Undoubtedly the biggest area of controversy in the coronavirus crisis has been the use of statistical evidence relating to death rates.
We are regularly told now that Britain has the highest number of deaths from COVID-19 in Europe and the second largest, after the United States, in the world. That may or may not be true. Countries have different ways of recording deaths and there are varying degrees of accuracy. In Italy, for instance, there is no national figure for deaths in care homes, whereas Britain now records all sites of death in the daily figures. The British Office for National Statistics (ONS) is considered as one of the best compilers of data in the world and this might have the effect of inflating the difference between death rates in the UK and elsewhere. It should be noted that the figures provided by the ONS attribute deaths to the virus if it mentioned as a possible cause on death certificates. In contrast, the figures provided by the Government require a positive test for coronavirus.
One other issue is the sensitivity of the tests for the virus used. The more sensitive, and accurate, they are the more deaths are going to be associated with the virus, and vice versa. In addition, finally, can we really trust the data from closed authoritarian countries such as China where the deaths per-millions is remarkably, and some would say unbelievably, small?
Finally, of course, the full impact of COVID-19 is not yet known. The experience of other viruses suggests that a second, or even third, peak might be even more severe. At the very least, we will have to wait until annual excess death rates are compiled.
If it is the case that the UK does have the highest death rate in Europe, then we can look for possible reasons. One might be a failure to utilise testing earlier and in a more widespread fashion. Other countries, particularly South Korea and Germany, did just this and their lower death rates might be explained by the rapid action taken. On the other hand, Italy has done a lot of tests and yet still has a high death rate in comparative terms.
Another reason for varying death rates, not one that it’s possible to blame the Government for, relates to density of population. The denser the population, the easier it is for the infection to be transmitted. Here, the UK is at a significant disadvantage. The population density of the UK is 275 people per sq. km. At the other extreme, the population density of Australia is 3 people per sq. km, and in New Zealand it is 18. In Europe, the UK has a higher population density than Sweden, Spain, Ireland, France, Italy, and Germany – we are, in other words, a crowded island as I’m sure you have recognised for yourselves! In addition, the density of population in urban areas is hugely important. It is no surprise at all that death rates have been highest in New York City and London, two of the most densely populated urban centres in the world.
Raw international comparisons are not particularly helpful though. We must also, of course, take population size into account. The UK’s population (of 67m) is bigger than Italy (60m), Spain (46m), Belgium (11m) and France (65m) so a greater number of deaths might be expected in the UK. The Population of the United States is 330 million (broadly equivalent to the combined total of the five most populated countries in Europe). In the second week of May, the total deaths attributed to COVID-19 in these five European countries (more than 120,000) was 50% higher than that of the USA.
As the UK Government’s scientific advisers have regularly said, the key indicator of the virus’s impact, in the UK and elsewhere, will be excess deaths (the difference between normal rates and those during the COVID crisis). Although all deaths from the virus are very tragic, and the pain and suffering of the victims and their families and friends should never be underestimated, some perspective is needed here. Having the daily death rates flashed on our TV screens tends to disguise the fact that, in normal times, people die every day too, and in sizeable numbers.
So, in 2018, a total of 616,014 people died in the UK, that’s 11,846 per week or 1,687 a day. Now, this year’s death rate will undoubtedly be higher. And much of this can be explained by COVID-19. However, the annual excess death rate is important because it is a sad fact that some (maybe many) of those whose deaths are attributed to COVID are likely to have died anyway during the year. In this context, I find it baffling that some seem to express surprise and shock that the death rate is much higher in care homes than anywhere else. Of course it will be! Those who go into care homes tend to be elderly and also tend to have underlying health conditions, making them extremely vulnerable to the virus.
One other factor here is that the lockdown itself will not be neutral. That is, excess deaths this year are likely to occur as a result of the lockdown. This will be a product of an unwillingness of people to attend hospital with other medical complaints, the diversion of health resources to cope with the virus and the economic impact of the pandemic (among which is possible future cuts in health spending). This illustrates how risk assessment is a crucial part of public policy making, and how the public is, surprisingly and somewhat inconsistently, risk averse when it comes to COVID-19.
The Government claims that protecting public health ought to take precedence over the health of the economy and personal liberty, and most people seem to agree with this assessment. But is this the right approach in the case of COVID-19, given that it is a disease which hospitalises relatively few and kills even fewer, and where the lockdown may result in considerable excess loss of life? I am not, here, of course, suggesting that nothing at all should have been done to tackle COVID-19 (no government in the world has adopted this strategy) but carefully weighing up the costs and benefits of a strategy which puts tackling the virus above anything else might lead to a more balanced approach.
Comparing the risk-averse approach to the virus with the approach taken with other risky activities is instructive. In the UK in 2018, over 10,000 and nearly 2,000 deaths respectively were caused by alcohol and drugs and by road traffic accidents. Many more are linked to air pollution, much of which derives from vehicle exhausts. And yet there is no serious proposal to prohibit alcohol or motor vehicles and the public is prepared to risk continuing to drink alcohol and to drive. The Government even deems it appropriate to wait for several more decades before prohibiting the use of petrol and diesel-powered vehicles (and is therefore prepared to accept many future deaths because of the economic benefits it produces).