# Covid deaths deiberatley over counted - a national scandal



## Amity Island (Jun 3, 2020)

The Spectator's response to the UK overcounting deaths as covid19 deaths regardless of true cause of death. Makes you wonder what the actual numbers are? 

Is it as low as just 1 in 10 of those recorded as caused by covid19 that are actually caused by covid19? Making the apparent 50,000 covid deaths closer to 5,000? Leading to the question, why the ongoing lockdown? What about the  "collateral damage" caused by the lockdown all the other deaths caused by missed appointments etc?

*"We like to beat ourselves up for having the worst Covid death toll in Europe — but we will never know, because we decided not to count properly. In a country that has always prided itself on the quality of its facts and figures, the missing Covid-19 data is a national scandal."*









						The way ‘Covid deaths’ are being counted is a national scandal
					

As a pathologist, I’m used to people thinking that my job mainly involves dealing with death. But nothing could be further from the truth. That is why I and many of my colleagues are so dismayed by changes introduced during the coronavirus epidemic which mean that pathology has not been able to...




					www.spectator.co.uk


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## KARNAK (Jun 3, 2020)

Thanks @Amity Island very informative in fact enlightening but worrying.


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## Thebearcametoo (Jun 3, 2020)

It seems odd to conflate a desire to know more about the disease through more testing both pre and post mortem with ‘they didn’t die from covid-19’. If someone had coronovirus symptoms and died then there’s a good chance that corona contributed to their death even if it wasn’t the only cause (cause can often be a combination of factors so more than one thing may be listed) but given we are in the midst of a global pandemic and we have had 50-60,000 excess deaths then I’m of the opinion that if it walks like a duck and talks like a duck then it involves a duck. A pathologist wanting more detail is a professional pointing out where we could have got more information that may help us in understanding the many different ways the disease affects people and that is legitimate criticism of the government’s handling of the crisis but it doesn’t undermine the need for lockdown or the fact that many people have died because of the pandemic.


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## Docb (Jun 3, 2020)

Ah, the Spectator.  Isn't that the rag with articles from somebody in Durham pretending they were in London?  More a Cummings mouthpiece rather than a source of accurate information or worth bothering with opinion.

All the experts have acknowledged from the beginning that counting deaths would be a problem.  They all said that the best measure would be excess deaths over what would be normally expected since that would cover those who would not have died had COVID not appeared. It gets rid of all symantics.  This currently stands at around 60,000.  Anybody trying to talk that down and pretending it has not happened should be thoroughly ashamed of themselves.


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## Amity Island (Jun 3, 2020)

Thebearcametoo said:


> I’m of the opinion that if it walks like a duck and talks like a duck then it involves a duck.


Hi,

Does that mean you agree with the sentiment of the spectator article?

What I mean is, up to 80% of patients (or the population) don't walk like a duck, eg they have none or just trivial covid symptoms. I think the article is saying that because the patients had a positive test during their stay in hospital (due to some serious health problem or an accident) were simply written off as a covid19 cause of death even though they weren't "walking like a duck".


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## Amity Island (Jun 3, 2020)

Docb said:


> Ah, the Spectator.  Isn't that the rag with articles from somebody in Durham pretending they were in London?  More a Cummings mouthpiece rather than a source of accurate information or worth bothering with opinion.
> 
> All the experts have acknowledged from the beginning that counting deaths would be a problem.  They all said that the best measure would be excess deaths over what would be normally expected since that would cover those who would not have died had COVID not appeared. It gets rid of all symantics.  This currently stands at around 60,000.  Anybody trying to talk that down and pretending it has not happened should be thoroughly ashamed of themselves.


I thought the article was making the point about attributing all deaths to covid19 just because a patient had a positive test during their hospital stay, regardless of whether they had any symptoms or the reason they were in hospital in the first place.

Also, could these excess deaths above and beyond the average and those due to covid19 for the time of year be due to missed hospital appointments and avoidance of hospitals and drs surgeries due to the lockdown strategy and the media terrifying people about a virus which most people will never know they've got or had it?


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## Bruce Stephens (Jun 3, 2020)

Amity Island said:


> What I mean is, up to 80% of patients (or the population) don't walk like a duck, eg they have none or just trivial covid symptoms. I think the article is saying that because the patients had a positive test during their stay in hospital (due to some serious health problem or an accident) were simply written off as a covid19 cause of death even though they weren't "walking like a duck"



Alternatively, the way it varies across countries (with their varied responses) it sure looks like a respiratory illness that kills around 1% (probably a bit less) of people it infects, more older people and less younger ones. And seems to cause some possibly long-term harm in some of those who survive.

Nobody argues that the lockdown (and other measures) isn't also causing harm, including premature deaths, so of course it's a balance.


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## Docb (Jun 3, 2020)

If Coronavirus appears on a death certificate then it is because a doctor considered that it was a contributor to the death of that patient at that time.  If they did not have it then they would have died some other time, maybe a short time later or maybe a long time later.  

And yes, the excess death numbers do include those who died without catching it because of the disruption of medical services.  Their death is as much a consequence of coronavirus as the fortunately few fit and healthy young people who had a bad reaction to the virus.


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## Amity Island (Jun 3, 2020)

Docb said:


> If Coronavirus appears on a death certificate then it is because a doctor considered that it was a contributor to the death of that patient at that time.


Hi DocB,

How do doctors "contribute" covid 19 as the cause of death when;

1. The doctor who has signed the death certificate, according to current NHS guidance doesn't have to have attended the patient prior (up to 28 days) to the patients death? I mean how could he tell?

2. How do doctors "contribute" a covid19 death (which they have been doing) when a covid19 test wasn't done during the patients stay ?

Patients (like most of the worlds affected population) may have presented no symptoms of covid19 and could of just had a covid test showing "positive" during their stay in hospital and still been given a "covid19" death certificate even though they presented no covid symptoms (whether that be a correct or false test result).


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## Amity Island (Jun 3, 2020)

Bruce Stephens said:


> Nobody argues that the lockdown (and other measures) isn't also causing harm, including premature deaths, so of course it's a balance.


Hi Bruce,

As a less destructive strategy to lockdown (inc worldwide economic destruction, redundancies, business failure, collateral damage, future global depression) do you think the country could have been left unharmed and left running smoothly by instead, isolating those that really needed to be isolated instead of isolating almost everyone?


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## Eddy Edson (Jun 3, 2020)

FWIW, here in Oz they take what they say is the international standard approach: if somebody who is an active COVID-19 case dies, they get included in the COVID-19 fatalities. 

Of course that may overcount - eg if somebody gets run over by a bus while an active case. But focusing on edge cases like that seems silly.

It could also result in undercounting. In a couple of cases here, you have a situation where somebody dies shortly after "recovering", in the sense of testing negative a couple of times after previously testing positive. These people probably died as a result of catching the disease, but they don't get included in the COVID-19 fatality count.

No data is perfect; things are always messy and ambiguous.

The excess-death approach seems to make a lot of sense. But it doesn't work well in a country like Oz, where COVID-19 related deaths are a tiny fraction of all deaths and would get lost in the statistical noise. It's quite likely that excess deaths here are actually negative compared to the long term average - less infectious disease spread etc.


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## Eddy Edson (Jun 3, 2020)

Amity Island said:


> Hi Bruce,
> 
> As a less destructive strategy to lockdown (inc worldwide economic destruction, redundancies, business failure, collateral damage, future global depression) do you think the country could have been left unharmed and left running smoothly by instead, isolating those that really needed to be isolated instead of isolating almost everyone?



Like Sweden tried to do? That didn't work well.

What would have worked better is robust test/trace/isolate from the beginning.


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## Eddy Edson (Jun 4, 2020)

Anybody who wants to nerd around with the FT excess mortality data, it's here: https://github.com/Financial-Times/...6fa673d#diff-499f178dcc373b03914d22c4626e0c39


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## Eddy Edson (Jun 4, 2020)

Eddy Edson said:


> Anybody who wants to nerd around with the FT excess mortality data, it's here: https://github.com/Financial-Times/...6fa673d#diff-499f178dcc373b03914d22c4626e0c39



One of the things which becomes apparent from doing a bit of nerding is the sensitivity of "excess deaths since the beginning of COVID-19" to your choice of starting date.

You can see that graphically in the FT's nice pics:



Look at Germany. In early 2020 you can see that fatalities were running *below* the long term average. 

So what starting date to use? 

From the data in the above link (which has been updated by a week or so since these pics were generated), if you compare German 2020 deaths from 1 Jan to last record date with the corresponding periods in 2016-2019, you get a range of excesses from *negative* 3.6K to positive 20.8K, with the median at 12.3K.  

If you instead look at the period from 1st week of March, taking that as the "start" of the outbreak, you get the range *negative* 17.7K to positive 12.6K, with the median at 6.8K.

If you take the start as last week of Feb instead, you get significantly different values: positive 7.9K to 26K, median 17K.

And so on. The UK is a lot more stable  - median excess around 60K no matter which of the start dates you choose, and much tighter ranges.

Anyway, my takeaway is that the FT's data visualisation always comes up with nice pics but you really need to look at ranges and sensitivites to get anything useful and non-misleading from the underlying data.  Single numbers by themselves are pretty meaningless. In this case, for example, you would probably need some more sophisticated stats work to be entirely confident that there have been *any* German COVID-19 related excess fatalities in 2020.

It's a bit depressing that the FT numbers are being flagged around as authoritative by people who should know better. But I guess maybe not a big issue for the UK numbers, given the stability. (But don't get me started on Spain ...)


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## Docb (Jun 4, 2020)

Amity, you have got to take the judgement of somebody and I would prefer to take that of a Doctor than a Journalist any day when it comes to assigning cause of death.  There are no conspiracies, just hard-working professionals doing the best they can in areas where, as Eddy says, things are a bit fuzzy.  You win a few, loose a few and you need to look at means and spread to get a working view of the data.

Eddy, your link goes to a CSF file.  Do you have a link that goes to the pic?


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## Eddy Edson (Jun 4, 2020)

Docb said:


> Amity, you have got to take the judgement of somebody and I would prefer to take that of a Doctor than a Journalist any day when it comes to assigning cause of death.  There are no conspiracies, just hard-working professionals doing the best they can in areas where, as Eddy says, things are a bit fuzzy.  You win a few, loose a few and you need to look at means and spread to get a working view of the data.
> 
> Eddy, your link goes to a CSF file.  Do you have a link that goes to the pic?



On th FT's un-paywalled corona page: https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441


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## Docb (Jun 4, 2020)

Thanks Eddy.

The South Africa data is curious.  Deprivation and African ethnicity are seen as big risk factors in the UK yet SA seems to have escaped.  The one piece of data missing in all this is country by country prevalence. Maybe CV has not got to SA yet.


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## Eddy Edson (Jun 4, 2020)

Docb said:


> Thanks Eddy.
> 
> The South Africa data is curious.  Deprivation and African ethnicity are seen as big risk factors in the UK yet SA seems to have escaped.  The one piece of data missing in all this is country by country prevalence. Maybe CV has not got to SA yet.



I'm not sure about SA in particular but African nations at face value have been doing extremely well. No doubt there's a bunch of reasons for this, including maybe being later to the party, having fewer imported index cases, not testing as much so number understated; etc.

But there are also good indications that experience with ebola has taught many of them how to deal with epidemics - standard TTI, strong govt response and leadership, community buy-in; no flu-modellers to ignore. Dealing effectively with this thing is really a matter of old & tested tehniques, maybe with a little bit of help from tech around the edges.


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## Eddy Edson (Jun 4, 2020)

Eddy Edson said:


> I'm not sure about SA in particular but African nations at face value have been doing extremely well. No doubt there's a bunch of reasons for this, including maybe being later to the party, having fewer imported index cases, not testing as much so number understated; etc.
> 
> But there are also good indications that experience with ebola has taught many of them how to deal with epidemics - standard TTI, strong govt response and leadership, community buy-in; no flu-modellers to ignore. Dealing effectively with this thing is really a matter of old & tested tehniques, maybe with a little bit of help from tech around the edges.



I've also seen it suggested that lack of obesity and T2D maybe some explanation for the low reported fatality rates in Africa. Obesity & T2D rates are growing quickly but still way below Western levels.


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## silentsquirrel (Jun 4, 2020)

Even in normal times, reasons for death on a death certificate are often (almost always??) best guesses rather than "fact".  Unless you do a post-mortem on everyone, this is inevitable.


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## mikeyB (Jun 4, 2020)

silentsquirrel said:


> Even in normal times, reasons for death on a death certificate are often (almost always??) best guesses rather than "fact".  Unless you do a post-mortem on everyone, this is inevitable.


That post is an insult to medical practitioners. Best guess? Final diagnosis more like. And a post mortem doesn’t necessarily give you the reason for death. I had every confidence in death certificates I issued. Whenever I had doubts I discussed the death with the coroner. That’s compulsory.

Of course, if you can show me any evidence for your statement, I’ll be happy to discuss it.


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## silentsquirrel (Jun 4, 2020)

mikeyB said:


> That post is an insult to medical practitioners. Best guess? Final diagnosis more like. And a post mortem doesn’t necessarily give you the reason for death. I had every confidence in death certificates I issued. Whenever I had doubts I discussed the death with the coroner. That’s compulsory.
> 
> Of course, if you can show me any evidence for your statement, I’ll be happy to discuss it.


Not intended as an insult at all, apologies you read it that way.
Agree re p-m.


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## Amity Island (Jun 4, 2020)

Eddy Edson said:


> Like Sweden tried to do? That didn't work well.
> 
> What would have worked better is robust test/trace/isolate from the beginning.


Eddy, I don't think Sweden had a strategy for only isolating those that needed to be isolated?


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## Amity Island (Jun 4, 2020)

Docb said:


> Amity, you have got to take the judgement of somebody and I would prefer to take that of a Doctor than a Journalist any day when it comes to assigning cause of death.  There are no conspiracies, just hard-working professionals doing the best they can in areas where, as Eddy says, things are a bit fuzzy.  You win a few, loose a few and you need to look at means and spread to get a working view of the data.
> 
> Eddy, your link goes to a CSF file.  Do you have a link that goes to the pic?


DocB,

I couldn't agree more, you do have to rely on a doctors moral judgement. However, I think some Doctors have been directed to enter a covid19 death even when no covid symptoms or tests have been done. I know there's an interview (attached below) in America with a Doctor who was very concerned about the way doctors are all currently being advised. What do you make of this? I'm not a doctor and don't know how they normally operate so can't comment.


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## Amity Island (Jun 4, 2020)

Eddy Edson said:


> I've also seen it suggested that lack of obesity and T2D maybe some explanation for the low reported fatality rates in Africa. Obesity & T2D rates are growing quickly but still way below Western levels.


Similar scenario in India, their population is nearing 1.5 billion people, but have had "just" 6091 covid deaths.





__





						covif deaths india - Search
					






					www.bing.com


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## Amity Island (Jun 4, 2020)

silentsquirrel said:


> Even in normal times, reasons for death on a death certificate are often (almost always??) best guesses rather than "fact".  Unless you do a post-mortem on everyone, this is inevitable.


I understand what you mean by "best guess", not literally a complete guess plucked out of thin air by the milkman off the street, but by a qualified doctor based on a patients records, symptoms and the doctors experience during the patients treatment.


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## Eddy Edson (Jun 4, 2020)

Eddy Edson said:


> I'm not sure about SA in particular but African nations at face value have been doing extremely well. No doubt there's a bunch of reasons for this, including maybe being later to the party, having fewer imported index cases, not testing as much so number understated; etc.
> 
> But there are also good indications that experience with ebola has taught many of them how to deal with epidemics - standard TTI, strong govt response and leadership, community buy-in; no flu-modellers to ignore. Dealing effectively with this thing is really a matter of old & tested tehniques, maybe with a little bit of help from tech around the edges.



Should say also that the FT data for South Africa only goes back to 2019 - the "excess deaths" are only vs last year. So not very meaningful and in a real analysis I suppose the confidence intervals would be pretty wide. Another reminder that the FT people are good at pretty, over-simplified data visualisation pics, not really very good at data analysis.


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## Bruce Stephens (Jun 4, 2020)

Eddy Edson said:


> I'm not sure about SA in particular but African nations at face value have been doing extremely well. No doubt there's a bunch of reasons for this, including maybe being later to the party, having fewer imported index cases, not testing as much so number understated; etc.



Age profile is probably a big one. Though (listening to David Miliband) they're still wondering a bit about where (or when) the expected COVID deaths are.


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## mikeyB (Jun 4, 2020)

I should imagine that the Africans David Milliband is worried about have survived more infections than they’ve had hot dinners, so they have top notch immune systems. Make it through childhood, you’re probably immune to everything.


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