ΟΝ CV19: SOME OBSERVATIONS ON DEATH RATES, NURSING HOMES

We can not escape the Media’s obsession with the Covid19 pandemic.  It sells copy and boosts viewership figures,  but too often these data are used  only to exaggerate politicized claims of one side or another.  Too often the headlines are:the “USA has the highest figures for Covid Deaths”.  

Mortality Rates Selected Natons April 30,2020

Country	Covid 19 Mortality	2020 Population	Mortality/Population	Mortality/Million
China	4,633	1,400,000,000	0.000003	3
Japan	442	126,000,000	0.000004	4
So. Korea	247	51,000,000	0.000005	5
Iran	5,877	84,000,000	0.000070	70
Germany	6,314	84,000,000	0.000075	75
Canada	3000	38,000,000	0.000079	78
Hubei Province Ch	4,633	59,000,000	0.000079	79
USA	59,266	320,000,000	0.000185	185
Netherlands	4,566	17,000,000	0.000269	268
UK	21,678	68,000,000	0.000319	318
France	23,660	65,000,000	0.000364	364
Italy	27,359	60,000,000	0.000456	455
Spain	23,822	47,000,000	0.000507	506
Belgium	7,331	12,000,000	0.000611	610
			μ = 216	216
Note that data fro China is represented twice
	Mean= 216,	MED = 172	Range=607	N=14

Figure 1. Chart of Covid 19 death rates for selected nations with crude data on mortality.

So what about the common use of raw cv19 mortality values  bandied about in the press as if these some how represented the nation’s state of epidemic readiness, political intention or technical ability, or as a means to characterize how a nation leadership is functioning  relative to the pandemic. 

Sadly the USA has experienced over 60,000 deaths (May 1, 2020) attributed to Coronavirus.   Italy is next with almost 30,000 deaths and France and Spain both record about 23,000 deaths. Belgium seems a bit better with only 7,000 deaths.  But what does this mean?  Not much.  

The raw figures are not “comparable”. They do not take into account the most obvious variable-the size of the population of the nation being evaluated.  . For a more meaningful look at these data one must take the population of that nation or entity into account by dividing the deaths (numerator) by the population (denominator) and multiplying by some standard value. In Figure 1 I chose to use the unit value of one million population. 

Figure 1 above records the raw data as well as a calculation of the deaths per one million population.  Population figures were taken from standard sources.  Rates of Covid 19 (cv19)  were resourced on the internet in various postings for April 29, 2020. . 

The Chinese values are those  reported in the media.  They at first seemed suspect since they were so far off values  for western democratic nations.  But when compared to other nations in Asia they apoear to be similar to those vales. So I included them.   I also included a calculation of the mortality/million population from  Huawei Province, China, (provincial capital city is Wuhan) since the Chinese reported that they actually encapsulated Wuhan and its surroundings in the early days of the outbreak.  Hubei’s provincial population values are those of a small nation. As well , they tend to coincide with several other nations of approximately the same size.  I included these data as well. They seem to suggest that China's data may have been reported accurately. The ability to ruthlessly seal of a province may have protected the rest of the nation from large scale outbreak of the disease. 

What stands out is that the USA,  though it has the highest raw number of deaths attributed to cv19  it is just about average (185/mill) when its population size is accounted for  on a per /million basis.

Casual evaluation of these data seem to reveal three different groups of nations.  The “Asian Group” which has reported single digit vales for deaths per million.  The “Canadian Group” with double digit figures for deaths/million and the “USA-Eu Group” which has values in the hundreds ranging from almost two hundred (USA) to 600 for Belgium . 

There must be many factors controlling these results.  One of these certainly is how the data is collected.  China for example as noted above is an authoritarian regime which can make decisions such as completer shut down and isolation of a province. That ability certainly must have had its effects on the outbreak.  Germany for example only records  Coronavirus deaths if the postmortem tests indicate the presence of the Covid 19 virus. That may skew it’s values to lower results. Other nations may over-counts cv19 deaths. Some claim Belgium does this. Iran’s  numbers are very close to those of Germany—both nations have near identical populations.  But two very different levels of medical care and care availability. Some claim that Iran’s figures may be  skewed by recording data from large city hospitals, while deaths in the countryside are largely underreported.  This seems very likely.  

Its obvious from what we now know of the virus that the age of the population is a powerful factor in mortality.  Older populations suffer more deaths. Further refinement of these data in Figure 1.  might be enhanced by evaluating the average age of the populations of nations, etc. .  In addition, we know that obesity and diabetes are important factors in mortality rates.  The Asian group may have lower mortality due to the fact that Asian populations are known to suffer very low rates of these two conditions which are very common in the USA-European group.  A glaring disparity between the Asian and USA-Eu groups may be the higher rates of diabetes and obesity in the latter countries.  Such evaluations should be pursued. 

Finally, the striking differences in mortality vales between  Asian and USA-EU nations may also be in good part attributed to the way western nation  treat the elderly.  In general, Asia cultures tend to hold the elderly in high respect and when they become infirm are cared for at home..often by family members.  In the west that is not the case.  In our modern society where everyone works there is no one home to care for the elderly.  Nursing homes and care homes have become  a major industry in the  modern era.  With the exception of Germany, where there are estimated two million elderly, but the vast majority (70%) are cared for at home by family members—the rest of the EU is quite different story.  Long term care homes  (UK) and nursing homes (USA) are a very large part of the social system. 

In the USA there are 15,600 nursing homes occupied by 1.4 million patients.  France has 7000  nursing homes /care homes where 600,000 elderly are cared for.   Belgium has 140,000 beds in nursing and care homes.  In Belgium it is claimed that as much as one half a of all deaths from cv19 occurred in nursing homes.  In Spain where there are 5,400 nursing homes 20% of cv19 deaths occurred in these homes.  In the UK there are 17,000 nursing homes and 400,000 residents.  

These nursing homes and care facilities have been hit very hard by the coronavirus pandemic. Here in New York State, in one of our most isolated communities, Greenport, Long Island on the eastern tip of the North Fork...a string of several deaths in a large nursing home in this community was reported when  the disease was unknown on the Island and very early in the pandemic.  In a suburb of  Syracuse, NY— far from the NY City hot spot—, a care facility there with 140 residential apartments were found to have ten percent of the residents infected with cv19.   Then too in NY State Gov. Cuomo (who famously observed that the virus was having a “feeding frenzy” in nursing homes) nevertheless mandated that recovering covid 19 patients be placed in nursing homes to complete  their recovery period. The results of this action were tragic.  These ‘recovering”  covid 19 patients —many still symptomatic and shedding viruses—were transported to nursing homes where the staff and facilities were not equipped with PPE or with trained personnel to protect the most vulnerable elderly residents from a deadly disease.  Thousands of these old and vulnerable folks tragically died in their beds.  So far gov. Cuomo has not been taken to task for this horrible error in judgement.  The USA has not tabulated the total deaths from nursing homes but they must be sizable. 

The toll on elderly trapped in nursing and care homes has not been confined to NY State or to the USA.  All over Europe we have herd of similar reports of dozens of elderly dying in nursing and care homes.  In Spain there were reports of many elderly dying in their beds and being abandoned there.   

Thus in conclusion is appears that the disparity in rate of deaths may be as many have said related largely to the health and age of the populations infected as well as cultural factors such as how we treat our elderly.