Comparing figures on corona infections and mortality can be misleading
The number of people dying in Belgium from the effects of the Coronavirus (COVID-19) is higher than in neighbouring countries. This high mortality rate makes it seem as if Belgium is not doing as well as its neighbours. The Dutch newspaper De Volkskrant even reported on 17 April that Belgium is the European leader in terms of the number of deaths. In the Netherlands, on the other hand, the statistics agency CBS reported that the actual number of deaths in a week is up to twice as high as officially reported. The figures from Germany are also surprising for many experts. To this day, it is a mystery why the mortality rates in Germany are so low. How is it possible that the differences between these three countries are so great? In order to find out, we need to take a closer look at the statistics and the way in which corona infections are reported.
Registered number of corona deaths on 24 April*.
*: based on various measuring systems. Sources: RKI.de, RIVM.nl and Sciensano.be
Belgium: suspicion of contamination also counts
When you consider that Germany has almost 8 times as many inhabitants as Belgium and 5 times as many as the Netherlands, the difference with Germany is very big. For Belgium, the reported hospital deaths were all persons infected with the Coronavirus. Of the reported deaths in residential care centres, however, it is not possible to say with certainty that they were infected. For the vast majority (92%) of these deaths in residential care centres, it is only a suspicion of infection. Only in a fraction of these deaths is corona actually identified (8%).
It should therefore be clear that it cannot be said with certainty that all reported deaths are also the result of contamination with the corona virus, let alone that all deceased persons were actually infected. In the meantime, there has been some political upheaval in Belgium, because the high number of figures would put Belgium in a bad light internationally, while others are of the opinion that in this way Belgium distinguishes itself as the country that does not withhold anything and reports in the best and most thorough way.
The Netherlands counts only infected cases
The Netherlands National Institute for Public Health and the Environment (RIVM) also publishes daily up-to-date figures on the Corona virus, more specifically the number of people tested positive, hospital admissions and deceased persons. The RIVM has already noted that the figures only include cases that tested positive for Corona. The official figures therefore only include deaths in hospitals where it is certain that there was contamination. Figures for so-called ‘excess deaths’ (the difference between the deaths during the Corona virus and what is ‘normal’) show that there are large numbers of ‘invisible’ corona deaths, particularly in institutional households (nursing homes, asylum seekers’ centres, etc.). It is for this reason that on Easter Monday, the Consortium of General Practitioners called on Dutch general practitioners to report hidden coronary deaths by also reporting those deaths for which there is a strong suspicion of Corona.
In Germany more persons are tested
The Robert-Koch Institute (RKI) only uses the official cases reported to the health authorities in accordance with the German Infection Protection Act (IfSG). However, unlike in the Netherlands, a lot of testing takes place in care centres. An explanation why the ratio of infected people to deaths in Germany is more favourable is clear: because in Germany many more people with mild complaints are tested than in the Netherlands and Belgium, the group with serious consequences is smaller. It was also suspected that the age of infected people is lower in Germany than in other countries. According to various sources (RKI, media), the situation regarding early testing was better than in neighbouring countries. Testing of many people and isolation, which is also one of the reasons given by the director of the Rober-Koch-Institut Lothar Wieler for the relatively low mortality rates (Kölner Stadtanzeiger, 31.3.2020).
Difficult to make a comparison
Itit is clear that a country comparison is not easy to make because the basis is not the same. Therefore, in order to make a meaningful comparison between countries, comparable figures should also be used. There is no point in comparing the figures from Belgium and the Netherlands at the moment, because the countries report in a different way as far as care centres are concerned. But of course there is no competition going on between the countries. Every death, wherever it occurs, is one too many.
It is even more dangerous to evaluate and compare national policies on this. Even the big differences with Germany have to be interpreted very cautiously at the moment. Only when, at a later stage, more is known about the effects of different measures will it be possible to better analyse the national measures. However, a more uniform way of reporting could be a basis for better comparison of national policies in the future. In addition, it would help to create well-coordinated policies across borders. Policy coordination between countries is particularly important for border regions. To achieve this, it is necessary to at least talk about the same facts.
By Ruben Tans, Pim Mertens and Martin Unfried. Researchers at Institute for Transnational and Euregional cross border cooperation and Mobility / ITEM