Why do some countries have such high cases but low death rates in comparison?

[Uhoh2020]

The worldometer figures are so confusing. Countries like India, Brazil, USA all have higher case numbers than us in the UK but the amount of deaths in comparison to cases is so much lower. Why is that? Surely it cant be down to our health care system as that is far from poor?
I know the UK deaths shown are deaths in settings not just hospital and also anyone who has died with a positive test is counted in the way we record the deaths. There will be a number of cases of deaths that would have happened anyway regardless of Coronavirus who happened to be positive at time of death.

I suspect it's because our case numbers are inaccurate and their death numbers are inaccurate.

If you look at the case numbers in the U.K

• we have zero idea how many test results have actually been returned, so is that 1000 positives out of 100,000 results yesterday or 1000 positives out of 2000 results yesterday?
• we have a figure for how many tests have been completed or posted. We know from previous info from the go to that they count nose and throat swabs separately so we can immediately halve the test number they present. How many of the posted tests get returned? How many are never received so get re-sent?
• look at any thread on here about whether people should self isolate and you will see loads of responses from people saying they wouldn't get tested and wouldn't self isolate as can't afford the time off work or think it's unnecessary, that's replicated on Twitter, Facebook, online news comments on articles......

To be honest I think a lot of those countries haven't peaked yet. Their populations are so much bigger than ours.

We don't know why yet. There's several possible causes -
Inaccurate reporting
Younger population
Propylactic treatment at early stage of the disease (I have heard Indian doctors have had some success here)
Factors influencing susceptibility (eg blood groups).
There's still a lot to learn, and unfortunately India and Brazil are still in a very active phase of the epidemic.

Less overweight people in those countries?

Less old people?

I think the figures are incredibly hard to compare.

Infection figures are entirely dependent on testing levels which vary widely so you can't really extrapolate a death rate from those. You could look at deaths vs population but that's not overly useful either because the spread of population in somewhere in the US is totally different to that in somewhere much smaller like the UK- Europe vs US might be a fairer comparison imo. You then have different countries reporting deaths differently in terms of which 'count' and which don't and so on. You also have less developed countries who don't have a grasp of their own true death figures, and certain governments that are unlikely to report accurate figures.

I'm not sure it will ever be clear.

Brazil & India have much higher % of young people than UK.

My DH works in the health sector in one of these countries. Very high cases but low numbers of deaths. Their population is very young and largely healthy. They locked down quite early and their health system is excellent and extremely well funded so they are able to treat everyone early on in the progress of the disease.

But also some of the medics there suspect that they have a different strain of the disease which is less deadly. I guess there are many different factors at play.

I think we are recording a lot of deaths here as Covid. people are going to hospital with serious things they would have died from Such as heart attacks, testing positive for covid and recorded as Covid. In other countries they are reported as a heart attack. I am aware of loads of cases of this especially in homes as well. It’s easier and no post Mortem necessary I think.

The UK has an unfortunate “perfect storm” of risk factors. We have one of the highest population densities in Europe, we are one of the most obese nations in Europe, we have an elderly demographic, we have a high proportion of diabetics, and we have a lot of BAME people working in high risk jobs such as the NHS and care homes.
If you have dark skin and live in Britain, it is almost impossible to absorb sufficient vitamin D from sunlight, so your immunity may be impaired if you don’t take supplements.
We were also slow to react in the early stages, and in the case of the SNP administration in Scotland actually concealed an outbreak in Edinburgh, failed to inform direct contacts, and allowed an infected conference delegate to spread it to the whole NE of England via a party in Newcastle. Not to mention also discharging hundreds of infected cases from hospitals to care homes without testing them, leading to carnage.
It is impossible to make fair comparisons between the UK and other countries until the pandemic is over, and we have the total death numbers corrected for population size, density and risk factors. And even then, third world countries will have very inaccurate recording. When poor people die in African slums, of any feverish illness, the locals tend to simply say it was malaria. It’s unlikely there would have been testing and diagnosis for patients who cannot afford healthcare in countries with no NHS.

They may also be testing more people than GB. If you only test people on the brink of death in hospitals then as a proportion of tested people the death rate is higher than if you test everyone. ie your population is 1000, 100 of them are sent to hospital and one in 10 of those in hospital die. If you test all 1000 your death rate is 1:100. If you only test those showing symptoms and are sent to hospital then your death rate is 1:10.

Not everyone is honest in their reporting. Not every country records every death, regardless of cause.

We are a bit blind as regards what is going on at the moment. Journalists can't really move around, so reporting seems to be based more on official information than investigation.

Once people can move around more, track down info, etc, I think truth will out.

Largely what Babadoc said.

Our government has an interest in hamming up "died with Covid" to justify a slow easing of lockdown against its social and economic costs. It needs to be seen to be worth the effort.
Countries such as Spain who are keen to attract tourists have an interest in trying to make cases look low and the hard lockdown more sucessful.

By the time you get to the newer slum growth in countries like India and Brazil, they have no official infrastructure in those areas and accurate data would be logistically be a nightmare to gather.

Our data gathering is different now to the start. We're testing on a suspicion or contact with Covid, rather than point of hospitalisation, so really we can't compare headline data with 3 months ago let alone other countries with different systems.

Based on antibody testing, UK cases are underestimated by at least 3 million; similar for Spain, Italy and Belgium.
Brazil and India case growth has only just started, deaths typically seem to lag by 3-4 weeks.
Younger population will have a big impact.
Not all countries are accurately reporting excess deaths, China will only report symptomatic cases etc.
Other factors will have an influence, but those are the big ticket items.

if underestimating by 3 million, what is the total you think have had it, MRex?

I thought the UK were only testing the most serious cases (ie hospital) for quite a while - this would obviously skew death rate upwards as the mild cases were not being recorded.

@flack - basic maths. The UK population is 66.7m, and the antibody tests are coming back fairly consistently as 5-7% of the population have antibodies, you can see both those stats on ONS. 66.7*0.05 = 3.3m. Roughly 300k known cases confirmed through testing symptomatic patients. That leaves ~3m additional cases.

If you’re interested in this sort of thing, listen to More or Less from Radio 4, on BBC Sounds. The whole of this series has been following CV statistical analysis. It’s the best programme!

Different countries have different criteria for testing.

Unless every country tests everyone and reports their figures accurately then comparing cases/deaths is completely pointless

In the UK there was very little testing earlier on - most tests were conducted on people in hospital already seriously ill.

In Russia and China there is evidence of drastic under-reporting of deaths -possibly by a factor of 10 or more.

Some countries are still ‘on the way up’ so deaths are going to increase.

Some countries have young populations and/or poorer health systems so fewer people with chronic conditions survive to die of Covid.

Multiple factors interacting in complex ways

If you subtract all the t2 how many deaths do we have?
How many people were t2 50y ago?

Other countries

• fortify food with vit d
• take cod liver oil
• thinner
• weather in countries
• more inflamatory conditions that are not being treated well in uk and some made worse by lack of vitamins.

Eg asthma we dont identify allergens so people smoke around their kids or have pets around them or eg feater duvet.
We dont treat thyroid issues until they are high.

Big population so everything done at scale and badly.
Even in normal times i couldnt book in for my dc to see someone overnight about an ear infection.
But ironically probably fewer of us smoke and that may be a bad thing.

It seems that BAME are not intrinsically high risk as deaths in. India and africa are lower than here.
So either racism/vit d/bad uk health or diet.

I don't know about other countries, but I wouldn't trust the data coming from India. There is lack of tests, so the numbers will be multifold. And the death numbers also won't be accurate at all. There must be people dying and they will never be reported because thy were never tested.
You need to have lived there to understand how horrible the situation it actually is there. And how you cannot trust any numbers.

Ah. I long thought 3 million (or 5%ish, anyway) was the known total since like... weeks ago. Didn't realise anyone believed it was only 300k.

I live in the Cayman Islands and we have a population of approx 60,000. We have 296 positives and 1 death with 22,000 people having been tested so far.

We have like 80% of our cases testing positive being asymptomatic as well. Due to mass screening of the population we are finding many asymptomatic cases. A lot of countries aren’t screening so are likely missing a lot of people that would test positive. This is partly due to WHO’s guidelines of only testing people with symptoms