In Part 1 of this series, I discussed the way in which statistics about SARS-CoV-2 infections and COVID-19 are being reported in the media in a manner that lacks context and proportionality. When it comes to the reporting of deaths, those same issues – and more – apply.
Deaths
Magazine writer Eric Pooley’s gritty motto on news reporting,
”If it bleeds, it leads”
is nowhere more evident than in the breathless news updates on deaths attributed to COVID-19.
The first problem with the grim body count is again, the lack of context.
‘1000 deaths from COVID-19’ sounds absolutely horrific – just picture 1000 body bags, each with the corpse of a human being inside – but as every student of statistics knows, the first question one should ask is,
“What’s the denominator?”
In other words, what was the total population (denominator) out of which a certain number of people (numerator) died? If 1000 people died out of population of 10 000, this would be a catastrophe of truly Biblical proportions. But if 1000 people died out of a total population of 100 000 000, it’s a mere blip on mortality statistics.
[Important note: in discussing the statistics associated with the SARS-CoV-2 virus and COVID-19), I am fully aware that each person who has lost their life was a human being with (hopefully) a family who loved them and is now grieving their death. As I write this, my 88 year old mother lies in a hospital bed, recovering from a fractured femur. I am gravely concerned for her safety since she is in an extremely high-risk category for serious COVID-19 disease, being elderly, frail, hypertensive, asthmatic, has cardiovascular and cerebrovascular disease, and now has severely reduced mobility and is in an environment that is effectively an incubation tank for all manner of pathogens, including the common coronaviruses that carry off frail elderly people in their thousands, every year.]
The second question that needs to be asked in order to set COVID-19 death reporting in context is,
“What’s the background mortality rate?”
People die, every day. Actuaries – cheery souls that they are – have formulas that allow them to calculate your risk of death in the next month, year or decade, based on your current age, smoking and health status, body mass index and other data.
Statisticians keep track of the death rates in each population, which vary depending on the season, and epidemiologists use this expected, or background, mortality to ascertain whether a new virus is causing more deaths than would be expected given the time of year.
So when we hear that a certain number of people have died ‘from’ COVID-19 in a single day, we should set that in the context of the background mortality rate. Here are some examples of background mortality rates:
- Worldwide, around 153 000 people die each day.
- In Italy, up to 2000 people die each day.
- In Germany, around 2500 people die each day.
- In Britain, about 600 000 people die each year – roughly 1640 per day.
- In Australia, 1 person dies every 3 minutes and 11 seconds, equating to roughly 452 deaths per day.
Thus, in the 91 days from the first reported case of COVID-19 on January 10, 2020 to the day I’m writing this article (9 April), 13 923 000 deaths would have been expected to occur worldwide. The 58 791 deaths thus far attributed to COVID-19 amount to 0.42% of this expected number of deaths.
The 50 deaths attributed to COVID-19 in Australia since the first death reported on March 1 amount to 0.28% of the 18 080 deaths we would expect during this time period.
[Here is a detailed account of the ages and underlying health conditions of the Australians, who have died so far.]
See how important context is? Without it, the raw numbers are uninformative, if not downright misleading.
Professor Neil Ferguson, the lead modeller at Imperial College London, whose mathematical modelling has informed the policy approach of governments all over the world, has acknowledged that up to two thirds of people whose lives may have been spared by the UK lockdown will die anyway, within the year. Why would this be so? Because the vast majority of the people who are dying from COVID-19 infection are very old, very sick, or both, and consequently their life expectancy is relatively short.
Michael Levitt, the Nobel laureate and Stanford biophysicist whose mathematical modelling of the number of COVID-19 cases and deaths in China proved uncannily accurate, used data from the Diamond Princess cruise ship to estimate that
“Being exposed to the new coronavirus doubles a person’s risk of dying in the next two months”.
That sounds a horrifying news headline in the making… until you realise that, as Levitt explains,
“Most people have an extremely low risk of death in a two-month period, so that risk remains extremely low even when doubled.”
However, this risk rises with age. Professor Sir David Spiegelhalter, at the University of Cambridge, points out that
“Nearly 10% of people aged over 80 will die in the next year, and the risk of them dying [in that time period] if infected with coronavirus is almost exactly the same… Many people who die of Covid [the disease caused by coronavirus] would have died anyway within a short period ”
Leading epidemiologist, Dr John Ioannidis was blunt in his assessment of the world’s reaction to SARS-CoV-2:
“The global economy and society may get a major blow from an epidemic that otherwise accounts for less than 0.01% of all 60 million annual global deaths from all causes and that kills almost exclusively people with relatively low life expectancy.”
If you’re wondering about the discrepancy between the 0.01% of total deaths globally and the percentages of COVID-attributed deaths that I quoted above, it’s quite simple to explain:
Since every country that has experienced a SARS-CoV-2 epidemic is very clearly past the peak of infection (meaning that the incidence rate of new cases is declining), the proportion of annual deaths from COVID-19 will be far lower than the percentage of deaths occurring during the months in which the epidemic was at its height.
Deaths ‘of’ vs deaths ‘from’
But there’s an even more important issue with reported death rates from COVID-19, and that is that, contrary to customary internationally standardised procedures for coding deaths, currently all people who die after testing positive for SARS-CoV-2 are counted in the tally of deaths ‘from’ the virus.
Italy – the country that has provided more grist to the mill of ‘if it bleeds, it leads’ journalism than any other country affected by SARS-CoV-2 so far – provides the most graphic illustration of the serious distortions caused by this unprecedented approach to defining cause of death.
Professor Walter Ricciardi, scientific adviser to Italy’s minister of health, explained that:
“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.
On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus [my emphasis], while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three.”
In other words, if an 85 year old man who has smoked since he was 15 and has cardiovascular disease, type 2 diabetes and chronic obstructive pulmonary disease, suddenly becomes acutely ill, is admitted to hospital, tests positive for SARS-CoV-2 and subsequently dies, his death will be counted in the tally of COVID-19 mortality.
The absurdity of this situation should be self-evident. Such an individual is at high risk of dying of any infection he encounters; even a splinter in his thumb could be the end of him. And even if he doesn’t suffer an infection, his life expectancy is very short due to his comorbidities.
The median age of those whose deaths were attributed to COVID-19 was 78.5, while life expectancy in Italy is just over 83 years.
(Side note: ‘Healthy’ is defined as not having a pre-existing chronic disease; smokers and people who are obese will be classified as ‘healthy’ if they have not yet been diagnosed with a chronic disease.
A systematic review of the evidence so far found that smokers were 1.4 times more likely to have severe symptoms of COVID-19 and approximately 2.4 times more likely to be admitted to an ICU, need mechanical ventilation or die compared to non-smokers.
Obese individuals are at significantly increased risk of type 2 diabetes, hypertension and cardiovascular disease, which are frequently undiagnosed, and a study of Chinese COVID-19 patients found that having a body mass index (BMI) ≥28 kg/m² (i.e. overweight) was independently associated with almost 6 times the odds of experiencing severe illness.)
The same unprecedented practices for recording cause of death have been adopted in the UK. As recently-retired Professor of Pathology and NHS consultant pathologist Dr John Lee explains,
“If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections [my emphasis]. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections [my emphasis].
Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections [my emphasis].”
The impact of this change in the way that the causes of deaths are reported in the UK is clearly evident from the graph below, prepared by the Office of National Statistics, which shows a marked drop in the number of people dying from dementia, ischaemic heart disease, chronic lower respiratory disease and cerebrovascular disease in the month of March 2020, compared to the average numbers of such deaths over the previous 5 years.
People whose primary cause of death would previously have been listed on their death certificate as acute myocardial infarction (heart attack), Alzheimer’s disease, COPD or cerebrovascular accident (stroke) are now having COVID-19 listed as primary cause of death.
In Germany, deaths from SARS-CoV-2 infection are also conflated with deaths with the virus. Director of the Institute of Virology at the University Hospital in Bonnhas, Professor Hendrik Streeck, whose forensic examination of SARS-CoV-2 infections in the small German village of Heinsberg (which included taking air samples, smears from doorknobs, cell phones and remote controls, and even toilet water samples from infected homes), did not find “any live virus on any surface”, describes a particularly egregious example:
“In Heinsberg… a 78-year-old man with previous illnesses died of heart failure, and that without Sars-2 lung involvement [my emphasis]. Since he was infected, he naturally appears in the Covid 19 statistics. But the question is whether he would not have died anyway, even without Sars-2.”
In the same interview, Streek described the virus as
“not that dangerous.”
The health authority of the German city of Hamburg is now having each death in a person who has tested positive for SARS-CoV-2 forensically examined so as to count only genuine deaths from the virus in their tally. This change has reduced the number of deaths attributed to COVID-19 by up to 50% compared to the official figures of the Robert Koch Institute, which counts all deaths with the virus.
In the US, the Centers for Disease Control (CDC) has issued guidelines for recording deaths during the COVID-19 epidemic as follows:
“It is important to emphasize that Coronavirus Disease 2019 or COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to [my emphasis] death.”
Take a minute to read that again. A doctor is required to record a patient’s death as attributable to COVID-19 if they assume that the person died of or with SARS-CoV-2 infection. How might one assume such a thing without testing the patient? And on what basis should a doctor assume that the patient’s death was due to SARS-CoV-2 infection rather than to any other respiratory virus that can cause similar symptoms?
The same reporting requirements apply in Australia:
It is not hard to find any of the information that I’ve shared in this article. The fact that most journalists are not reporting on it is reprehensible.
German author and journalist Harald Wiesendanger is scathing in his criticism of his own profession:
“I am ashamed of my profession. I have been working as a science journalist with a focus on medicine for over 35 years. At any time I could stand by what I do for a living. However, if what the mass media deliver in the Corona crisis almost completely goes through as “journalism”, I don’t want to have anything to do with it anymore. If what they sell as “science” and pass on undigested to their target groups is all science, I will quickly vacate my area of work…
How a profession that is supposed to control the powerful as an independent, critical, impartial Fourth Estate can succumb as quickly as lightning to the same collective hysteria as its audience, almost unanimously, and give itself over to court reporting, government propaganda and expert deification: It’s incomprehensible to me, it disgusts me, I’ve had enough of it, I dissociate myself from this unworthy performance with complete shame. Truthfulness and careful research; Protection of honour and respect for the dignity of people – including those who have different opinions; counterchecking every source of information, no matter how credible it may appear at first glance; avoiding sensational images that could arouse exaggerated hopes or fears: all of this is one of the top priorities of every press code.”
Sadly, the majority of our media outlets have also abandoned their important role as the Fourth Estate. The public’s interest would be served by media committed to thoroughly investigating the SARS-CoV-2 epidemic and presenting helpful and correct information that equips people with the information to accurately assess their own risk level and take appropriate and proportionate precautions to protect themselves and their families without succumbing to panic, as well as demanding full transparency from political and medical authorities who are currently making decisions that impact on the civil liberties, livelihood and health of every citizen in this nation without disclosing any of the mathematical modelling that informs these decisions.
Instead, the majority of both commercial media outlets and the public broadcasters in this country are eagerly participating in fear-mongering and misinformation campaigns by:
- Failing to provide necessary context to incidence and mortality statistics.
- Focusing on ‘outlier cases’ to magnify the public’s fear that they may be at risk (“afflicting the comfortable”, as Finley Peter Dunne put it).
- Failing to ask our political leaders important questions about the evidence base for the strategy that this country has adopted, when a) other countries such as South Korea and Sweden are managing SARS-CoV-2 without lockdowns and massive infringements of civil liberties, and b) the peak of infection is clearly over, rendering all further attempts at containment useless.
I strongly recommend that you thoroughly vet your ‘media diet’, including your social media feed; a good place to start is the list of questions provided in the article On Corona, the Media, and Propaganda.
In Part 3, I’ll compare the incidence, morbidity and mortality of COVID-19 with influenza.
Remember, taking good care of your health is even more important than usual due to the high levels of stress generated by the world’s response to COVID-19, and the fact that people with pre-existing chronic disease, as well as smokers and people with obesity, are at higher risk of serious complications of infection.
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