Coronavirus: is it fair to compare countries’ death tolls?

Boris Johnson has defended Downing Street’s decision to ditch its daily death tallies for different countries at coronavirus briefings, arguing that comparing the figures while the crisis is still unfolding is “premature”.

The prime minister hit back after Labour leader Keir Starmer criticised the “baffling” U-turn, pointing out that the data has been used by Johnson “for seven weeks to reassure the public”.

Brandishing a copy of the government’s international comparisons chart at Prime Minister’s Questions on Wednesday, Starmer replied: “The problem with the prime minister’s answer is it’s pretty obvious for seven weeks when we weren’t the highest number in Europe they were used for comparison purposes, as soon as we hit that unenviable place they’ve been dropped.”

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How are countries calculating Covid-19 deaths?

There are significant differences in how death figures are reported by different countries. Some of the tallies only include deaths in hospitals, whereas other countries - such as the UK - now include deaths in care homes and the wider community.

In the US, the Centers for Disease Control and Prevention (CDC) instructed states to begin recording untested but likely coronavirus deaths in their counts in mid-April - a decision that was criticised by some experts, as USA Today reported at the time.

Business Insider says that the Trump administration is pressuring the CDC to change its counting method, as the confirmed US death toll soars to almost 87,000, according to latest figures - by far the highest total in the world.

By contrast, Italy only counts the deaths of people who have tested positive for Covid-19. The same is true in Spain, where people who die at home or in care homes are usually not tested, according to The Telegraph.

Fernando Simon, Spain’s national coronavirus emergency response chief, acknowledged last month that the “real number of deaths is hard to know”, amid warnings that the true total could be many thousands higher than official data suggests.

Neighbouring France has factored nursing home deaths into its reported coronavirus deaths, but not fatalities in the wider community - although the government plans to add this latter category to its count from June, the newspaper reports.

Meanwhile, China is facing growing criticism over “an apparent cover-up” of its death numbers, says the Daily Mail. Downing Street removed China from its international comparison charts in late April amid widespread scepticism over the data provided by Beijing.

Addressing reporters at Downing Street last week, Foreign Secretary Dominic Raab said: “There are different ways of counting deaths, as we know. We’ve had that debate in this country. We now publish data that includes all deaths in all settings, and not all countries do that.”

An analysis by the Financial Times suggests that the global Covid-19 death toll may be almost 60% higher than reported in official counts.

The year-on-year comparison of death figures for March and April found a “50% rise in overall mortality relative to the historical average for the locations studied… In all the countries analysed except Denmark, excess deaths far outnumbered the official coronavirus death tolls.”

So should death tolls be compared?

“I’m not sure that the international comparisons work unless you reliably know that all countries are measuring in the same way,” Raab insisted last week.

However, David Spiegelhalter, a professor of the public understanding of risk at Cambridge University, suggests that it may be useful to compare overall death rates of countries - not just coronavirus deaths.

“The only unbiased comparison you can make between different countries is by looking at all-cause mortality,” he told the FT. “There are so many questions about the rise we’ve seen in death that have not got Covid on the death certificate, yet you feel are inevitably linked in some way to this epidemic.”

The newspaper analysis of deaths tallies for the past two months found that in Italy’s Lombardy region, the original epicentre of the coronavirus outbreak in Europe, more than 13,000 excess fatalities were recorded in the official statistics for the nearly 1,700 municipalities for which data is available. This is a 155% rise on the historical average and far higher than the 4,348 coronavirus deaths reported in the region.

As well as varying methods for recording deaths, another key explanation for differences in deaths rates is differences in how countries have responded to the pandemic.

Professor Martin McKee from the London School of Hygiene and Tropical Medicine told Euronews that the main reason why the UK death toll is so high is that the government was too slow in implementing a lockdown.

“It’s actually quite simple,” Professor McKee said. “If we look at the countries that responded quickly and got in at the very beginning, they're the ones that have managed to contain the epidemic.”

Another possible factor is that not all countries are fighting the same version of the new coronavirus. Scientists have discovered that the virus has already mutated several times as it has spread across the world, and different variants have taken root in different places.

“Researchers in Germany identified three main genetic groups of the virus in April, which they named A, B and C,” says The Guardian’s science editor Ian Sample. “Groups A and C are mostly found in Europeans and Americans, while group B is most common in East Asia.”

The team behind a study conducted at the New Mexico-based Los Alamos National Laboratory have suggested that a more virulent form of the virus, known as Spike D614G, “began spreading in Europe in early February”, reaching the US soon after.