8 ms·

Looking at number of total deaths, it's possible a lot of countries are undercounting coronavirus deaths.

andialo 6y ago
It's also interesting to look at the trend. The daily number of deaths to the daily number of cases has dropped rapidly all around the world. Not sure why but it's a very good sign. If I saw this trend only in a handful of countries I'd say they are undercounting (FWIW I still think they are) but because we can see this in US, EU and Asia, it'd say virus is getting less deadly/treatment is getting significantly better.
- 488643689 6y ago
  Could also mean we test more people, register more mild cases.
  - acqq 6y ago
    > we test more people, register more mild cases. That, and the age structure of the infected changed: the older people are doing what they can to avoid the infection, if they are able to do that. Also, across the world, different measures are still in place, changing the dynamics of the spread, compared to the start of the pandemic when the spread was practically unconstrained. The dynamics of the spreading is also different in different settings. There's no any scientific reason to believe that "the virus" changed in any way biologically. It's the world that does its best to adapt. Also, the schools and the universities are not opened for students at the moment in many countries, also slowing down the spreading. Edit: answer to: "Viruses don’t mutate?" The coronaviruses have additional mechanisms to correct the copying, slowing down the mutations, compared to e.g. flu viruses. Edit2: answering: "The main reason for why Coronaviruses don't mutate much is because they don't have to": I wouldn't call that "the main reason", but it's a part of their success. Coronaviruses have longer genome than many other viruses, and having uncontrolled mutations in that longer genome would make them degrade too fast, so there is that molecular mechanism they have, correcting the copying errors. Additionally, they have other mechanisms to recombine their genetic material, something like "sex between (corona)viruses" where even more than two parents could be possible. But that's different from mutations and happens under different conditions. Knowing all that, and all that what est31 mentions, it is indeed true, the coronaviruses really simply don't need to "mutate fast." Edit3: "There different strains" is not true. They are different isolates, where the completely minor differences exist, but for all it is known, until somebody proves otherwise, and nobody has, there is still just a single "strain" of SARS-CoV-2. Edit4: Thanks to Gibbon1, yes, comparing with influenza is tricky, but maybe it's good to give readers the idea once again that this is surely not flu and that the viruses aren't the same and don't behave the same.
    - RalfWausE 6y ago
      Would it not be possible that through quarantine of infected people we "outbreed" the dangerous strains of covid19? People with symptoms going to be isolated, so their strain of the virus can not infect as much people as a hypothetical other strain which don´t produce symptoms... just an idea.
      - raducu 6y ago
        The problem is in as much as 50% of the cases, the same deadly virus causes no symptoms in some, so you really don't know if you are asymptomatic because of the strain or your immune system.
      - andialo 6y ago
        That would be my guess too. More testing does not explain falling CFR in South Korea for one thing.
        zaroth 6y ago
        Not ventilating people at the first sign of O2 dropping helps a lot.
    - nmfisher 6y ago
      > There's no any scientific reason to believe that "the virus" changed in any way biologically. Viruses don’t mutate?
      - simiones 6y ago
        They do, but there has been no sign of this one mutating in any significant way as far as I know.
      - est31 6y ago
        Viruses have mutations all the time in random places in their genome, in fact in the course of an infection you have a "quasispecies" of viruses in your body with a diversity of different genomes, but most of those mutations don't do anything relevant. Think of someone modifying a // comment in your code or adding/removing an empty if clause somewhere. In some viruses, mutation is very relevant to fighting the disease, e.g. for HIV it's immensely large. But for the Coronavirus the mutation rate is rather low, and even though it does mutate, no variant has been discovered yet that's functionally different to already existing variants. The main reason for why Coronaviruses don't mutate much is because they don't have to. While influenza constantly comes up with mutations so that it can come back seasonally, it seems that Coronaviruses take a different approach by evading adaptive immunity instead. E.g. feline Coronaviruses can infect cats over and over again, without large increases in ability for cats to fight it. That's also the case a bit for SARS-Cov-2, there are reports of humans getting infected a second time, but they are rather rare reports, we'd have far more of them if humans had no good adaptive immunity.
  - andialo 6y ago
    > Could also mean we test more people, register more mild cases. Note that the trend is worldwide. Even in countries with very high testing in the beginning. South Korea for one!
    - 488643689 6y ago
      Most countries got their shit together and infection rates decreased. That means the same test capacity is now testing less severe cases, more preemptively across the population. I also think it's unlikely to have the virus pathology synchronized across the world with current travel restrictions. Last time I checked the virus actually seem to feature some "dual gene pool" mechanics, which should make it more robust and adaptable to "fading out".
      - andialo 6y ago
        Also note that current CFR is lower than the PFR back in March in many regions!
- ArkVark 6y ago
  Herd Immunity: https://www.reuters.com/article/us-health-coronavirus-italy-antibodies/over-half-of-people-tested-in-italys-bergamo-have-covid-19-antibodies-idUSKBN23F2JV https://www.reuters.com/article/us-health-coronavirus-italy-... 57% in Bergamo province with antibodies. Italian lockdowns didn't stop COVID - human immune systems did. This also means for every 1 detected case, there were 46 actual COVID instances in Bergamo.
  - oarsinsync 6y ago
    > 57% in Bergamo province with antibodies. Should actually read 57% of a "random" sample of 9965 people who were tested in Bergamo province have antibodies.
  - rjtavares 6y ago
    Italian lockdowns stopped COVID from turning every city a Bergamo.
  - legulere 6y ago
    > Italian lockdowns didn't stop COVID - human immune systems did. That might be true for Bergamo, but certainly not for the rest of Italy, especially outside of Lombardy which had much lower infection numbers and death numbers. Having as many dead as in Bergamo everywhere (0.58% of the whole population according to a short google search) would be unacceptable.
  - raducu 6y ago
    Of course at some point, if the spread of virus is uncontained, the real numbers are going to be much higher than numbers of tests. If all of the world reached Bergamo stage, there would be no way to test 57% of the world population. That doesn't mean there are 46 * 18 million cases world wide -- the deaths would be catastrophic world-wide, just like they were in Bergamo.
  - sgt101 6y ago
    Blood donors in London ~17%, rest of UK ~10% in July; 45k deaths for <20% antibodies (which may or may not mean immune)... seems to me that without a lock down the UK at least would have been looking at 200k deaths before getting close to herd immunity. I'm not ok with that myself, but of course opinions may vary.
fiblye 6y ago
The NYT has a tracker for this: https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... A few countries are close enough to be considered accurate. Some are off by over 100%.
- swebs 6y ago
  Why isn't China on that list as well?
  - rjtavares 6y ago
    We don't have reliable information for how many people die in China per week, so we can't compare.
  - mensetmanusman 6y ago
    China has exactly hit their amazing numbers with pitch-perfect accuracy. Hail Mao!
- nwellnhof 6y ago
  The graphs only show actual vs. expected deaths and don't take any reported deaths from COVID-19 into account. They're simply about excess mortality, not about reporting accuracy.
  - creato 6y ago
    Yes, that's the point. Absent another explanation for unusual deaths, it seems likely they are due to COVID-19.
    - lixtra 6y ago
      Or people not going to the hospital in time because they are afraid of covid.
      - 6y ago
gvv 6y ago
Absolutely, just look at the numbers coming from China.
- spuz 6y ago
  What numbers?
est31 6y ago
This undercounting effect already happens each year with the seasonal flu, it's a known effect [0]. The number of total deaths increases larger than the number of people who have flu listed as medical cause on their death certificate. Technically, for the individual, it's correct that they didn't die from the flu, but it has weakened them enough for another looming danger to hit them prematurely. [0]: https://en.wikipedia.org/wiki/Mortality_displacement https://en.wikipedia.org/wiki/Mortality_displacement
- jtbayly 6y ago
  > Technically, for the individual, it's correct that they didn't die from the flu... I’m not sure this is accurate. From what I’ve read, many people simply aren’t tested. They are old, got pneumonia, and died. The cause of the pneumonia may have been any number of things, but some large proportion of them are expected to be flu during flu season.
m0zg 6y ago
Interestingly, the US is not one of those countries. If you tally up the excess deaths for the year (as per the public CDC data), they match C19 fatalities nearly exactly.
- p49k 6y ago
  Another commenter above linked to a NYT article that shows the US likely underreported by 20% from March-July.
- benaadams 6y ago
  Which means the US is undercounting C19 fatalities? Since lockdowns cut the flu season short; stopped all school shootings and most firearm deaths; cut traffic accidents etc
  - deleted 6y ago
    [deleted]
  - zaroth 6y ago
    I don’t think lockdowns cut the flu season short - how would they stop flu but not COVID in March? School shootings are not an appreciable cause of excess death, firearm deaths are mostly suicides which probably went up not down, similar to overdose deaths. More starkly, visits to the ER for strokes and heart attacks plummeted during lockdown. But there weren’t actually fewer strokes and heart attacks. Many of those people just died at home. In short, no one can say how many of excess deaths were COVID vs lockdown deaths, but it certainly isn’t the case that the “lockdown”‘category is actually a net negative.
- jtbayly 6y ago
  The mistake here is that the CDC data is incomplete until you go back about 8 weeks. So comparing today’s Covid deaths to the CDC’s current excess death number will never be accurate. Instead, take the numbers from 8 weeks ago for both and compare. What you will see is a significant gap.
mjul 6y ago
It is very important to be aware that there is no uniform way of counting these COVID-19 deaths. It is not just Iran. For example, I believe that Belgium has a very inclusive count (proven or suspected) and other countries count only if proven. This also means that some countries undercount when they have insufficient testing capacity. Also, with co-morbidities there is a choice whether to assign the cause of death to these factors or to COVID-19. If someone was dying from lung cancer and also contracted Covid-19 at the end what was the cause of death? So the rule of thumb is: don’t try to compare numbers between countries. And also note that in some cases you cannot event compare data locally: for example, in the UK, England and Scotland have different definitions.
- mjul 6y ago
  I might also add that the WHO (the Word Health Org, not the band) has issued guidelines about how to classify these deaths, including answering the question about co-morbidities. They recommend a very inclusive count. But to put that in a realistic perspective, it is a little bit like if you corporate Enterprise Architecture function published new guidelines for how to ensure data consistency across business units. Publishing a document does not make it so overnight.

It's also interesting to look at the trend. The daily number of deaths to the daily number of cases has dropped rapidly all around the world. Not sure why but it's a very good sign. If I saw this trend only in a handful of countries I'd say they are undercounting (FWIW I still think they are) but because we can see this in US, EU and Asia, it'd say virus is getting less deadly/treatment is getting significantly better.

488643689 6y ago
Could also mean we test more people, register more mild cases.
- acqq 6y ago
  > we test more people, register more mild cases. That, and the age structure of the infected changed: the older people are doing what they can to avoid the infection, if they are able to do that. Also, across the world, different measures are still in place, changing the dynamics of the spread, compared to the start of the pandemic when the spread was practically unconstrained. The dynamics of the spreading is also different in different settings. There's no any scientific reason to believe that "the virus" changed in any way biologically. It's the world that does its best to adapt. Also, the schools and the universities are not opened for students at the moment in many countries, also slowing down the spreading. Edit: answer to: "Viruses don’t mutate?" The coronaviruses have additional mechanisms to correct the copying, slowing down the mutations, compared to e.g. flu viruses. Edit2: answering: "The main reason for why Coronaviruses don't mutate much is because they don't have to": I wouldn't call that "the main reason", but it's a part of their success. Coronaviruses have longer genome than many other viruses, and having uncontrolled mutations in that longer genome would make them degrade too fast, so there is that molecular mechanism they have, correcting the copying errors. Additionally, they have other mechanisms to recombine their genetic material, something like "sex between (corona)viruses" where even more than two parents could be possible. But that's different from mutations and happens under different conditions. Knowing all that, and all that what est31 mentions, it is indeed true, the coronaviruses really simply don't need to "mutate fast." Edit3: "There different strains" is not true. They are different isolates, where the completely minor differences exist, but for all it is known, until somebody proves otherwise, and nobody has, there is still just a single "strain" of SARS-CoV-2. Edit4: Thanks to Gibbon1, yes, comparing with influenza is tricky, but maybe it's good to give readers the idea once again that this is surely not flu and that the viruses aren't the same and don't behave the same.
  - RalfWausE 6y ago
    Would it not be possible that through quarantine of infected people we "outbreed" the dangerous strains of covid19? People with symptoms going to be isolated, so their strain of the virus can not infect as much people as a hypothetical other strain which don´t produce symptoms... just an idea.
    - raducu 6y ago
      The problem is in as much as 50% of the cases, the same deadly virus causes no symptoms in some, so you really don't know if you are asymptomatic because of the strain or your immune system.
    - andialo 6y ago
      That would be my guess too. More testing does not explain falling CFR in South Korea for one thing.
      - zaroth 6y ago
        Not ventilating people at the first sign of O2 dropping helps a lot.
  - nmfisher 6y ago
    > There's no any scientific reason to believe that "the virus" changed in any way biologically. Viruses don’t mutate?
    - simiones 6y ago
      They do, but there has been no sign of this one mutating in any significant way as far as I know.
    - est31 6y ago
      Viruses have mutations all the time in random places in their genome, in fact in the course of an infection you have a "quasispecies" of viruses in your body with a diversity of different genomes, but most of those mutations don't do anything relevant. Think of someone modifying a // comment in your code or adding/removing an empty if clause somewhere. In some viruses, mutation is very relevant to fighting the disease, e.g. for HIV it's immensely large. But for the Coronavirus the mutation rate is rather low, and even though it does mutate, no variant has been discovered yet that's functionally different to already existing variants. The main reason for why Coronaviruses don't mutate much is because they don't have to. While influenza constantly comes up with mutations so that it can come back seasonally, it seems that Coronaviruses take a different approach by evading adaptive immunity instead. E.g. feline Coronaviruses can infect cats over and over again, without large increases in ability for cats to fight it. That's also the case a bit for SARS-Cov-2, there are reports of humans getting infected a second time, but they are rather rare reports, we'd have far more of them if humans had no good adaptive immunity.
- andialo 6y ago
  > Could also mean we test more people, register more mild cases. Note that the trend is worldwide. Even in countries with very high testing in the beginning. South Korea for one!
  - 488643689 6y ago
    Most countries got their shit together and infection rates decreased. That means the same test capacity is now testing less severe cases, more preemptively across the population. I also think it's unlikely to have the virus pathology synchronized across the world with current travel restrictions. Last time I checked the virus actually seem to feature some "dual gene pool" mechanics, which should make it more robust and adaptable to "fading out".
    - andialo 6y ago
      Also note that current CFR is lower than the PFR back in March in many regions!
ArkVark 6y ago
Herd Immunity: https://www.reuters.com/article/us-health-coronavirus-italy-antibodies/over-half-of-people-tested-in-italys-bergamo-have-covid-19-antibodies-idUSKBN23F2JV https://www.reuters.com/article/us-health-coronavirus-italy-... 57% in Bergamo province with antibodies. Italian lockdowns didn't stop COVID - human immune systems did. This also means for every 1 detected case, there were 46 actual COVID instances in Bergamo.
- oarsinsync 6y ago
  > 57% in Bergamo province with antibodies. Should actually read 57% of a "random" sample of 9965 people who were tested in Bergamo province have antibodies.
- rjtavares 6y ago
  Italian lockdowns stopped COVID from turning every city a Bergamo.
- legulere 6y ago
  > Italian lockdowns didn't stop COVID - human immune systems did. That might be true for Bergamo, but certainly not for the rest of Italy, especially outside of Lombardy which had much lower infection numbers and death numbers. Having as many dead as in Bergamo everywhere (0.58% of the whole population according to a short google search) would be unacceptable.
- raducu 6y ago
  Of course at some point, if the spread of virus is uncontained, the real numbers are going to be much higher than numbers of tests. If all of the world reached Bergamo stage, there would be no way to test 57% of the world population. That doesn't mean there are 46 * 18 million cases world wide -- the deaths would be catastrophic world-wide, just like they were in Bergamo.
- sgt101 6y ago
  Blood donors in London ~17%, rest of UK ~10% in July; 45k deaths for <20% antibodies (which may or may not mean immune)... seems to me that without a lock down the UK at least would have been looking at 200k deaths before getting close to herd immunity. I'm not ok with that myself, but of course opinions may vary.

fiblye 6y ago

The NYT has a tracker for this: https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav... A few countries are close enough to be considered accurate. Some are off by over 100%.

swebs 6y ago
Why isn't China on that list as well?
- rjtavares 6y ago
  We don't have reliable information for how many people die in China per week, so we can't compare.
- mensetmanusman 6y ago
  China has exactly hit their amazing numbers with pitch-perfect accuracy. Hail Mao!
nwellnhof 6y ago
The graphs only show actual vs. expected deaths and don't take any reported deaths from COVID-19 into account. They're simply about excess mortality, not about reporting accuracy.
- creato 6y ago
  Yes, that's the point. Absent another explanation for unusual deaths, it seems likely they are due to COVID-19.
  - lixtra 6y ago
    Or people not going to the hospital in time because they are afraid of covid.
    - 6y ago

gvv 6y ago

Absolutely, just look at the numbers coming from China.

spuz 6y ago
What numbers?

est31 6y ago

This undercounting effect already happens each year with the seasonal flu, it's a known effect [0]. The number of total deaths increases larger than the number of people who have flu listed as medical cause on their death certificate. Technically, for the individual, it's correct that they didn't die from the flu, but it has weakened them enough for another looming danger to hit them prematurely. [0]: https://en.wikipedia.org/wiki/Mortality_displacement https://en.wikipedia.org/wiki/Mortality_displacement

jtbayly 6y ago
> Technically, for the individual, it's correct that they didn't die from the flu... I’m not sure this is accurate. From what I’ve read, many people simply aren’t tested. They are old, got pneumonia, and died. The cause of the pneumonia may have been any number of things, but some large proportion of them are expected to be flu during flu season.

m0zg 6y ago

Interestingly, the US is not one of those countries. If you tally up the excess deaths for the year (as per the public CDC data), they match C19 fatalities nearly exactly.

p49k 6y ago
Another commenter above linked to a NYT article that shows the US likely underreported by 20% from March-July.
benaadams 6y ago
Which means the US is undercounting C19 fatalities? Since lockdowns cut the flu season short; stopped all school shootings and most firearm deaths; cut traffic accidents etc
- deleted 6y ago
  [deleted]
- zaroth 6y ago
  I don’t think lockdowns cut the flu season short - how would they stop flu but not COVID in March? School shootings are not an appreciable cause of excess death, firearm deaths are mostly suicides which probably went up not down, similar to overdose deaths. More starkly, visits to the ER for strokes and heart attacks plummeted during lockdown. But there weren’t actually fewer strokes and heart attacks. Many of those people just died at home. In short, no one can say how many of excess deaths were COVID vs lockdown deaths, but it certainly isn’t the case that the “lockdown”‘category is actually a net negative.
jtbayly 6y ago
The mistake here is that the CDC data is incomplete until you go back about 8 weeks. So comparing today’s Covid deaths to the CDC’s current excess death number will never be accurate. Instead, take the numbers from 8 weeks ago for both and compare. What you will see is a significant gap.

mjul 6y ago

It is very important to be aware that there is no uniform way of counting these COVID-19 deaths. It is not just Iran. For example, I believe that Belgium has a very inclusive count (proven or suspected) and other countries count only if proven. This also means that some countries undercount when they have insufficient testing capacity. Also, with co-morbidities there is a choice whether to assign the cause of death to these factors or to COVID-19. If someone was dying from lung cancer and also contracted Covid-19 at the end what was the cause of death? So the rule of thumb is: don’t try to compare numbers between countries. And also note that in some cases you cannot event compare data locally: for example, in the UK, England and Scotland have different definitions.

mjul 6y ago
I might also add that the WHO (the Word Health Org, not the band) has issued guidelines about how to classify these deaths, including answering the question about co-morbidities. They recommend a very inclusive count. But to put that in a realistic perspective, it is a little bit like if you corporate Enterprise Architecture function published new guidelines for how to ensure data consistency across business units. Publishing a document does not make it so overnight.