Is Britain REALLY the sick man of Europe? We've had the most deaths but figures reveal there's more to the story than meets the eye
by Fiona Macrae for the Daily MailBritain has the worst death toll for Covid-19 in Europe and the second highest in the world — or does it?
The latest figures, read out at the Government press briefing on Monday afternoon, show 36,914 Covid deaths in the UK. Only the United States, which has a population five times the size of the UK’s 67.9 million, has more.
In contrast, Germany, which has a bigger population than the UK, has reported just over 8,000 deaths, and Ireland, our nearest neighbour, has had only 1,608.
It’s easy for us to assume that the figures reflect how well — or how badly — individual governments have handled the pandemic.
However, experts say that while some countries, including the UK, have clearly done worse than others in terms of deaths, it is too early to choose between them because the daily death tolls don’t tell the whole story.
‘This is not Eurovision — it’s pretty pointless to try to rank them,’ says Sir David Spiegelhalter, a statistician and a professor of the public understanding of risk at the University of Cambridge.
‘Just looking at the raw number of deaths is not a great way to compare what’s going on,’ adds Jason Oke, a statistician at the University of Oxford.
Partly, this is because when we compare different countries’ death tolls, we are not comparing like with like but, to put it simply, apples with pears.
One of the clearest reasons is that countries are not counting deaths in the same way. Some, such as the UK, are including only people who have tested positive for the virus. Others, such as Belgium, also include suspected cases, which will increase their total.
‘We also need to consider how the size of a country’s population, the density of its population (that is, how tightly packed together its citizens are) and how old they are affect its death toll,’ says Dr Oke. Densely populated cities such as London and New York are likely to be worse hit than remote parts of Ireland or Norway.
Then there is the fact that different countries are at different stages of dealing with the virus, meaning the data isn’t complete. Some countries that appear to be doing well may suffer resurgences when they come out of lockdown; or, if they’re in the southern hemisphere, things may get worse when winter sets in in the next few months. Others that have a high death toll now could fare better during any second wave of the disease.
‘It’s almost like deciding the final score when you’re only halfway through a football game,’ says Dr Oke. ‘Who knows what is going to happen in the second half? It’s anybody’s call.’
He believes we need to wait for six months before we have the full picture. Then, we can use statistical techniques to draw more accurate comparisons.
One technique (already used with flu) involves looking at ‘excess deaths’ — the number of extra deaths over a set period of time compared to the same period in previous years.
Another technique, which is common when compiling international data on cancer, takes into account the size and age of each country’s population.
‘While neither method is perfect, they would allow for more accurate international comparisons than the raw figures we have now,’ says Dr Oke.
In the meantime, here we take a look at the numbers we do have and the stories behind the statistics of some of the countries ‘apparently’ faring better or worse than others.
UNITED KINGDOM
Population density helped spread
Deaths: 36,914
Population: 67.9 million
Deaths per million: 544
Average age: 40.5 years
People per square mile: 727
How deaths are counted: Deaths in hospitals, care homes and in the community of people who have tested positive for Covid-19 are included in the daily updates. (A second set of figures is released weekly by the Office for National Statistics and uses data from death certificates and so includes suspected cases — ones in which testing hasn’t been done but it is thought that the virus played a part.)
BEHIND THE FIGURES: On May 5, the UK’s death toll overtook Italy’s to become the highest in Europe and the second worst in the world. But while it’s easy to think of things that Britain could have done to better control the pandemic, population density may have pushed up the death toll, says Hannah Fry, an associate professor in the mathematics of cities at University College London.
Covid-19 thrives on close contact — and with 727 people per square mile, the UK is four times as crowded as Ireland, which reported a death rate more than 20 times lower than the UK.
It also has a higher proportion of people living in towns and cities than most other European countries. London is one of Europe’s biggest cities and has a population of nine million — more than twice that of Berlin.
‘It’s safe to say the number of people visiting a supermarket or pressing the buttons on the lift in a block of flats will make a difference,’ says Hannah Fry.
The UK also has one of the highest levels of obesity in Western Europe, and a recent study by the University of Liverpool of Covid patients in hospital found those who were obese were almost 40 per cent less likely to survive than their slimmer counterparts.
Research also shows that three-quarters of the Covid-19 patients in intensive care in the UK are overweight or obese.
‘Coronavirus is not something that affects everyone equally — existing health conditions matter too,’ adds Hannah Fry.
IRELAND
Younger population kept death rate low
Deaths: 1,608
Population: 4.9 million
Deaths per million: 328
Average age: 38.2 years
People per square mile: 186
How deaths are counted: Deaths in hospitals, care homes and the community, including those suspected to have had Covid-19 but not confirmed with tests.
BEHIND THE FIGURES: Ireland’s relatively young population may have given it an advantage. The disease is particularly dangerous for the elderly and a recent analysis found that pensioners are 34 times more likely to die of the disease than working age Britons.
At 38.2 years, the average age in Ireland is almost a decade lower than in Italy and two years younger than the UK. With age the most important factor when it comes to surviving Covid-19, Ireland’s comparatively youthful population could be having a big effect on its death toll, says Dr Oke. ‘If the age structure of England and Wales’s population looked like Ireland’s, I suspect the number of deaths would be reduced by thousands.’
UNITED STATES
There are a lot more people to infect
Deaths: 97,049
Population: 331 million
Deaths per million: 293
Average age: 38.3 years
People per square mile: 94
How deaths are counted: Deaths in hospitals, care homes and the community, including those suspected of having had coronavirus but not tested.
BEHIND THE FIGURES: The United States has more deaths than any other country but it also has a huge population. If we look at deaths per million people instead, it isn’t the worst in the world any more. Indeed, the rate of 293 deaths per million is almost a third of the rate for Belgium, which has the most deaths per capita of any country.
Another way of looking at the U.S. death toll is to compare it with the combined figure for the five largest countries in Western Europe. The UK, Germany, France, Italy and Spain have a joint population that’s similar to the U.S. but their combined death toll is nearly 50 per cent higher.
Factoring population size is ‘such a simple thing’ yet easily overlooked, says Dr Oke.
‘If you take into account population size, then the U.S. is doing better than most of Europe.’
BELGIUM
Includes a broad range of symptoms
Deaths: 9,312
Population: 11.6 million
Average age: 41.9 years
Deaths per million: 803
People per square mile: 991
How deaths are counted: Deaths in hospitals, care homes and the community, including those of people suspected to have had Covid-19 but not been tested.
BEHIND THE FIGURES: Belgium, a small country with a population of 11 million, has recorded more deaths from coronavirus than China, where the virus is thought to have originated.
While there are questions over how far the Chinese figures can be trusted, Belgium’s death toll of 9,312 is the highest per capita in the world.
Unlike many other countries, it also includes suspected deaths in its tally and says that this ‘very complete way of counting’ has helped it track the virus’s spread and quickly intervene in hotspots of disease.
‘If you want to compare our numbers with a lot of other countries, you basically have to cut them in half,’ says Steven Van Gucht, head virologist at the National Institute for Public Health in Belgium.
Belgium may also be using a broader definition of coronavirus symptoms than other countries that include suspected cases, pushing its total even higher, says Dr Oke.
Indeed, its definition of a suspected case includes symptoms as diverse as diarrhoea, a runny nose, chest pain and falls.
‘In Belgium, they are erring on the side that any time they remotely suspect that Covid-19 was involved, they’ll include it in the official stats,’ adds Hannah Fry. ‘This is why it is unfair to look at the number of deaths alone.’
ITALY
Bigger families may be playing a part
Deaths: 32,785
Population: 60.5 million
Deaths per million: 542
Average age: 47.3 years
People per square mile: 533
How deaths are counted: Most of the daily total is made up of deaths in hospital of people who have tested positive for Covid-19. Data on other deaths, including those in care homes, is patchy.
BEHIND THE FIGURES: The figure of 32,785 is the second highest in Europe but may be an undercount.
Like many other countries, Italy records only the deaths of people who have tested positive for the virus. However, ‘there has not been massive screening in care homes, so we do not know the exact number of Covid-19 cases and related deaths there’, says Eleonora Perobelli, a researcher in long-term care and government policy at SDA Bocconi School of Management in Milan.
We also know that with an average age of 47.3 years, the Italian population is one of the most elderly in the world, putting it at higher risk of severe Covid-19.
Its emphasis on family life, including multi-generational households in which older people live under the same roof as their children and grandchildren, is also thought to have fuelled the spread of the virus simply because it is harder to keep the generations apart than if they were living in separate homes.
‘Multi-generational households, by virtue of having younger people going in and out, would expose older people more than if they lived on their own,’ says Dr Oke.
GERMANY
An undoubted success so far, but will it last?
Deaths: 8,247
Population: 83.8 million
Deaths per million: 98
Average age: 45.7 years
People per square mile: 623
How deaths are counted: Deaths in hospitals, care homes and the community of people who have tested positive for coronavirus. Suspected cases can be tested after death.
BEHIND THE FIGURES: With 8,247 deaths in a population of almost 84 million, Germany’s per capita death toll is less than an eighth of that of neighbouring Belgium and a fifth of the UK’s.
Like Italy, Germany also has a relatively older population.
However, many of its initial cases of Covid-19 were in fit, young people who were thought to have brought the disease back from skiing holidays in Italy, before passing it on to people who were of a similar age and, therefore, more likely to recover.
Even today, only around 20 per cent of Germany’s cases are in the over-70s.
Dr Oke says that while it is widely agreed that Germany — which has done vast amounts of testing — is a success story when it comes to controlling the coronavirus, the unpredictable nature of pandemics makes it too early to claim victory.
‘Who knows if, in three months’ time, their count will be closer to ours,’ he adds. ‘You might call it now and be lucky — but it’s a waiting game.’
HOW TO KNOW IF YOUR SYMPTOMS ARE COVID
By Dr Nick Summerton
Working as a GP for the Covid Clinical Assessment Service, set up to manage patients who need to speak to a doctor after calling NHS 111, I chat to at least five patients an hour over the phone.
Based on what I am told, my advice will vary from calling an ambulance to suggesting they get tested, or stay at home and monitor themselves closely.
But symptoms are tricky blighters. They continually change and the same symptoms can be caused by different problems.
The number of symptoms being recommended to identify those with Covid-19 is growing: the list now includes, as well as a dry cough and a raised temperature (which is where we started), changes in a person’s sense of taste or smell, extreme tiredness, breathlessness, loss of appetite, sore throat, diarrhoea, muscle pain and headache.
Perhaps the best way to spot people with Covid-19 is to think about symptoms in three broad groups: general viral symptoms, symptoms linked to the virus as it enters our bodies, and symptoms from organs that it might infect.
I have found that Covid-19 is more likely if an individual has at least four new symptoms from two or more of these groups.
General viral symptoms: (Occasional or continuous) fever or raised temperature, chills with or without shaking, loss of appetite, fatigue or extreme tiredness, muscle/joint pains, headache, dizziness.
Entry symptoms: Alterations of smell or taste, soreness in the throat, sore eyes, nasal congestion or runny nose.
Organ-specific symptoms: Lungs: dry cough, mild to moderate breathlessness, heaviness on the chest. Guts: diarrhoea, vomiting, nausea.
- Dr Summerton has been a GP for 32 years and has written books focusing on diagnosis.
P.S. can we trust China’s figures?
With just 4,645 deaths in a population of more than 1.4 billion, China appears to have done extraordinarily well in controlling the spread of the virus. Too well, in fact.
The credibility of its figures has been questioned, amid concerns that the authoritarian regime is covering up the true scale of the outbreak. French President Emmanuel Macron has warned that it is ‘naive’ to suggest China has handled the pandemic better than other countries.
Cabinet Office Minister Michael Gove has said ‘some of the reporting from China was not clear about the scale, the nature, the infectiousness of the virus’.