Tracking the coronavirus: why does each country count deaths differently?

France only records Covid-19 fatalities in hospitals, Spain does not include unconfirmed cases in senior homes, and the Netherlands only tests hospitalized patients

A coronavirus patient in Germany is transferred by helicopter to hospital.
A coronavirus patient in Germany is transferred by helicopter to hospital.Marcel Kusch (GTRES)
Elena G. Sevillano

The enormous differences between Covid-19 fatality rates in different countries raise questions about the way countries are tracking their own coronavirus outbreaks.

Numerous hoaxes are making the rounds on social media regarding how Germany and the Netherlands are “sweeping bodies under statistical rugs” and the UK is “asking permission from the deceased’s relatives to decide whether they are included in the official count.”

But epidemiology experts warn that governments are not tracking coronavirus deaths properly. In Spain, for instance, deaths of untested people in private homes and senior residences are not being included, say regional officials.

And then there is the added problem of determining the true number of coronavirus infections. When very few people get tested, as is the case in Spain due to a shortage of testing kits, the percentage of deaths over total infections comes out higher, leading to elevated fatality rates.

Testing and recording

Most of the scientific community is assuming that in the absence of greater detection – 429,526 tests had been conducted between the beginning of the outbreak and March 28 – the real number of both deaths and infections could be much higher than what is being officially reported.

Italy is counting all patients who tested positive and who died, regardless of other aspects of their clinical history, following criteria from the Higher Institute of Health.

In the United Kingdom, until the epidemic became apparent, when a patient died in the hospital from a respiratory disease, the direct cause of the infection was not reported unless legally required, as in the cases of anthrax, botulism, malaria or tuberculosis. Since March 5, Covid-19 has been included on that list as well. But most tests have been done at hospitals or on people with severe conditions. When the number of confirmed cases reached around 500, British health authorities warned that the reality could be closer to anything between 5,000 and 10,000.

Nursing homes

In France, authorities have only been counting deaths at the country’s 600 hospitals and clinics caring for Covid-19 patients. This leaves out elderly people who die at home or at one of the 7,000 long-term care homes that operate in France. But when news of multiple deaths in French nursing homes emerged, President Emmanuel Macron announced that these centers would be tracked starting this week.

Something similar is happening in Spain, where at least 352 people had died at nursing homes until last Thursday, according to data collected by EL PAÍS, given that the Health Ministry does not provide figures. This newspaper has reported on the plight of seniors at understaffed and under-resourced nursing homes across the country.

In Germany, where the fatality rate is only 0.72%, there has been some controversy over the fact that the figures provided daily by the Robert Koch Institute (RKI) show a delay over those released by Johns Hopkins University, which is tracking the disease worldwide. A source at RKI told EL PAÍS that “all deaths connected to the Covid-19 disease are registered in the notification data: those who died directly from the disease and those with underlying diseases who got infected, when it is impossible to clearly prove the ultimate cause of death.” This source said that victims can be tested post mortem, but did not clarify whether all suspected Covid-19 deaths are getting an autopsy.

And in the Netherlands, tests are only conducted on hospitalized patients. The agency in charging of tracking the disease says that the real number could be higher.

With additional reporting by Rafa de Miguel, Enrique Müller, Lorena Pacho, Silvia Ayuso and Isabel Ferrer.

English version by Susana Urra.

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