Coronavirus: How UK death toll compares with rest of world

Britain has the fourth deadliest major coronavirus outbreak in the world and has now suffered more deaths per million people than France, according to statistics.

As the UK this week began including people who died in care homes in its official statistics, its death rate rose above that of France, which had already done so. 

The Department of Health now says 27,510 people have been officially confirmed as victims of the COVID-19 outbreak, a rate of approximately 394 per million people in a population of around 67million.

In France, where 24,376 people had died by yesterday, the rate is 373 per million, according to a project led by University of Oxford researchers.

Spain remains the worst-hit large country in the world, with a death rate of 525 coronavirus victims per million population, while Belgium – which has a population of just 11million, has experienced a surge in deaths recently and its rate has hit 655.

Scientists say that accurately comparing countries is difficult and unreliable because each government records death and disease differently, making like-for-like comparisons impossible.

But looking at even raw numbers shows the UK is doing worse than its neighbours, experts say, and can give a broad view of what is happening globally.

 The true death rate of the coronavirus – the percentage of patients infected who die – is still unknown but is believed to be somewhere between 0.1 and 1 per cent.

How many people die of the virus per million people in the population cannot reveal the fatality rate of the disease unless the entire population is infected.

Professor David Leon, an epidemiologist at the London School of Hygiene & Tropical Medicine, said the data could only amount to ‘simplistic comparisons’.

Differences in how countries record data – and not knowing exactly what those differences are – make the numbers unreliable, Professor Leon said. 

Understanding the failings in UK’s gathering of data – only recently including people from care homes or those who die at home, and only counting people who have officially tested positive – gives an insight into why other countries’ data may be unreliable.

Statistics suggest the true death toll in the UK is already in excess of 40,000 – 50 per cent higher than it appears to be.

But more detailed statistics may take weeks or months more to become available. 

Raw rolling data, in the meantime, may go some way to show how badly a country has been affected and how well authorities there have coped with it. 

Germany, for example, has been praised as having one of the best responses to the outbreak of anywhere in the world and as a result relatively few people have died.

More than 163,000 people testing positive for the virus while 6,623 of those have died. That figure represents approximately 75 deaths per million people in its population of 83million.

The country has been credited for quickly starting a massive testing regime which, for the past month, has carried out an average 400,000 tests per week.

This has enabled the country to better track and suppress outbreaks of the disease, and on March 6 it became one of the first nations in Europe to start telling people to self-isolate if they became ill. 

China also has a remarkably low death rate per million, although there are concerns about the validity of its data. Official figures show 4,633 people died there – 3.2 per million people in its population, which is 90 per cent lower than the global average. 

The country had gone into a drastic lockdown in which people were required to stay at home by martial law and all transport was stopped and roads blocked.  

Data cannot show for sure that countries hit harder by the virus, however, were worse affected because they didn’t respond as well to outbreaks.

The University of Bath’s Dr Kit Yates, a senior lecturer of mathematical biology and the author of The Maths of Life and Death, told MailOnline: ‘There’s nothing that you can conclusively draw [from data like this] because countries are testing in different ways and it’s comparing apples with oranges. 

He added: ‘You can look at it for a broad view but the whole picture isn’t going to be clear for a long time afterwards. 

‘You can say that Germany is doing well. Clearly Germany’s got far fewer cases and deaths than the UK, which is in part attributable to testing rigorously.

‘But it’s really difficult to say whether the UK is doing better or worse than Spain because Spain’s not reporting deaths in the community. Both countries have both under-reporting and over-reporting.’  

Dr Yates said that raw data was enough to see generally which countries had suffered the most and the least in the pandemic. 

Italy, for example, is known to have had a particularly high death rate because it was caught off-guard by a devastating outbreak in the north of the country.

The country, where almost 28,000 people have died, had scaled back protective measures after banning all flights into the country from China.

But a cluster of cases in the Alps in the north of the country, near Milan, spread fast and hit a population with a high average age and where many people lived in rural areas without fast access to big city hospitals. 

Both Dr Yates and Professor Leon both said that study of excess deaths, when the data becomes available, will be the most accurate way of measuring deaths.

Speaking about the deaths per million measure, Professor Leon said: ‘This data is of limited usefulness – the most comparable way of looking at how different countries have been affected is to look at mortality from all causes of death during the pandemic and compare it to what we would expect to see had the pandemic not occurred.’

But he, too, agreed that the raw data was enough to see that the UK had been hit hard.

He said: ‘None of this detracts from the fact that the indications are, even from the crudest data, that the UK is really not doing particularly well.

‘But exactly where it will end up compared to Italy, we don’t know. It’s certainly not doing as well as Norway, Czech Republic or Australia.

‘I think the timings and the extent of the excess deaths will begin to tell us something about the adequacy of the Government response. It won’t be definitive but it will give us an indication.’       

University of Cambridge professor, Sir David Spiegelhalter, wrote in The Guardian yesterday that comparing death rates at face value was ‘deeply unreliable’.

He said that second hand impacts, such as people dying because access to medical care was restricted, could mean the impact of the virus spread wider than a single number.  

‘If it’s difficult to rank this country, it’s even trickier to give reasons for our position,’ he wrote. ‘COVID-19 mainly harms the elderly, with the average age of deaths above 80, and its fatality rate doubles every seven years as a person ages. 

‘Italy’s population is elderly (it has a median age of 47), while Ireland’s is much younger (a median age of 37), so we would expect different effects. And Covid-19 is a disease of crowded areas – New York is rather different from Reykjavik.’

The death rate per million people in Italy is 463, according to the Our World in Data comparison, putting it below Spain’s 525. 

The two are thought to be the countries hit worst by the virus and are the only ones, in addition to Belgium, to have recorded more deaths per person than the UK.

Difficulty in comparing death numbers across countries arises from the ways governments record them.

For example, France includes people who die outside of hospitals as well as inpatients, something Britain only started to do this week. 

In other countries such as Spain and Italy, it is less clear at what point they have been including non-hospital deaths, and how they record them. 

A World Health Organization report found that between 42 per cent and 57 per cent of COVID-19 deaths happening in major European were happening in care homes, The Guardian reported.

But how accurately these have been recorded isn’t clear, Professor Leon said.

‘We believe people who were of a certain level of sickness would have got to hospitals [and died in hospital] even if they were from care homes,’ he added, suggesting that some patients might get counted twice. 

The death rate per million for countries around the world has been calculated by the Our World in Data project, which is run by researchers at the University of Oxford and the Global Change Data Lab, a registered charity.

The project puts the world average of deaths per million people at 29.84 for May 1. Global statistics show around 234,000 people worldwide have now died in the pandemic.