Covid death rates are political. When they are seen as evidence for good or bad government on matters of life or death, how could they not be? The UK fare was compared with Germany. Should both countries have been like Sweden? When new data arrives far from resolving arguments over which strategies worked best, it tends to further inflame disagreements.
The report by the World Health Organization on Covid-associated deaths was released last week. According to the WHO, the number of deaths caused by the Pandemic will be around 15 million more than officially recorded.
The estimated excess deaths didn't come as a surprise to those who have been following the situation. This estimate is not as high as people may have thought. The University of Washington and the Economist have done modelling that suggests 18 million excess deaths.
More people died in the Pandemic than have been officially registered. Many countries didn't have the infrastructure to identify Covid deaths. The response to the Pandemic has been devastating to social and healthcare around the world.
The WHO report seems to provide a lot of information for any narrative and it is unlikely to check the politics of the Covid debate in the UK or elsewhere.
India's official excess death estimate is 10 times lower than the WHO's. The methodology used by the WHO and its estimate for India has been rejected by the authorities. They released their own death figures two to three months ahead of schedule to counter the narrative that they opposed publication of the report.
According to the WHO estimates, Germany significantly underestimated Covid deaths, France overestimated them and the UK got it about right
The UK has been compared with other countries to be either the epitome of failure or a roaring success. According to the WHO report, the UK has performed fairly poorly. It is ranked 56th in the world and 15th in the European Union in terms of excess deaths per 100,000 people. The UK's excess death toll is below Germany and Italy. According to the WHO estimates, Germany underestimated Covid deaths, France overestimation them, and the UK got it about right, suggesting that the much-criticised approach was a reasonable proxy for Covid.
Some countries became synonymous with their strategies for fighting the swine flu. Sweden has been praised as a shining example of how to protect the rights of its citizens while navigating a health crisis because of the lack of stringency of its measures.
Sweden's estimated excess death of 56/100,000 is less than the UK's, but it still looks flattering relative to the majority of EU countries.
Covid excess death figures are difficult to measure precisely, which is one of the reasons why the WHO report won't settle many arguments. They don't offer simple, incontrovertible answers even in the absence of ideological disagreements. Pandemic excess deaths are the difference between the number of people who died and the number of people who may have died.
The worst performer by some margin is Peru, despite enforcing the harshest, longest lockdown
In high-income countries, the number of deaths is accurately recorded, but it is not always the case in parts of the world where estimates can be unreliable. It is more difficult to get an accurate number for the number of deaths that may have occurred had the Pandemic not happened. The WHO relied on a fairly complex model and the extent to which some of its estimates may have been coloured by modelling assumptions will be critiqued.
No single straightforward narrative is supported by the report. It shouldn't be too surprising. A single number for each country is not likely to capture the full complexity of the situation. Lower-middle income countries in eastern Europe and South America have been badly affected by a relatively unfavorable age pyramid, low vaccination coverage and disruption to their economy and healthcare systems. The US did poorly with excess deaths, with the exception of Richer countries.
Australia, Japan, Luxembourg, and New Zealand all kept excess deaths close to zero. Being rich and geographically isolated helps.
The stringency of measures does not seem to be a good indicator of excess deaths. While countries that achieved low excess deaths tended to have fairly tight measures in place, the worst performer by a long shot is Peru. This was not effective at reducing viral transmission and probably contributed to the excess death toll.
The results from the WHO report will be analysed extensively by planners, though they are unlikely to be of much help to inform actionable strategies. The message is that richer countries kept excess deaths low by limiting the spread of sars-coV-2 until the arrival of vaccines and then achieved high vaccination coverage in elderly people. The relative success stories were built on pre-existing geographic and socio-economic advantages.
The main thrust of the WHO report is to reduce inequality, improve health and provide a robust social and healthcare system that is ready for the worst. Even if the next one takes a while to hit, that would be money well spent.
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