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Explainer: How does Ireland count Covid-19 deaths compared to other countries?

There have been more than 700 deaths attributed to Covid-19 in Ireland so far.

Tony Holohan provides figures at a Department of Health briefing
Tony Holohan provides figures at a Department of Health briefing
Image: RollingNews.ie

TO DATE, MORE than 700 people in Ireland have died as a result of Covid-19.

That official number is part of a global total of almost 180,000 people, but has been held up by some as an example that Ireland may not be doing as well as other countries in tackling the virus.

But international comparisons don’t always tell the full story. Different countries don’t all count deaths in the same way, so data isn’t consistent at an international level.

And other factors like population can also muddy the waters when it comes to analysing how each country is coping with the global pandemic. 

So how exactly are the statistics being tallied in Ireland and abroad? And can we infer anything from the number of comparative deaths internationally? 

WHO definition

Attributing a death to Covid-19 isn’t as straightforward as it might seem.

It may be obvious in some cases, such as when a previously healthy patient dies after becoming infected with Covid-19, but the process isn’t always that clear-cut.

Many deaths occur in hospitals and other settings where patients had other illnesses, or among those with chronic conditions, all of which complicates the process.

The World Health Organization (WHO) does provide guidelines on the classification of deaths related to the coronavirus, which also provide some clarity in situations involving those complicated cases.

According to those guidelines, a death due to Covid-19 is defined as:

a death resulting from a clinically compatible illness, in a probable or confirmed Covid-19 case, unless there is a clear alternative cause of death that cannot be related to Covid disease.

The WHO definition also says that where there is a period of complete recovery from Covid-19, a person’s death should not be attributed to the coronavirus.

Importantly, the organisation also says that deaths due to Covid-19 should not be attributed to another disease (such as cancer), but should be counted independently of any pre-existing condition that may have triggered a severe course of the virus.

That means that deaths from Covid-19 should be counted in those complicated cases, even when a person may have had another illness or chronic condition.

Different approaches

But despite this guidance, there are still a range of issues when it comes to accurately gauging the number of deaths due to Covid-19 around the world.

On a basic level, attributing deaths to Covid-19 is down to the judgement of individual medical workers in different facilities in different countries.

In the UK, the Office for National Statistics counts all deaths where Covid-19 is noted on a person’s death certificate, regardless of whether they were tested or not.

Meanwhile in the US, doctors who report deaths from Covid-19 to the Centers for Disease Control and Prevention (CDCP) are asked whether a patient died “as a result of this illness” – so those that may not have directly died from coronavirus could be omitted from official figures there.

There are further problems relating to whether someone who died from Covid-19 was even tested, or whether they were known to have had the virus when they died. 

This would have been particularly problematic a number of weeks ago, when the spread of Covid-19 across the world coincided with a global shortage of testing kits.

In Spain, officials previously reported that the deaths of some untested patients in private residences and nursing homes were not counted.

More issues have also emerged relating to those who have died in care homes and the community in other countries.

The UK in particular has attracted controversy for only counting those who die from Covid-19 in hospitals.

A report in today’s Financial Times, which analysed data from the Office for National Statistics, suggests that the UK’s death rate may be as high as 41,000, more than double what official figures are saying.

However, France is on example of a country which does include those who died in care homes in its daily Covid-19 figure. 

Such methods of calculation are ultimately down to different approaches, but reveal the range of difficulties that arise when it comes to comparing data internationally.

That’s before other considerations, such as miscalculations or omissions, are even accounted for.

Ireland’s approach

For its part, Ireland’s deaths are made up of people who passed away in hospital, nursing homes, and other residential settings.

The numbers are collated by the Health Protection Surveillance Centre (HPSC) and supplied to the Chief Medical Officer, Dr Tony Holohan, who reads them out at each daily coronavirus briefing.

The deaths due to Covid-19 that are announced are almost always lab confirmed; that is, the deceased has been positively identified as having Covid-19.

An exception to this emerged on Monday, when Holohan said health authorities had been informed of 77 ‘suspected’ deaths from Covid-19, where no test result had been forthcoming.

However, it should be noted that there can be delays between when a person dies from Covid-19 and when the National Public Health Emergency Team is informed of their passing.

This is simply down to practicalities: as mentioned above, establishing a cause of death is not always a straightforward process, and even when it happens, it takes time to notify the HPSC.

What’s more, authorities can be notified of a person’s cause of death up to three months after their passing, and not all deaths are notified until the end of that period.

This is what caused Holohan to release a separate graph of the 77 deaths announced on Sunday, showing how those deaths occurred over a period of several days.

Holohan has called for quicker registration of deaths in Ireland in order to gain a clearer picture of the impact of Covid-19 here, particularly in the country’s nursing homes.

International comparisons

As it stands, our wide-ranging approach, combined with a relatively small population, mean that international comparisons of death rate per capita usually make Ireland look like a poor performer.

John Burn-Murdoch of the Financial Times previously told TheJournal.ie that the use of cases or deaths per capita to benchmark a country’s performance can be misleading, because it tends to make smaller countries look like they are doing worse.

San Marino, Vatican City, Andorra and Luxembourg top the table when it comes to the number of confirmed cases per capita. The same measurement also places Ireland higher than Italy, which was once the global epicentre of the virus.

At the time of writing, Ireland also has a higher number of deaths per capita than the US, which has nearly twice the number of confirmed deaths as the next highest country, Italy.

Similarly, Ireland’s figure could also be adjusted if health officials took a similar approach to the UK and counted deaths in hospitals only.

Ireland currently ranks within the top 10 EU countries when it comes to the total number of deaths from Covid-19. But if we only counted deaths in hospitals, we would fall to 13th.

Ultimately, each country’s data has to be taken for what it is. International comparisons such as this are not a wholly accurate measure of a country’s approach.

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