Answering FAQs: Part 3

What can we tell from international comparisons? What is the ‘real’ death toll?

Anthony B. Masters


To help the Royal Statistical Society, I wrote answers to frequently asked questions about COVID-19.

Given my frequent posts on this topic, the answers were similar to words already written. The main constraint was a limit of 400 words.

What can we tell from international comparisons?

International comparisons are challenging.

There is no standard definition of a ‘COVID-19 death’. Countries count these figures in different ways.

Before mid-August, there were different definitions in the United Kingdom:

  • England (Public Health England): confirmed deaths in all settings. The person has a positive test result for SARS-CoV-2.
  • Wales (Public Health Wales): deaths in Welsh hospitals and care homes. The deceased person must have tested positive for the virus. A clinician must suspect the COVID-19 disease was a causative factor in the death.
  • Scotland (Public Health Scotland): confirmed deaths in all places. The person must have died within 28 days of their first positive test result. The Public Health Agency in Northern Ireland also uses this definition.

After a review by Public Health England, the changed measure uses the 28-day cut-off.

RIVM in the Netherlands counts “overleden COVID-19 patiënten” (deceased COVID-19 patients). This measure counts deaths in hospital with a positive test result. Sciensano in Belgium includes deaths where doctors suspect the deceased has COVID-19.

Countries can change definitions too. NHS England used to provide the figure for England. That was a count of only confirmed deaths in hospitals.

Interpretations are also difficult. Countries have different testing regimes. Processed tests affect the number of confirmed deaths. Tests can differ: false negative results reduce lab-confirmed deaths.

Travel influences seeds and outbreaks. How many people live close together affects how this virus spreads. Demography, cultures, and health policies differ.

Despite these challenges, countries can learn from each other during this pandemic.



Anthony B. Masters

This blog looks at the use of statistics in Britain and beyond. It is written by RSS Statistical Ambassador and Chartered Statistician @anthonybmasters.