The Prime Minister has claimed “massive success” in reducing the death toll of Covid-19 in Britain. Meanwhile critics accuse the government of incompetence and say a late response to the pandemic has caused tens of thousands of avoidable deaths.
Who is right? We took the data from August 10 and crunched it every which way to better understand the UK’s performance. The results are not flattering but outbreak is far from over yet.
The raw death toll, the stuff of nightly news bulletins, is the simplest way to consider deaths in Britain. It’s just a count of the number of people recorded to have died from Covid-19. If we do this using the official data collected by Public Health England (PHE), we see that the UK has more Covid-19 deaths than any other country in Europe.
It is not just European countries we compare poorly to on this measure. As of August 10, the UK also had the fourth largest death toll from Covid-19 in the world. Only the US, Brazil and Mexico had officially recorded more deaths. Figure 2 Overall reported Covid-19 deaths in countries that have 30,000 or more confirmed Covid cases in the world. Source: Covid-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University.
But were you really at less risk from Covid-19 in the Netherlands (population 17.3 million), than in the UK where 66.7 million live? To know this, we need Covid-19 mortality per capita.
To calculate this, take the total number of people who have died from Covid-19, divide by the population of the country, and multiply by 100,000. This gives you Covid-19 deaths per 100K people and allows for a comparison between counties which takes the relative size of their populations into account. Using this metric on August 10, the UK had the second highest death count in the world and Belgium was the worst (1). In recent days, Spain has crept ahead of Britain.
For example, Belgium, which has most deaths per capita, counts all deaths which are “possibly related” to Covid-19 as Covid deaths and no test is required. The UK, in contrast, only counts deaths as Covid-19 deaths where the individual tested positive for the virus before they died.
One way of getting a less biased estimate of deaths is to look at how many more people died in each country compared to previous years in that country. This is known as “excess deaths”. If excess deaths are higher this year than in previous years it is assumed to be because of Covid-19.
This metric, say experts including the chief medical officer for England Professor Chris Whitty, is the clearest way to quantify deaths caused by Covid-19. It captures all deaths which were directly caused by Covid-19 but also those caused indirectly by the pandemic; where a person dies because they were unable to get medical treatment for a non-Covid condition such as a heart attack, for example.
On the excess deaths measure, the UK, like most other countries, seems to be under reporting overall Covid-related deaths. The official UK count on August 10 was 46,611 and excess deaths compared to previous years was 63,919.
For some countries including Germany, France, Sweden and the US, reported Covid-19 deaths match observed excess deaths. The UK on the other hand is among countries that seem to be significantly under reporting deaths compared to excess deaths. Other countries that seem to be under reporting deaths are Peru, Ecuador, Portugal and Spain. Switzerland and Belgium on the other hand seem to be over reporting Covid-19 deaths.
On August 12, PHE tweaked the way it defines a Covid death. Rather than counting any death which followed a positive test as a Covid death, it said only those deaths which occurred within 28 days of a positive Covid test would be counted.
There is logic to this - you don’t want to count a death from a road accident as a Covid death just because the individual had previously had Covid-19, for example. But the change has made the gap between the UK’s reported deaths and excess deaths even wider than before, cutting the number of total recorded deaths by more than 5,000.
So where does the UK stand if we rank countries by excess deaths per capita, the measure which Prof Whitty says the nation’s performance should ultimately be judged by? On this measure, the UK has the highest excess death rate in Europe. Globally it comes in third after Ecuador and Peru, although data is not available for all countries.
Figure 6 Excess deaths in European countries where data is available as of 10–08–2020. Source: The Economist’s tracker for Covid-19 excess deaths.
There is one final way of crunching the data. We can compare the number of people reported to have died of Covid-19 with the number who tested positive for the virus. This is also known as the “case mortality rate”.
A country that tests aggressively for Covid-19 will have a low case mortality rate, because it identifies mild infections as well as more severe cases. A country that tests fewer people on a per capita basis, however, will have a high case mortality rate because it is missing cases.
On this measure, the UK has the worst record in the world. The most likely explanation is that our testing regime, although improved, is still not picking up a very large number of positive cases. This is true, even if you discount cases early in the pandemic when the testing system was still being built, as the chart below shows.
So how has Britain performed? As of August 10, the UK had the highest confirmed Covid-19 death toll in Europe and the second-highest confirmed Covid-19 deaths per capita in the world.
On the better measure of per capita excess deaths, Britain had the highest count in Europe and the third highest in the world. The UK also has the worst case mortality rate in the world, reflecting its Covid testing capacity which remains relatively low.
But what of the economy? Some have suggested (against the historical evidence from the 1918 Spanish Flu Pandemic and other outbreaks) that there is a binary trade off between measures taken to protect lives and economic performance. That thinking may help explain why the UK’s pandemic preparedness plan, in common with others in the west, did not include the aggressive social distancing measures and stockpiles of PPE common to many south east Asian pandemic plans.
The pandemic is far from over and the picture may yet change but the UK also performs poorly in terms of relative economic loss. Death and the fear of death clearly correlate with a county’s ability to keep the cash registers ringing as the chart below shows.
The authors are: Dr Ghaith Aljayyoussi, is an MRC fellow at the Liverpool School of Tropical Medicine. Dr Kate Cross is a lecturer at the University of St Andrews.
 This is based on all countries with 2,000 cases or more. It is also based on the definition of Covid deaths prior to 12 August 2020. Based on the new UK definition of Covid deaths, we would have the fourth worst deaths/capita in the world after Belgium, Spain and Peru.