Daily numbers, graphs, analysis thread 4

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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.

Bigchoc,

Although all the things you have listed are true, age is still tremendously important.

www.google.co.uk/amp/s/www.nytimes.com/2020/04/04/world/europe/germany-coronavirus-death-rate.amp.html

According to the above article, although the average age (and mortality rate) are increasing in Germany, as of April 4th the average age of infection was 49 in Germany and around 62 in Italy and France. Thirteen years in age will account for a factor of 3-5 in fatality rate. The remaining factor of 2-3 is probably explained mainly by Germany testing healthier patients (clearly there is also overlap in these two factors). The more you test, as you know, the lower the denominator.

I would suspect better hospitals and more ICU beds, although helpful, are not the main factors. Ultimately we are comparing first world countries and, certainly in France (for instance), their system has not been overwhelmed. More ICU beds will only make a difference on the margin as it will mean more elderly and very sick will get them, whose chance in surviving it is less than 50% anyway.

That doesn't follow at all, Larry.

We don't know the average age of infection for most countries since they are only testing the ill. Germany is doing far more testing, and therefore the case (not infection) age skews younger because younger people are far less likely to be ill. In countries where only the sick are tested the average case (not infection) age will be much older than those doing mass testing, which is the best approach as far as we can tell....

Shoots,

Which is why I acknowledged the overlap between the factors....

However it is also believed that the average infection age is actually lower in Germany. Unless you have a reason or source to dispute it?

In NZ we currently have 9 CV19 deaths. Six of these are all from the same dementia care home. All 9 deaths are over 70 year olds. All deaths are being reported in figures, not just hospital deaths. There are currently 4 aged care homes with infections. This seems to be the most vulnerable population, as even in lockdown, it has people coming and going (staff).

Could the accepting of 600,000 Syrian refugees in 2015/16 have resulted in an increase in health facilities in Germany? An unexpected consequence, a bit like the UK having food stores due to worries about Brexit affecting food supplies.
Matt Hancock, I think it was, mentioned the German company Bosch as a reason for their ability to test (I think it was testing).
Someone on the radio said that a pandemic control paper had been published by our Gov when Jeremy Hunt was health sec but it had been shelved.

Bosch or Roche ?

Not sure - I could have misheard, it was one of the 5pm briefings

Why is it we can all understand here about lag of reporting deaths, post mouths, establishing cause of death etc.
Yet we have journalists who actually can not understand we can't know accurate figures day on day.

Larry I can't read behind that paywall

However, mass testing significantly skews the average age of cases
Especially with drive-through testing and also testing within businesses, which skews heavily towards the under-65s

In Germany, anyone with mild symptoms can get tested, if their doctor thinks it possible they have CV

Those in the UK who are tested are in hospital, massively skewed towards the very elderly
Possibly the UK would have a similar "real" age of those infected, if it tested asimilar demographics

It should not be a surprise that a country who followed the classic pandemic strategy of mass testing, track, trace, monitor
and has the highest level & capacity of healthcare in Europe

does better than countries who don't

This is like "the harder I work, the luckier I get"

"Could the accepting of 600,000 Syrian refugees in 2015/16 have resulted in an increase in health facilities in Germany? "

No, Germany had a very high capacity for decades before that

It has always been a choice made to pay higher tax for a v high level of healthcare

"However it is also believed that the average infection age is actually lower in Germany. Unless you have a reason or source to dispute it?"

We do statistics, not belief
Until the UK has a similar test program, to find the milder cases, age comparisons are more guestimates

I have the daily reports from the RKI (German public health authorities) on age & sex distribution of cases and deaths

btw,
Germany includes COVID deaths from nursing and care homes

https://www.theguardian.com/world/2020/apr/14/care-homes-coronavirus-why-we-dont-know-true-uk-death-toll

which if anything should skew figures higher than th UK and most countries

Unless we see a comparison of figures from different countries of the ages of those being tested, I'm going to presume that younger people in the UK, being the ones likely to show fewest symptoms, are going to be underrepresented in a country where only those admitted to hospital have been tested. Therefore the average age of those with Covid in the UK is obviously going to be higher (according to official figures).

TheDozyProject that is a very clear chart, and worrying. An updated one to then end of April will probably show even greater differences.

Median ages of population:

The UK has a lower median age than most other W / N European countries

Italy: 47
Germany: 46
Spain: 45
France: 42
UK: 40

https://www.worldometers.info/world-population/population-by-country/

Been following for a while and thought I'd add the case/death graphs for Sweden. Testing regime is more like the UK than Germany but all covid deaths are counted not just those in hospital. Graph comes from here www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/bekraftade-fall-i-sverige

Bigchoc,

I do not understand your previous post. You have cited data which says the median age is 50, very close to the mean of 49 that I mentioned.

There are meant to be 2 factors at play. Initially, young and fit skiers brought the epidemic into Germany. Subsequently, it could be to do with more tests of healthier people.

However, the reality is that, out of cases with a median age of 49, the CFR is about 3%. For France, on the other hand, with a median (tested) age of 62, the CFR is between 10 and 11%. A large proportion of this observed difference is due to the median age of the tested cases.

We can speculate about the real size of the epidemic and median age of untested cases, but it seems unlikely that different health care, comparing 2 1st World countries, explains a difference of 3x the CFR.

@BigChocFrenzy - excellent analysis, thank you. The picture in the UK compares terribly. I wish I were in Germany!

@BigChocFrenzy thank you for that article, explains the situation perfectly, and i get so annoyed when the gov keeps saying we are tracking France.

Cfr is nonsense. Gold standard should be excess deaths.

More musings... not facts, sorry, but I just wonder:

So, Germany has a well funded healthcare system, and a fantastic manufacturing base. Their health system allows for the purchase of care from private companies, by their local authorities, and based upon need. Very de-centralised and flexible.

PHE does not run like that. Contrary to belief, very few services are actually "privatised" or contracted out. The British public will not tolerate it. So they try to do as much as they can in house. Hence the slow uptake of private offers of help with PPE, Ventilators, etc etc. They is now quite a lot of this in the system, but it hasn't been "approved" for use by the NHS yet . The failings of a centralised and highly bureaucratic system run by civil servants.

Not a popular view, but if we want a system like the Germans, we will have to pay more for it, but "privatise" the supply of healthcare, so we have capacity in the system.

Other things to note, our ICU/Ventilator capacity is still not exceeded, so that does not explain high death rate, Nightingale London still only has a handful of patients.

Japan (5th largest economy in the world) is asking citizens for donated raincoats due to lack of PPE.

Other things to note, our ICU/Ventilator capacity is still not exceeded, so that does not explain high death rate, Nightingale London still only has a handful of patients

Baah I found your post interesting re the NHS and also above.

It not at full capacity makes me wonder if the biggest increase to individual risk is the late response in U.K. v Germany.

Lock down slows it but neither Germany nor U.K. are trying to contain until vaccine (unlike eg NZ who may be).

I think more worryingly when services are contracted out, whether to private, state, not for profit/charities, the NHS have to go with the cheapest provider unless they can justify the higher price.

So call "world-class commissioning" under labour was already a race to the bottom. Localised commissioning under the tories, became a sprint. It was worst under Andrew Lansley, but Hunt and Hancock did n't change direction.

Larry I was pointing out that the median age of cases in Germany is around the median age of the population
So a more typical sample of the country

If the UK tested as much, there would probably be similar age distribution around the UK median.
As it is, the 80% of UK cases that are mild - moderate are being nearly all missed

You also ignore the fact that Germany and France include care home deaths, unlike the UK
So does Ireland, whose median age is closer to the UK than the other 2.

You missed all the other points I listed about what the UK does not do and should, but germany does:

Mass testing enables early monitoring
Early treatment - not the last gasp UK hospitalisation - means much higher survival rates
German hospital doctors interviewed keep banging on about how important it is to bring in cases as soon as there are breathing problems, to avoid ever needing ICU

Why is is so unacceptable to you that a country that still cannot manage the measures that epidemiologists and hospital specilaists recommend would do worse than a country that follows the advice ?

The UK should be doing better than most other countries:

more time to observe other countries, lower median age, GB with no land borders - e.g. Germany has 9,
UK #2 in the Global Preparedness Index for Pandemics ....

As long as there is this denial about the UK under-performing so much,
there will not be the pressure to make the necessary improvements

Is it possible that some of the excess deaths we’re seeing in the ONS figures represent people dying without getting thru on 111 or thinking they don’t need hospital yet? I am wondering if that’s an area we’re doing worse than Germany.

btw, I have read several reports claiming that Nightingale's are nearly empty because they have been given almost no medical staff of their own.

Hence they have to demand that hospitals send staff with any patient
Obviously most hospitals can't / won't do this

Has anyone a reliable source with name of medical professional to confirm or deny this ?