The vanguard
05/10/2020 - 15:24
- Clarín.com
- World
The coronavirus pandemic statistics are darts against national pride. The most advanced economies on the planet find themselves on top of podiums that no country - and, above all, no government - wants to get on. Who leads the world ranking of deaths per inhabitant? (Belgium) Who holds the title of nation with the most victims by Covid in Europe? (UK has taken it from Italy) And in the world? (USA) And what is the country with the most infected? (USA again) And the second one? (Spain, closely followed by Italy and the United Kingdom).
It is a macabre competition that makes headlines in the press every day and that the rulers do not hesitate to use when it suits them. Donald Trump recently outraged Belgians by displaying a graph, with Belgium at the top and the U.S. seventh, of the countries with the most victims relative to their population, to defend themselves against criticism. "It is the difference between public health science and political motivation , " exclaimed Steven Van Gucht, Belgium's chief virologist. "We record the data in a more correct way," he claimed.
In addition to hurting homeland pride, international rankings exasperate scientists. "Ranking countries, like a football league, is absurd," says David Leon, professor at the London School of Hygiene and Tropical Medicine.
All the experts agree. The Covid-19 statistics, both for cases and deaths, are still very incomplete and, if they are not reliable to assess the extent of the pandemic within a country, they are even less so for comparing countries.
Governments report only the infected they can detect , depending on their ability to perform tests. The more tests, the more cases. To complicate matters further, the number of tests carried out is not equal to the number of people tested, since a patient is usually tested several times.
"All countries have a knowledge deficit, due to the high prevalence of asymptomatic cases or those with mild symptoms. The only way to compare countries is by conducting seroprevalence surveys (presence of antibodies in blood) with similar criteria ”, defends José Martínez Olmos, who was Secretary General of Health with José Luis Rodríguez Zapatero. The results of the Spanish survey are expected for the third week of May.
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The death figures, the ones that hurt the most, are also a mirage, since not all countries count the same . Even knowing what data each collects is difficult, says Leon. Until recently, most only counted deaths in hospital and with a positive test, leaving out, for example, nursing homes, which have turned out to be the main focus of the epidemic. When the UK retroactively included non-hospital deaths, the number skyrocketed by 5,000 more in a single day.
Also in Spain the criteria change and the statistics lag behind. If hospital deaths are automatically accounted for, the rest must go through the civil registry. A process that, especially in the most affected areas, has been slowed down by saturation, says Martínez Olmos. As they are entered in the registry, only those where the death certificate points to Covid-19 are included in the official statistics.
There is a great element of discretion in attributing the cause of death. With terminal cancer do you die from or with Covid-19? "There will be a variation in the behavior of doctors in each country and individually," says Leon.
Belgians include in their statistics all those killed in residences, with or without tests. It is not anecdotal: deaths in residence represent 53% of the total, and of these, 84% are without tests. While Belgian scientists believe they are the least likely to have to correct their data, the government is under pressure to change the method that has placed the country in the international press (and Trump's charts) as the leader in deaths per capita. Even Prime Minister Sophie Wilmès has said deaths are being overestimated.
Political cainism aside, having objective data to make comparisons between countries is crucial for science, in order to evaluate the effectiveness of different national strategies and prepare for the successive waves of the pandemic, emphasizes Leon. "Hospital death data is useful for comparing trends and seeing when each country reaches its peak . But not to compare the total impact on Covid-19 mortality, "he says.
For this, the British epidemiologist maintains, there is a much more reliable metric: excess mortality. Look, week by week, the total deaths from any cause that have occurred in a country and calculate the difference with the average number of deaths recorded in recent years . "Excess will tell the scope of the epidemic, including deaths directly and indirectly caused by Covid-19," says Leon. It will reflect deaths that have grown, such as heart attacks that have taken longer to go to the emergency department, and others that will take years to manifest: people who will die because in these months the colonoscopy that would have detected cancer in time was not done. We must counterpose people who have not died thanks to the pandemic, due to traffic accidents or accidents that have not occurred or the fall of pollution.
Accessing the data on excess mortality in each country is not easy, not even in Europe. And even less to the data of autocratic and opaque regimes such as China or Iran, whose official figures are far below the western ones.
Leon has signed an article in The Lance urging governments to make them public. "Some are reticent. It seems immoral to me unless there is no very strong legal reason, ”he regrets.
It is not a tasteful dish for any government to admit that there may be 30% -40% more deaths than official figures say , as preliminary data from some of the worst hit countries suggests. But there are also technical reasons: "Statistical offices need time to process certificates and there is a lack of human resources," says Markéta Pechholdová, an expert demographer on mortality at the Prague University of Economics.
In Spain, the Carlos III Health Institute monitors excess mortality, an initiative promoted after the lethal 2003 heat wave. Martínez Olmos stresses that the data is public, but asks for caution: “Excess mortality needs time to apply Plausible hypotheses about which deaths are attributable to Covid-19 and which are not. A gap is inevitable. ”
The public health expert also calls for taking comparisons across countries with caution. "We cannot compare the deaths per capita without correcting it, for example, based on the percentage of elderly people in each country . "
Martínez Olmos does not see political intent in underestimating deaths. “Knowing if we have 30,000 or 40,000 victims is not essential information for managing the pandemic. Excess mortality does not change trends or demographic profiles. What is essential to make decisions is early detection and asymptomatic ”, he argues.
Everything indicates that the underestimation will be minimal in countries like the Czech Republic, where there are few cases and deaths, and more important in the territories where the pandemic is severe and have a large population, Pechholdová believes. Germany, which has registered 90 deaths per million inhabitants compared to 560 in Spain, is one of the European countries with the most elusive data, but the excess of deaths in Berlin or Hesse, collected by the Euromomo center, shows a minimal deviation.
Leon insists that making rankings is wrong. "What the data shows clearly is that countries like the United Kingdom, Italy, Spain or France have not done well. Only confirmed deaths are already huge. If the UK is ahead of Italy or vice versa it is a pointless distraction. Neither has done well and it is even more evident if you compare it with Norway, the Czech Republic or New Zealand, which have managed to control the epidemic. ”
Gemma Saura. The vanguard