TO use the most popular opening conversational gambit these days, I am no epidemiologist. I just try to make sense of the news. I do however mightily distrust the media for good reasons.
Out of the 685,623 people in the world who had tested positive for Covid-19 by Sunday, 32,137 had died – meaning 4.7 per cent – but this death rate is meaningless.
Half of people in Iceland who are test-positive have no symptoms and most of the rest have mild cold-like symptoms. This does not tell us much either, except that Iceland tests a lot of people and the virus came to Iceland more recently than to, say, Italy.
What is noticeable and hopeful is evidence that the virus is already surprisingly widespread in many countries and that most cases are not detected because the infected people have few or no symptoms.
Measures to prevent deaths sometimes cause deaths. In a German nursing home for people with advanced dementia, 15 test-positive people died, but not necessarily from the virus. Some of these may have died as a result of the changes to their routine: Isolation, no physical contact, staff wearing masks.
I quote from an interesting article in the Financial Times. Mike Ryan, executive director of the World Health Organisation’s health emergencies programme, has outlined four factors that might contribute to the differing mortality rates: Who becomes infected, what stage the epidemic has reached in a country, how much testing a country is doing, and how well different healthcare systems are coping.
But there are other sources of doubt too, including how many coronavirus victims would have died of other causes if no pandemic had occurred. In a typical year, about 56million people die around the world – an average of about 153,000 per day.
Researchers at the University of Hong Kong have estimated that in Wuhan, where the pandemic began, the likely death rate was 1.4 per cent – much lower than the previous estimate of 4.5 per cent, which was calculated using official statistics on the region’s cases and deaths.
In the UK, where the Government has been criticised for a slow initial response, only the most serious cases are being tested. In total 1,231 people have died out of 19,758 confirmed cases, giving a death rate of 6.2 per cent.
Rosalind Smyth, professor of child health at University College London, said official UK coronavirus data was ‘so misleading that it should not be used’. Using conservative estimates, the true number of people infected ‘is likely to be 5-10 times higher’, she added.
But different countries are also reporting cases and deaths in different ways. In Italy, Covid-19 is listed as the cause of death even if a patient was already ill and died from a combination of illnesses. ‘Only 12 per cent of death certificates have shown a direct causality from coronavirus,’ said the scientific adviser to Italy’s minister of health last week.
Spain’s national government simply lists how many people with confirmed cases of coronavirus have died and provides no extra information on any other medical conditions.
In the UK, about 150,000 people die every year between January and March. To date, the vast majority of those who have died from Covid-19 in Britain have been aged 70 or older, or had serious pre-existing health conditions. What is not clear is how many of those deaths would have occurred anyway if the patients had not contracted Covid-19.
Speaking at a parliamentary hearing last week, Professor Neil Ferguson, director of the Medical Research Council’s Centre for Global Infectious Disease Analysis at Imperial College London, said it was not yet clear how many ‘excess deaths’ caused by coronavirus there would be in the UK. However, he said the proportion of Covid-19 victims who would have died anyway could be ‘as many as half or two-thirds’.
Italy does not distinguish between people who die with, and people who die of, the coronavirus. But there is evidence that many deaths of people with, or of, the virus are not being reported as such at all. This is very worrying.
I quote Ambrose Evans-Pritchard in The Daily Telegraph. He is pessimistic and alarmist about everything, but has strong arguments to alarm us.
We have a ‘real time’ laboratory before our eyes. What is happening at the Italian coalface is not remotely consistent with claims being made by some that the death rate from Covid-19 is akin to seasonal winter flu at around 0.1 per cent.
The mayors of Bergamo and Brescia – two Covid-19 hotspots – say the reported deaths in their cities are a small fraction of the true numbers. An epidemiological portrait is easy to construct. You compare deaths since January with seasonal averages over recent years. The Italian daily newspaper Corriere Della Sera has done exactly that.
The small town of Nembro has 11,600 inhabitants. Typically, it would have 35 deaths over the first quarter. This year it had already had 158 deaths by March 24. Yet the official data counts just 31 Covid-19 mortalities. The implication is that the real pandemic death rate has been four times higher.
The same method showed that deaths were 6.1 times normal in Cernusco and Pesaro, and 10.4 times higher in the city of Bergamo. This is partly because Covid-19 care is crowding out treatment for other diseases. But that changes nothing in practical terms. It is all part of the same drama.
Ambrose Evans-Pritchard suspects that the Government’s original strategy of herd immunity wasted weeks when what was happening in Wuhan and Lombardy was ignored and that
Boris Johnson ‘overruled bad counsel in the nick of time’.
I am told by insiders that the reverse is true, that the Scientific Advisory Group for Emergencies (SAGE) wanted a lockdown earlier and was overruled by Johnson.