 2011 found it had 29.2 intensive care beds per 100,000 people – considerably more than the 12.5 per 100,000 in Italy, 9.7 in Spain or just 6.6 in the UK.
Officials say Germany’s hospitals were already in shape to cope with an epidemic, with enough intensive care beds and ventilators. Meanwhile, Italy’s hospitals have been overwhelmed and there are fears the UK’s health system will buckle under the pressure.
How the country reports deaths
Dr Gatherer said that every country reports its deaths differently, which may be behind the varying mortality rates.
‘It’s really difficult to know why different countries in Europe have different death totals,’ he said. ‘It may be something to do with the way that deaths are recorded, for instance a distinction might possibly be made between deaths with COVID-19 and deaths from COVID-19.’
Both Dr Yates and Professor Leon both said that study of excess deaths, when the data becomes available, will be the most accurate way of measuring deaths.
Speaking about the deaths per million measure, Professor Leon said: ‘This data is of limited usefulness – the most comparable way of looking at how different countries have been affected is to look at mortality from all causes of death during the pandemic and compare it to what we would expect to see had the pandemic not occurred.’
But he, too, agreed that the raw data was enough to see that the UK had been hit hard.
He said: ‘None of this detracts from the fact that the indications are, even from the crudest data, that the UK is really not doing particularly well.
‘But exactly where it will end up compared to Italy, we don’t know. It’s certainly not doing as well as Norway, Czech Republic or Australia.
‘I think the timings and the extent of the excess deaths will begin to tell us something about the adequacy of the Government response. It won’t be definitive but it will give us an indication.’
University of Cambridge professor, Sir David Spiegelhalter, wrote in The Guardian yesterday that comparing death rates at face value was ‘deeply unreliable’.
He said that second hand impacts, such as people dying because access to medical care was restricted, could mean the impact of the virus spread wider than a single number.
‘If it’s difficult to rank this country, it’s even trickier to give reasons for our position,’ he wrote. ‘COVID-19 mainly harms the elderly, with the average age of deaths above 80, and its fatality rate doubles every seven years as a person ages.
‘Italy’s population is elderly (it has a median age of 47), while Ireland’s is much younger (a median age of 37), so we would expect different effects. And Covid-19 is a disease of crowded areas – New York is rather different from Reykjavik.’
The death rate per million people in Italy is 463, according to the Our World in Data comparison, putting it below Spain’s 525.
The two are thought to be the countries hit worst by the virus and are the only ones, in addition to Belgium, to have recorded more deaths per person than the UK.
Difficulty in comparing death numbers across countries arises from the ways governments record them.
For example, France includes people who die outside of hospitals as well as inpatients, something Britain only started to do this week.
In other countries such as Spain and Italy, it is less clear at what point they have been including non-hospital deaths, and how they record them.
A World Health Organization report found that between 42 per cent and 57 per cent of COVID-19 deaths happening in major European were happening in care homes, The Guardian reported.
But how accurately these have been recorded isn’t clear, Professor Leon said.
‘We believe people who were of a certain level of sickness would have got to hospitals [and died in hospital] even if they were from care homes,’ he added, suggesting that some patients might get counted twice.
The death rate per million for countries around the world has been calculated by the Our World in Data project, which is run by researchers at the University of Oxford and the Global Change Data Lab, a registered charity.
The project puts the world average of deaths per million people at 29.84 for May 1. Global statistics show around 234,000 people worldwide have now died in the pandemic.