Daily numbers, graphs, analysis thread 4

[Barracker]

Welcome to thread 4 of the daily updates.

Resource links:
Worldometer UK page
Financial Times Daily updates and graphs
HSJ Coronavirus updates
Johns Hopkins Coronavirus Resource Centre
NHS England stats, including breakdown by Hospital Trust
Covidly.com to filter graphs using selected data filters
ONS statistics for CV related deaths outside hospitals, released weekly each Tuesday

Thank you to all contributors for their factual, data driven, and civil discussions.

The current figures are suggesting that most deaths are occurring in hospitals.
Coronavirus: One in five deaths now linked to virus www.bbc.co.uk/news/health-52278825
It’s part way through this article.
How accurate that is remains to be seen.

I found an interesting study on why female cells are more likely to fight off the influenza virus- something to do with its response to oestrogen.
It could explain the disparities in in outcomes between male and female patients and why in relative terms, female patients have more positive health outcomes.

journals.physiology.org/doi/pdf/10.1152/ajplung.00398.2015

Wow. Will need to tell my husband to start identifying as female so he stands a better chance

On about Anglia they have declared 59 deaths in last 24 hours. That's for Essex Norfolk Suffolk bedfordshire.

The Government is trying to hoodwink Joe public. They are not testing care sector because they know that's where they will due in large numbers and without a test no one will know real amount of deaths. It's terrible it really is! No way we can compare with France. Agree we have already past 20,000. And the reporters are still not holding the government to task enough.😡

Can't compare not can compare.

We know the number of excess deaths because the ONS is collecting death data that can be compared against other years. On what basis are you saying there are over 20000 deaths? This thread is focussed on stats and scientific reports.

@pocketem thank you for highlighting this! Every time they say it I am screaming at them and the journalists that they have included care home deaths and these are well over 40 percent of the total. As you say the hospital deaths in france are less than 10,000.

The issue is that if most deaths in the U.K. occur in hospital and a substantial number of deaths in France do not, then comparing hospital deaths wouldn’t be accurate either.

No way we can compare with France. Agree we have already past 20,000.

Is there any proof of this? The ONS figures so not even tally with this number. Also, how does anyone know for sure that every single person in a care home with Covid is being left to die there and not taken to hospital? Or is this all guess work?

We know the number of excess deaths because the ONS is collecting death data that can be compared against other years. On what basis are you saying there are over 20000 deaths?

I think the PP is extrapolating using the data provided by the ONS and the updated NHS daily data, both of which show that the daily released figures are a huge underestimate.

Personally I suspect that 20,000 is possibly overstating the current state of play, but there would certainly be an argument for inflating the number of deaths reported in the past 11 days by at least 25% to allow for deaths which have occurred outside hospital, or within the hospital system but have not yet been reported.

Bearing in mind we have just had 4 days of systematic under-reporting (due to the bank holiday) asnd that most countries have between 40-55% of deaths occurring in the community, it is probably significantly more than that. Potentially anywhere between another 3,500 and 7000.

Thanks for your this thread OP. Been following this on and off for few days.
I am consultant looking after patients on covid ward. I have patients from care home on my ward and I have discharged quite a few elderly patients with covid back to their care homes as well.

The issue is that if most deaths in the U.K. occur in hospital and a substantial number of deaths in France do not, then comparing hospital deaths wouldn’t be accurate either.

There is no reason for this to be true, though, as in the case of care homes (which I would assume make up the majority of community deaths) there is ancedotal evidence that very few residents are being moved to hospital.

Mortality associated with COVID-19 outbreaks in care homes: early international evidence

Data from US and 5 European countries indicate around half of all COVID deaths are in care homes

https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/

However, these threads deal with statistics and try to be accurate, so imo UK to France comparisons
should either be wrt hospital deaths only, so we subtract care home deaths from the French numbers,
or we have to extract the COVID care home deaths from ONS and add these to the UK totals

professor That's useful to hear
Are you allowed to say roughly what % of patients on your COVID ward are from care homes ?

The ONS figures in the BBC article I linked to showed the location of death as mostly hospitals.
The problem is the lag in the data

The ONS figures for the UK show v v low care home % compared to the US and the 5 other Euopean countries

So I suspect data is very incomplete and figures will change

I suspect data is very incomplete and figures will change

I suspect this is the case too.

The real question is not "How many patients in Covid wards are from care homes?" but "How many people with serious Covid symptoms are being transferred from care homes to hospitals, and how many are not being?"

I don't know the answer to that. I doubt anyone does at this time. Fairly sure it is not data that is officially collected, and individual care homes can only talk about their individual position, which for many reasons may be different to the situation in another care home.

It seems unlikely to me that only %5 of deaths in the UK are in care homes when the figure is 50% in other countries. the NHS Covid-19 Decision Support Tool posted by BigChoc earlier in the thread pretty much rules anyone over 80 and needing help with daily living from being aggressively treated. I'm not saying that's wrong - in many cases ITU treatment would do more harm than good to an elderly frail person - but if that is the case most care home residents who catch Covid will be treated in the home.

FT
prod-upp-image-read.ft.com/765d3430-7a57-11ea-af44-daa3def9ae03

Ireland includes care home deaths (indeed all deaths) whereas Northern Ireland does not, so although it appears that Ireland has a higher death rate I'm beginning to doubt that and worry about what will happen when restrictions are lifted if NI follows London rather than Dublin.

Office for National Statistics (ONS))@ONS*

In London nearly half (46.6%) of deaths registered in week ending 3 April 2020 involved COVID-19

The West Midlands also had a high proportion of COVID-19 deaths, accounting for 22.1% of deaths registered in this region

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending3april2020?hootPostID=744197d2d03c11c0bbf3fa4a3e9aeb41

Of deaths involving COVID-19 registered up to week ending 3 April 2020,
90.2% (3,716 deaths) occurred in hospital, with the remainder occurring in hospices, care homes and private homes

I suspect you are right but I also am not sure it is as high as 40% of deaths either.
This makes country to country comparisons difficult.
For example, if only 60% of CV cases die in hospital in France but 75% die in hospital in the U.K. then the hospital deaths are not really operating on the same basis.

Comparing uk number of deaths with France is not helpful because the population size is different. A country with a larger population is likely to have a higher number of deaths. Again it is not comparing like with like.

Yes, if hospital admissions are made on a different basis from country to country,
then we should only really compare total COVID deaths

(I know German hospitals may indeed put centenarians on a ventilator, as health rationing is not a thing here and German doctors really will treat beyond the last gasp sometimes)

Unless countries are actually flouting long-standing WHO guidelines for COD,
total deaths should be reasonably comparable, even allowing for different testing resources post-mortem

WHO guide:
[[https://apps.who.int/iris/bitstream/handle/10665/40557/9241560622.pdf?sequence=1&isAllowed=y
apps.who.int/iris/bitstream/handle/10665/40557/9241560622.pdf?sequence=1&isAllowed=y]]

England & Wales - same thing, just stated in fewer pages:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/757010/guidance-for-doctors-completing-medical-certificates-of-cause-of-death.pdf

Zxy The populations of the UK and France are very similar indeed, each 65-67 million,
so very reasonable to compare directly

Germany has population 83 million, but has far fewer COVID deaths than either France or the UK

So there more important factors than population size to consider