Sweden? Japan? UK? The debates over who had a “good” Covid will not end | Francois Balloux

NOTNational Covid death rates are, inevitably, political. How could they not be when they are considered proof of good or bad government in matters of life and death? How did the UK fare compared to, say, Germany? Should the two countries have looked more like Sweden? However, when new data arrives, far from settling arguments about which pandemic mitigation strategies have worked best, it tends to further inflame disagreements or harden pre-existing positions.

The same goes for the much-anticipated report from the World Health Organization (WHO) on deaths associated with Covid, published last week. The WHO estimates that around 15 million more people died from the pandemic in 2020-21, about 2.7 times more than officially recorded deaths.

While surprising, the estimated excess deaths came as little surprise to those who have been following the situation closely. On the contrary, this estimate is lower than many might have expected. Indeed, two previous modeling efforts, by the Economist and the University of Washington, have suggested around 18 million additional deaths.

The fact that more people have died in the pandemic than have been officially recorded as Covid deaths should be largely indisputable. Many countries simply did not have the diagnostic infrastructure in place to identify every Covid death. The pandemic – and, to some extent, our response to it – has also been devastating to society and healthcare worldwide.

Now the WHO report appears to provide ammunition for virtually any narrative and is unlikely to verify the politicization of the Covid debate – in the UK or elsewhere.

For example, India’s own official estimate of excess mortality is about 10 times lower than the 4.7 million people reported by the WHO. Indian authorities have vehemently rejected the methodology used by the WHO and its estimate for their country. They even objected to the release of the report and released their own 2020 death figures two to three months ahead of schedule to offer a counter-narrative.

Here, many comparisons have been made with other countries to highlight the UK as the epitome of failure or a resounding success. In fact, according to the WHO report, the UK fared fairly mundanely. An estimated 109 additional deaths per 100,000 people put it 56th in the world for “best performing” countries and in the middle of the table compared to the European Union, ranking 15th out of the 27 EU member states. The UK’s estimated excess death toll is lower than Germany and Italy, but higher than France. According to WHO estimates, Germany significantly underestimated Covid deaths, France overestimated them and the UK was right, suggesting that the much-criticized ‘death within 28 days’ approach following a positive test” was a reasonable indicator of Covid death before the Omicron. vague.

Some countries have become synonymous in the public imagination with particular pandemic mitigation strategies. Sweden has been criticized by some for the lack of rigor in its measures and hailed by others as a shining example of how to protect the rights of its citizens while going through a health crisis.

To the possible disappointment of its supporters and detractors, Sweden’s estimated excess mortality of 56/100,000 is about half that of the UK and, although it is higher than that of other Nordic countries, it still looks flattering. compared to the majority of EU countries.

An additional reason why the WHO report will not settle many arguments stems from the fact that excessive Covid death figures are extremely difficult to measure accurately. Even in the absence of ideological disagreements, they do not offer simple, indisputable “follow the science” answers. Pandemic excess mortality represents the difference between the number of people who died, compared to a hypothetical number of people may be deadif the pandemic had not happened.

Actual death tolls are accurately recorded in high-income countries, but this is not necessarily the case in many parts of the world, where estimates can be crude. Obtain an accurate count for the hypothetical number of deaths that could have occurred due to the pandemic not arrived is even more difficult. (WHO relied on a fairly complex model and the extent to which some of its estimates may have been colored by modeling assumptions will be discussed and critiqued.)

The report paints a complex picture that does not support any simple and straightforward narrative. Which shouldn’t be too surprising. A single figure for each country is unlikely to capture all the complexity of very different socio-economic situations and two years of often inconsistent policies. Lower-middle-income countries in Eastern Europe and South America have been particularly affected, probably due to a relatively unfavorable age structure, low vaccination coverage and disruption of their economies and of their health systems. Wealthier countries tended to do better overall, with the exception of the United States, which fared rather poorly with an excess death toll of 144/100,000.

A few countries have maintained excess deaths close to zero or even below zero, including Australia, Iceland, Japan, Luxembourg, Mongolia and New Zealand. Being wealthy and geographically isolated helps.

The stringency of mitigation measures does not appear to be a particularly strong predictor of excess deaths. While countries that achieved a low excess of deaths tended to put in place fairly strict measures, Peru is the worst performer to some extent, despite enforcing the toughest and longest lockdown. This proved ineffective in reducing viral transmission and likely contributed negatively to excess deaths.

The findings of the WHO report will no doubt be thoroughly analyzed by pandemic planners, although they are unlikely to be of much use in informing actionable strategies “one-size-fits-all, one-size-fits-all”. science “. The main message is that wealthier, more insular countries kept excess deaths low by limiting the spread of Sars-CoV-2 until vaccines arrived, and then achieved high vaccination coverage among the elderly. These relative successes are largely based on pre-existing geographic and socio-economic benefits rather than unique, well-thought-out mitigation plans.

Read this way, the main goal of the WHO report boils down to reducing inequalities, improving health, and providing a strong health and social system that offers the best preparedness for a pandemic. It would be money well spent, even if the next one is slow to arrive.

François Balloux is the director of the Institute of Genetics at University College London

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