International Comparability

How do countries count deaths with COVID-19?

As the pandemic progresses, journalists and the public compare COVID-19 deaths between countries.

This article discusses the problems of international comparisons in statistics. I also went on a podcast to talk about COVID-19 death statistics.

Death counts

News organisations claimed the UK has the highest COVID-19 death toll in Europe. This claim appears in Reuters, Daily Mirror, The Guardian, and elsewhere.

The European Center for Disease Control and Prevention (ECDC) is a common source. Our World in Data uses ECDC data for their COVID-19 analyses.

It is difficult for these kinds of sites to host all the necessary information. The measure sounds simple: the number of deaths with COVID-19.

What does each country’s figures mean? To answer this question, we must look at health institutes in each country.

United Kingdom

In the UK, the submitted figures come from the Department of Health and Social Care. The statistic is the number of deaths with a positive test for COVID-19. The count is for all places, including care homes and at home. Before 29th April, almost all reported deaths were in hospital.

This is what the UK government’s website says:

From 29 April, figures for deaths include all cases where there is a positive confirmed test for coronavirus. The figures include deaths with lab-confirmed COVID-19 in all settings, not just those in hospital, and this provides us with a single figure on an equivalent basis for the whole of the UK.

For England, Scotland and Northern Ireland: it is all confirmed deaths with COVID-19. For Wales, their count is of suspected deaths from COVID-19 in hospitals and care homes. All counted deaths must have a prior positive test result.

The Netherlands

The health institute in the Netherlands collates their statistics. The RIVM website states the death counts are with positive tests within hospitals and elsewhere (including nursing homes). The measure is “overleden patienten”, or ‘deceased patients’.

The graph is by date of death. (Image: RIVM)


Sciensano, the Belgian health institute, changed its measure on 30th March:

Inclusion of both confirmed and suspected COVID-19 deaths.

Belgium includes deaths where there is clinical suspicion, without lab confirmation of COVID-19.

There is a dashboard for Belgian COVID-19 data. (Image: Sciensano)

No standardised measures

There are no standardised measures. ‘How many people died with COVID-19’ sounds simple. Countries count these figures in different ways.

Even under the same definition, confirmed deaths may not be comparable. Countries have different testing regimes — which change over time. There are different tests, with different false negative rates. Confirmed cases affects confirmed deaths.

Interpretations are also difficult. How many people live close together influences the viral spread. Demography, cultures, social structures and health policies differ.

International comparisons are challenging. These comparisons should proceed with caution and without prejudice.

Countries can learn from each other in this pandemic. Given issues with comparability, we should avoid strong claims with macabre league tables.

After the pandemic, excess deaths will provide the cleanest way of comparing countries.

I was on the Full Fact podcast, talking about COVID-19 death statistics.

This is only the second podcast I have ever done. I was rather nervous.

Some of my answers meandered. I made an omission, saying “all deaths”, when I meant to say “almost all”. In future interviews, I need to get to the point and take natural pauses.

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

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