Coronavirus : Update 23 from the Epicenter

Posted by in Coronavirus

The true numbers of Covid-19 deaths is continually questioned from both sides of the lockdown debate, with claims of rampant under and over reporting.

Those who see governments’ reactions to the pandemic as exaggerated tend to claim that anyone dying with Covid-like symptoms is logged as a victim of the virus even in the absence of a positive test result and despite the severity of co-morbidities. They often go further and claim that hospitals are incentivized to keep Covid numbers high, due to the increased compensation they receive for coronavirus cases.

These stories appear in many countries, but here’s an example from the US. The quote is from a family doctor who is also a Republican senator in response to Anthony Fauci’s assertion that everything was being handled above board :

I would remind him that anytime health care intersects with dollars it gets awkward. Right now Medicare has determined that if you have a COVID-19 admission to the hospital, you’ll get paid $13,000. If that COVID-19 patient goes on a ventilator, you get $39,000, three times as much. Nobody can tell me after 35 years in the world of medicine that sometimes those kinds of things impact on what we do.

Dr. Sen. Scott Jensen April 8th 2020

Those on the other side of the argument claim that many deaths that happen outside of hospitals were not attributed correctly to the pandemic. Here is a replica of the quote I used in Update 14 :

“There are significant numbers of people who have died but whose death hasn’t been attributed to the coronavirus because they died at home or in a nursing home and so they weren’t swabbed. There were 164 deaths in Bergamo in the first two weeks of March this year, of which 31 were attributed to the coronavirus. That compares with 56 deaths over the same period last year.”

Giorgio Gori, mayor of Bergamo

As usual, I’m guessing that the truth lies somewhere in the middle – or at least is more nuanced than either side claims, and there’s one easy way to find out : Excess Mortality.

Ever wonder how historians are able to claim to know that the Black Death (Bubonic Plague) killed between 75 and 250 million people across Europe and the Near East from 1346 to 1353?

Do you think there were Bubonic Plague test kits and official records? No, of course not, however basic death records are available. So those studying that pandemic, like the many that followed (up to and including the 1918 Spanish Flu, SARS, and MERS) used a simple measure of excess mortality to determine the overall effect of the virus on the population.

Excess mortality is a term used in epidemiology and public health that refers to the number of deaths from all causes during a crisis above and beyond what we would have expected to see under ‘normal’ conditions.1In this case, we’re interested in how deaths during the COVID-19 pandemic compare to the average number of deaths over the same period in previous years.

Excess mortality is a more comprehensive measure of the total impact of the pandemic on deaths than the confirmed COVID-19 death count alone. In addition to confirmed deaths, excess mortality captures COVID-19 deaths that were not correctly diagnosed and reported as well as deaths from other causes that are attributable to the overall crisis conditions.

Look at the overall death rates in a country and you will quickly see the true effect of the virus. You will see a complete picture that catches misdiagnosed cases (on either side of the argument), that includes those that tragically died because they were unable to make their regular cancer screening appointments, and that is balanced by this year’s reduced numbers of victims of medical malpractice or kids who didn’t drown in their neighbor’s pool due to the lockdown.

I took the data from The Human Mortality Database and made my own charts on ObservableHQ. Feel free to follow the link, insert your country and scroll down to the Excess Mortality section.

Here are some of those charts and a short assessment of what they show. Let’s start with Italy. The 2020 total mortality figures are in red. The 2016-2019 curves are in grey. Some countries report their figures in near realtime. Italy lags behind somewhat, so you can only see 2020 numbers up to week 40 (the end of September), and therefore not into the second wave.

However you view the world, it’s difficult to deny that during the peak of the pandemic, nearly twice as many people were dying in Italy compared to the average year.

Excess Mortality in Italy 2020

Looking at the age groups, it’s clear that there has been an effect on the whole population except the very young, however those 75 and up were dying at the end of March at more than double average rates.

Now, let’s have a brief look at some countries of interest :

Spain is another country that was hit hard by the virus and this is clearly shown in Excess Mortality :

Spain Excess Mortality 2020 showing 260% increase at pandemic peak

Germany has a completely different picture. We knew that Merkel’s government had been successful in keeping deaths under control, but this shows the true extent of her efforts. I highlighted the 2018 peak as it looks suspiciously like Italy’s 2020 Coronavirus curve, but it’s likely the cause of a particularly viscous flu season and it illustrates the hypothesis that those countries who had a series of years with unusually low mortality rates were hit hardest by Covid.

Germany Excess Mortality 2020 showing little effect of Covid

Such differences are repeated in various places around the world. Here is Sweden and Denmark’s numbers :

Sweden vs Denmark Excess Mortality 2020

Finally, the US is somewhat unique as it shows a consistent level of Excess Mortality since the pandemic started, which matches the observation from Update 21 that the US is not one country but combination of northern (temperate) and southern (tropical) climates with corresponding pandemic models :

US Excess Mortality 2020 (you can ignore the last data point…)

OK, that’s all. Hope that was mildly interesting. Stay safe and keep your fingers crossed for the vaccine!