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There a few possible (and reasonable) explanations in the HN comments, one more is that often covid-19 leads to pneumonia and that may be what is attributed as

There a few possible (and reasonable) explanations in the HN comments, one more is that often covid-19 leads to pneumonia and that may be what is attributed as the cause of death, (nefarious or not). I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Another possibility is that medical resources are being monopolized by covid patients, or people don't want to go to hospital for fear of catching it themselves. This situation is still caused by covid but wouldn't be shown in the reported deaths from covid. The article brings up a valid concern, but doesn't explore any other possibile explainations which is irresponsible when people are already panicking.

goatlover 7y ago
The numbers really don't seem consistent across all the countries. Just one example is the death rate in Germany is 0.9% while the death rate in Spain is 8.5%, nearly a magnitude of difference with both countries have several 10s of thousands of cases, and that number varies between the two extremes all over the continent (and world).
- ekianjo 7y ago
  There are multiple variables at play. For example in Italy there is a high percentage of people living with their parents in the age 20-40s bracket, which should lead to more elderly contamination. Also the health services between Germany and Italy should not be even comparable in terms of equipment and capacity.
  - goatlover 7y ago
    Do you think that's enough to account for a 146 to 6 difference in deaths per million between Spain and Germany?
    - ekianjo 7y ago
      In Italy the hospitals were overwhelmed so you should expect the mortality to increase very fast when you can't even give basic treatment to patients in need. The same thing happened in Wuhan and that led to massive death toll. But as I said, many variables at play and we will surely have a better understand of what mattered the most to prevent mortality.
    - coldtea 7y ago
      After you run out of ventilators the sky is the limit when it comes to deaths. When you still have ventilators, only a few very elderly/unlucky die... So a country with 10,000 cases and 1,000 ventilators can have 20 deaths, and another with 10,000 cases and 500 ventilators might have 400 -- if of the 10,000 cases in both 520 need ventilator... (and some die, whether with ventilator or not, but many wouldn't if they had ICU/ventilator treatment).
      - scarmig 7y ago
        Medical system capacity and utilization explain the vast majority of the variation in mortality among different countries, after accounting for stage of the epidemic. When things are not above capacity, mortality is 0.5% or less. After reaching capacity, mortality jumps 10x or more. Age distribution can only account for variations within, at most, a factor of two.
        goatlover 7y ago
        So Spain's (and France's to a lesser degree) medical system got overwhelmed that much faster than Germany's or the UK's?
        marvin 7y ago
        They might have been very late with testing. I know this was barely on the radar in France even 2-3 weeks ago. MRSA has also been suggested as a component.
      - petertodd 7y ago
        You'll need to back up the claim that "only a few very elderly/unlucky die" What % of people actually survive after being on a ventilator? Because I've seen various studies and anecdotes of this for C19 specifically, with results ranging from "basically no-one" to "80%, at least temporarily, but hardly anyone is actually out of hospital yet so maybe they're going to die later". Beyond C19, this study suggests roughly something like 50% long-term survival IIUC: https://www.ncbi.nlm.nih.gov/pubmed/26003390 https://www.ncbi.nlm.nih.gov/pubmed/26003390 Ventilators are invasive things that themselves can do lung damage. Fairly common for people to choose not to go on them in end-of-life directives.
  - Udik 7y ago
    > health services between Germany and Italy should not be even comparable in terms of equipment and capacity. Italy's health care is among the best in the world, and Lombardy's is several points above the Italian average. Germany has apparently 2.6 times the amount of IC beds available in proportion to the population- in the Covid epidemic this should offset the reach of maximum capacity by a week.
- gregoryl 7y ago
  You can't compare those numbers without an in-depth understanding and comparison of who is being tested in each country.
  - goatlover 7y ago
    Which means the numbers are not consistent.
    - BurningFrog 7y ago
      I'd just say the numbers are different.
      - gregoryl 7y ago
        I like to thing of it as a unit problem. The numbers are presented as x "items", but the definition of "items" for each of the numbers is not consistent (or, even, actually known).
      - goatlover 7y ago
        Another case in which the numbers are oddly (one might say "suspiciously") different are the UK's number of critical patients (163) compared to their known number (19522), which is very low at 0.8% compared to France's 11.5%. That's a massive difference in the number of seriously critical patients, given that the UK has a sufficiently large sample size now.
        tomp 7y ago
        > critical patients What does that even mean? The UK isn't testing unless you need hospital care (or you're special, e.g. Prince Charles, Boris Johnson, Idris Elba), aren't all of those patients somewhat critical? Or is "critical" just "hooked up to a ventilator" in which case it could be limited by the number of ventilators instead?
- voisin 7y ago
  I read that Germany is not testing the dead, so if someone wasn’t tested while alive then their death is attributed elsewhere. Italy is testing the dead to get a more accurate picture. I find it baffling that there isn’t an international standard for testing in a situation like this so that we can get a handle on what is actually going on. If we don’t have data, how can we possibly draw inferences and learn anything?
  - krona 7y ago
    There are international standards and the standard is that flu is not normally considered a cause of death. It's not realistic to expect autopsies to be performed and coroners reports to be written on every person who dies of pneumonia during an epidemic.
    - voisin 7y ago
      And yet I understand this is what is happening in Italy where the suspected cause of death is Covid19. If we don’t make it realistic to expect this (during a pandemic), then how can we trust the numbers?
  - goatlover 7y ago
    Right, for example what if there is a second strain going around that is obscured by the large inconsistencies in testing and reporting?
- Symmetry 7y ago
  Wildly different case fatality rates might be caused by the same infection fatality rate if milder infections are systematically less likely to turn into medical cases in some countries. Compare the age distribution of infections in Iceland versus the Netherlands for instance. https://twitter.com/alexandreafonso/status/1243557013759700997 https://twitter.com/alexandreafonso/status/12435570137597009... We have every reason to think that just as large a fraction of the 10-19 year olds in the Netherlands have gotten this in the Netherlands as in Iceland but when it stays as a cough and light fever many medical regimes are never going to test those cases. And countries have different demographic profiles, though not enough to explain a 10x difference. And medical systems get overwhelmed in some places which could possibly be up to a 10x difference in a really cases.
- bugzz 7y ago
  A huge factor here is time. 3 weeks ago I saw a bunch of people saying "Look, South Korea tested a lot of people, finding the majority of the mild cases, and thus only has a death rate of 0.5%". Since then, however, deaths/cases in SK has risen to 1.59%, and increasing daily. They don't have many new cases, what's happening is the cases from 3-4 weeks ago are dying. Germany has tested a lot and found a lot of cases earlier in the disease progression. I'm sure their death rate will rise like S.K.'s did. Not all the way to the 8% - 10% we see in Spain and Italy, but I'd guess up to 2%.
ekianjo 7y ago
> I did hear rumors of Japan doing this intentionally to make it look more under control than it was. That is probably happening in Japan because of lack of testing (it's almost impossible to get tested) and ultimately "up to the physicians" - and as you mention it's also possible there are some strict government guidelines to make it look less serious than it actually is, but who knows...
guscost 7y ago
> people don't want to go to hospital for fear of catching it themselves To be exact, this group of deaths would be caused by the fear of COVID, as you say.
- harikb 7y ago
  How about we at least track those deaths caused by unavailable treatment or postponed, but critical surgeries. If my community is affected I don’t care if Covid is killing us directly or indirectly. They all should be counted at least under a different category. Ignoring them would like claiming puerto rico only had 100 deaths from hurricane
  - guscost 7y ago
    The "direct/indirect" distinction is very important because once we have more perspective on this disaster, we should try to find out whether the alarm and the various extreme measures helped or not, and to what extent. I'm not saying that we should ignore the downstream effects of the pandemic, I'm saying the opposite - we should look at them with extreme scrutiny.
    - goatlover 7y ago
      Exactly. That would be very helpful for the next pandemic.
ddevault 7y ago
>I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Tangental note, but this caught my eye. It's exactly the kind of comment I would expect to hear in a movie about a global disaster. "I hear Japan is hiding their numbers", "I hear China has a secret cure", "I hear Missouri is untouched by all of this", "I hear..." I would appreciate it if we avoided this kind of hearsay on HN during these difficult times.
- ekianjo 7y ago
  Then it would be good to explain clearly why Japan is such a large outlier while Korea was not. And please no "they wear masks" and "they wash hands" bullshit, because there are no more masks in Japan for months now and hygiene is approximative at best - and apart form closed schools it's pretty much business as usual in Japan so there is virtually no reason why the virus would not run its course here as well.
  - ddevault 7y ago
    >Then it would be good to explain clearly why Japan is such a large outlier I decline. It might be what coopsmgoops suggests, or it may be something else. I don't posess the facts and therefore I won't speculate on matters of public health.
  - m3kw9 7y ago
    Japanese ppl don’t like touching each other they don’t really shake hands socially but they bow when saying hello and good bye. That is not the main reason but things like this in a culture adds up. Japanese is also exceptionally clean
    - haltingproblem 7y ago
      I would appreciate if you can breakdown how cleanliness in Japan (say vs. the US) helps stop (propagate for the US) the spread of the Corona Virus. I have seen the Japan is exceptionally clean argument which is independent of the Japanese don't like to touch each other and are less touchy-feely as a culture (hugs, handshakes, etc. ) than Western countries.
ars 7y ago
> I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Japan, Iran, South Korea, and maybe China are all fuzzing their numbers: https://aatishb.com/covidtrends/?country=Australia&country=Canada&country=China&country=France&country=Germany&country=India&country=Iran&country=Italy&country=Japan&country=Pakistan&country=South+Korea&country=Spain&country=Switzerland&country=US&country=United+Kingdom https://aatishb.com/covidtrends/?country=Australia&country=C... Notice how they are the outliers compared to a ton of countries.
- ShorsHammer 7y ago
  South Korea has tested more citizens than anywhere else on Earth. That's for a population of 50 million. Are you sure they are "fuzzing" their numbers or a matter of confirmation bias here?

goatlover 7y ago

The numbers really don't seem consistent across all the countries. Just one example is the death rate in Germany is 0.9% while the death rate in Spain is 8.5%, nearly a magnitude of difference with both countries have several 10s of thousands of cases, and that number varies between the two extremes all over the continent (and world).

ekianjo 7y ago
There are multiple variables at play. For example in Italy there is a high percentage of people living with their parents in the age 20-40s bracket, which should lead to more elderly contamination. Also the health services between Germany and Italy should not be even comparable in terms of equipment and capacity.
- goatlover 7y ago
  Do you think that's enough to account for a 146 to 6 difference in deaths per million between Spain and Germany?
  - ekianjo 7y ago
    In Italy the hospitals were overwhelmed so you should expect the mortality to increase very fast when you can't even give basic treatment to patients in need. The same thing happened in Wuhan and that led to massive death toll. But as I said, many variables at play and we will surely have a better understand of what mattered the most to prevent mortality.
  - coldtea 7y ago
    After you run out of ventilators the sky is the limit when it comes to deaths. When you still have ventilators, only a few very elderly/unlucky die... So a country with 10,000 cases and 1,000 ventilators can have 20 deaths, and another with 10,000 cases and 500 ventilators might have 400 -- if of the 10,000 cases in both 520 need ventilator... (and some die, whether with ventilator or not, but many wouldn't if they had ICU/ventilator treatment).
    - scarmig 7y ago
      Medical system capacity and utilization explain the vast majority of the variation in mortality among different countries, after accounting for stage of the epidemic. When things are not above capacity, mortality is 0.5% or less. After reaching capacity, mortality jumps 10x or more. Age distribution can only account for variations within, at most, a factor of two.
      - goatlover 7y ago
        So Spain's (and France's to a lesser degree) medical system got overwhelmed that much faster than Germany's or the UK's?
        marvin 7y ago
        They might have been very late with testing. I know this was barely on the radar in France even 2-3 weeks ago. MRSA has also been suggested as a component.
    - petertodd 7y ago
      You'll need to back up the claim that "only a few very elderly/unlucky die" What % of people actually survive after being on a ventilator? Because I've seen various studies and anecdotes of this for C19 specifically, with results ranging from "basically no-one" to "80%, at least temporarily, but hardly anyone is actually out of hospital yet so maybe they're going to die later". Beyond C19, this study suggests roughly something like 50% long-term survival IIUC: https://www.ncbi.nlm.nih.gov/pubmed/26003390 https://www.ncbi.nlm.nih.gov/pubmed/26003390 Ventilators are invasive things that themselves can do lung damage. Fairly common for people to choose not to go on them in end-of-life directives.
- Udik 7y ago
  > health services between Germany and Italy should not be even comparable in terms of equipment and capacity. Italy's health care is among the best in the world, and Lombardy's is several points above the Italian average. Germany has apparently 2.6 times the amount of IC beds available in proportion to the population- in the Covid epidemic this should offset the reach of maximum capacity by a week.
gregoryl 7y ago
You can't compare those numbers without an in-depth understanding and comparison of who is being tested in each country.
- goatlover 7y ago
  Which means the numbers are not consistent.
  - BurningFrog 7y ago
    I'd just say the numbers are different.
    - gregoryl 7y ago
      I like to thing of it as a unit problem. The numbers are presented as x "items", but the definition of "items" for each of the numbers is not consistent (or, even, actually known).
    - goatlover 7y ago
      Another case in which the numbers are oddly (one might say "suspiciously") different are the UK's number of critical patients (163) compared to their known number (19522), which is very low at 0.8% compared to France's 11.5%. That's a massive difference in the number of seriously critical patients, given that the UK has a sufficiently large sample size now.
      - tomp 7y ago
        > critical patients What does that even mean? The UK isn't testing unless you need hospital care (or you're special, e.g. Prince Charles, Boris Johnson, Idris Elba), aren't all of those patients somewhat critical? Or is "critical" just "hooked up to a ventilator" in which case it could be limited by the number of ventilators instead?
voisin 7y ago
I read that Germany is not testing the dead, so if someone wasn’t tested while alive then their death is attributed elsewhere. Italy is testing the dead to get a more accurate picture. I find it baffling that there isn’t an international standard for testing in a situation like this so that we can get a handle on what is actually going on. If we don’t have data, how can we possibly draw inferences and learn anything?
- krona 7y ago
  There are international standards and the standard is that flu is not normally considered a cause of death. It's not realistic to expect autopsies to be performed and coroners reports to be written on every person who dies of pneumonia during an epidemic.
  - voisin 7y ago
    And yet I understand this is what is happening in Italy where the suspected cause of death is Covid19. If we don’t make it realistic to expect this (during a pandemic), then how can we trust the numbers?
- goatlover 7y ago
  Right, for example what if there is a second strain going around that is obscured by the large inconsistencies in testing and reporting?
Symmetry 7y ago
Wildly different case fatality rates might be caused by the same infection fatality rate if milder infections are systematically less likely to turn into medical cases in some countries. Compare the age distribution of infections in Iceland versus the Netherlands for instance. https://twitter.com/alexandreafonso/status/1243557013759700997 https://twitter.com/alexandreafonso/status/12435570137597009... We have every reason to think that just as large a fraction of the 10-19 year olds in the Netherlands have gotten this in the Netherlands as in Iceland but when it stays as a cough and light fever many medical regimes are never going to test those cases. And countries have different demographic profiles, though not enough to explain a 10x difference. And medical systems get overwhelmed in some places which could possibly be up to a 10x difference in a really cases.
bugzz 7y ago
A huge factor here is time. 3 weeks ago I saw a bunch of people saying "Look, South Korea tested a lot of people, finding the majority of the mild cases, and thus only has a death rate of 0.5%". Since then, however, deaths/cases in SK has risen to 1.59%, and increasing daily. They don't have many new cases, what's happening is the cases from 3-4 weeks ago are dying. Germany has tested a lot and found a lot of cases earlier in the disease progression. I'm sure their death rate will rise like S.K.'s did. Not all the way to the 8% - 10% we see in Spain and Italy, but I'd guess up to 2%.

ekianjo 7y ago

> I did hear rumors of Japan doing this intentionally to make it look more under control than it was. That is probably happening in Japan because of lack of testing (it's almost impossible to get tested) and ultimately "up to the physicians" - and as you mention it's also possible there are some strict government guidelines to make it look less serious than it actually is, but who knows...

guscost 7y ago

> people don't want to go to hospital for fear of catching it themselves To be exact, this group of deaths would be caused by the fear of COVID, as you say.

harikb 7y ago
How about we at least track those deaths caused by unavailable treatment or postponed, but critical surgeries. If my community is affected I don’t care if Covid is killing us directly or indirectly. They all should be counted at least under a different category. Ignoring them would like claiming puerto rico only had 100 deaths from hurricane
- guscost 7y ago
  The "direct/indirect" distinction is very important because once we have more perspective on this disaster, we should try to find out whether the alarm and the various extreme measures helped or not, and to what extent. I'm not saying that we should ignore the downstream effects of the pandemic, I'm saying the opposite - we should look at them with extreme scrutiny.
  - goatlover 7y ago
    Exactly. That would be very helpful for the next pandemic.

ddevault 7y ago

>I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Tangental note, but this caught my eye. It's exactly the kind of comment I would expect to hear in a movie about a global disaster. "I hear Japan is hiding their numbers", "I hear China has a secret cure", "I hear Missouri is untouched by all of this", "I hear..." I would appreciate it if we avoided this kind of hearsay on HN during these difficult times.

ekianjo 7y ago
Then it would be good to explain clearly why Japan is such a large outlier while Korea was not. And please no "they wear masks" and "they wash hands" bullshit, because there are no more masks in Japan for months now and hygiene is approximative at best - and apart form closed schools it's pretty much business as usual in Japan so there is virtually no reason why the virus would not run its course here as well.
- ddevault 7y ago
  >Then it would be good to explain clearly why Japan is such a large outlier I decline. It might be what coopsmgoops suggests, or it may be something else. I don't posess the facts and therefore I won't speculate on matters of public health.
- m3kw9 7y ago
  Japanese ppl don’t like touching each other they don’t really shake hands socially but they bow when saying hello and good bye. That is not the main reason but things like this in a culture adds up. Japanese is also exceptionally clean
  - haltingproblem 7y ago
    I would appreciate if you can breakdown how cleanliness in Japan (say vs. the US) helps stop (propagate for the US) the spread of the Corona Virus. I have seen the Japan is exceptionally clean argument which is independent of the Japanese don't like to touch each other and are less touchy-feely as a culture (hugs, handshakes, etc. ) than Western countries.

ars 7y ago

> I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Japan, Iran, South Korea, and maybe China are all fuzzing their numbers: https://aatishb.com/covidtrends/?country=Australia&country=Canada&country=China&country=France&country=Germany&country=India&country=Iran&country=Italy&country=Japan&country=Pakistan&country=South+Korea&country=Spain&country=Switzerland&country=US&country=United+Kingdom https://aatishb.com/covidtrends/?country=Australia&country=C... Notice how they are the outliers compared to a ton of countries.

ShorsHammer 7y ago
South Korea has tested more citizens than anywhere else on Earth. That's for a population of 50 million. Are you sure they are "fuzzing" their numbers or a matter of confirmation bias here?