Cheerless Christmas
Cheerless Christmas
Covid-19 has forced the cancellation of Christmas plans around the world. But should it have? Is Covid-19 really as bad as the numbers suggest?
Although it was originally performed at Easter, Handel’s Messiah is now most often performed in the month before Christmas. In 2019, there were Messiah performances in many cities around the world, including London, Dublin – where Messiah was first performed – Nashville, Amsterdam, Cape Town, Tokyo, Sydney and of course in Wellington.
The 2020 Christmas season, however, has been different. Very few cities saw Messiah performances, and even fewer would have seen performances to an audience of more than 2000. So, when I walked onto the stage of a packed Michael Fowler Centre here in Wellington with other members of The Tudor Consort, I knew that I was remarkably privileged. The NZSO’s 2020 performance of Messiah, with conductor Gemma New, was a unique and special event at a time when Covid-19 was reaching record levels in many countries.
Those of us in New Zealand were privileged in other ways this Christmas too. We could go to shops, bars and restaurants without restrictions. We had no rules for how many people we could invite into our homes for Christmas dinner or any other celebration. We didn’t have to weigh up our desire to see our family with our fear that we could infect them with a dangerous virus. These are simple freedoms, and much of the world doesn’t have them right now.
A few months ago, I didn’t expect the situation in Europe and Britain would become this bad. In September, although there was a resurgence of Covid-19 in many European countries, it seemed that some were doing a reasonable job. Germany still had the disease under control and, despite some earlier signs that it was getting away, so did Italy. Croatia, and even Greece – which is hardly seen as a paragon of good governance – looked as if they had Covid-19 managed as well.
I really thought that we were making progress against this very tricky virus.
The good news didn’t last. A month later, Covid-19 was, again, out of control in Europe. Back in April, during the autumn peak, France had 200 new cases a day, and we thought that was bad. At the start of November, it was consistently reporting more than 600 a day. Croatia and Italy, which looked quite good in September, had caught up to Spain and Britain in terms of new cases per capita. Even Germany and Greece were seeing alarming rises in case numbers.
Although restrictions were imposed, and daily case numbers began to fall in many countries, the restrictions came far too late to prevent outbreaks many times worse than those in April. By December, Britain, Croatia, France and Spain all had death rates around 1000 per million people – truly horrifying numbers. In the USA, the rate was also around 1000 per million people, while in Italy it was 1200 per million. If those rates were applied to New Zealand, we would have lost at least 5000 people to Covid-19 by now.
It’s only by putting the numbers into context that we can really comprehend just how significant this pandemic is. The numbers are huge – nearly 85 million cases globally, 1.8 million dead, 60 million recovered, leaving 23 million people, about a third of the total cases, infected right now. But there are 7.8 billion people on earth, and many different causes of illness and death. How does Covid-19 really compare?
Last year, 55 million people died (compared to about 140 million people born, but that’s another topic). The leading cause of death was ischaemic heart disease, that is, diseases of the heart relating to a narrowing of the coronary arteries. Last year 9 million people died from ischaemic heart disease. The next most common causes of death were stroke (6 million) and chronic obstructive pulmonary disease, or chronic lung disease (just over 3 million). The fourth most common, and the leading communicable disease, was infection of the lower respiratory tract, that is, diseases like pneumonia and tuberculosis. These diseases killed just under 3 million people.
It’s immediately clear that Covid-19 is going to change the figures significantly for 2020. It can be classified as a lower respiratory infection, and if we do that, it pushes those diseases ahead of chronic lung disease, and into third place. If we keep Covid-19 as a separate category, it sits around 6 or 7 in the rankings, similar to cancers of the respiratory tract, and Alzheimer’s and other dementias.
If we look at wealthy countries alone, the figures are even more stark. In the USA, the leading cause of death is again heart disease, killing 655,000 in 2018, with cancers killing slightly fewer – 599,000. Covid-19, which has killed around 346,000 in the USA so far, easily comes in third, well ahead of accidents, which killed 167,000 in 2018.
For New Zealand, the leading causes of death are similar, even though the rankings and classifications differ slightly. Cancer was the leading cause of death in 2017, killing just under 10,000, with 4,800 dying from heart disease and 2,400 from strokes. Of course, Covid-19 has killed very few people in New Zealand, just 25 people, so it clearly won’t make much difference to our statistics. But if we had suffered the kinds of death rates seen in Europe and the USA, we would have lost 5000 to Covid-19, putting it ahead of all causes apart from cancer.
These numbers are startling, but there’s one other point which we need to take into account when we consider deaths from Covid-19. The disease is most dangerous in older people and those with pre-existing medical conditions, such as heart disease. In fact, there’s a very strong overlap between leading causes of death and underlying conditions which increase the risk of Covid-19. Perhaps Covid-19 is mostly killing people who would have died of other causes anyway. Perhaps, if we take that point into account, Covid-19 isn’t in fact as bad as it appears.
To understand whether that really is the case, we need to look at statistics for cause of death in 2020 and compare them to previous years. If there was a big drop in the number of people who died of heart disease in 2020, for example, that would be a clear signal that Covid-19 was replacing other causes of death. Unfortunately, we can’t do that just yet, because it takes a while for the data to be compiled and released, and the 2020 figures aren’t easily accessible yet.
What we do have, for some countries at least, is data on total mortality. If we compare the total numbers of deaths in previous years with the total numbers who have died in 2020, we can estimate how many more people have died this year compared to previous years – that is, if more have died at all. This figure is known as “excess mortality”, and it’s a far more important number to understand than the total numbers of cases and deaths.
There are still some issues with the excess mortality data. We can’t tell the impact of the most recent peaks in case numbers in Europe, because there is still a lag in reporting. But we can get a pretty good picture of what happened during the spring peak in Europe, back in April. And what we see makes it starkly clear. Croatia, Germany and Greece, which managed the virus effectively in April, saw barely any increase in excess mortality. Britain, France, Italy and Spain, which did not, saw huge increases in mortality during the April peak. Following that peak, those four countries did not see a corresponding drop in mortality, meaning that the peak wasn’t just a case of a whole year’s worth of deaths crammed into one or two months.
When we look at the total numbers, we also see evidence that Covid-19 is resulting in many more deaths than would have occurred otherwise. Britain has had just under 75,000 reported Covid-19 deaths, and the excess mortality is similar, around 80,000. This figure suggests that Britain’s reported number of Covid-19 deaths is reasonably accurate. Spain, in contrast, has only 50,000 reported Covid-19 deaths, but excess mortality at a level similar to Britain’s, meaning that the figures for Covid-19 deaths in Spain are badly underestimated. For Italy, though, there is a different picture. Italy has had a similar number of deaths to Britain, around 75,000, but excess mortality is only around 60,000. This suggests that, to some extent, Covid-19 is replacing other causes of death there.
Beyond Europe, the available figures for excess mortality suggest that the situation in Italy is relatively rare. The USA has had nearly 350,000 reported Covid-19 deaths, with excess mortality only slightly over that number. At least we can say that the USA has done a good job of reporting Covid-19 deaths. Mexico, very probably, has not. They have reported 125,000 Covid-19 deaths, but excess mortality is close to 200,000. It’s possible that some of the excess mortality is due not to Covid-19 itself, but to people dying of other causes who were unable to get treatment, or to health impacts from lockdowns and increased poverty. However it seems likely that at least some of the discrepancy is due simply to under-reporting. Russia is another country which has under-reported Covid-19 deaths in comparison to excess mortality. They’ve reported only 57,000 Covid-19 deaths, but their excess mortality is about 180,000. That’s a massive level of under-reporting.
But the USA, Mexico and Russia are large, populous countries, and so we’d expect them to have high numbers. To really understand what is happening, we need to consider excess mortality in relation to the total population size. Once we do that, some smaller countries start to show up in the statistics, with some very sobering numbers indeed.
The worst, by a margin of hundreds of deaths per million, are Peru and Ecuador, which have both had more than 2000 excess deaths per million people. Neither country’s outbreak has had much media attention. That may be partly because the official figures for Covid-19 deaths don’t seem quite as bad as excess. When the reported numbers are considered, Peru has still had a serious outbreak, with nearly 38,000 reported Covid-19 deaths, and 1,100 deaths per million people. But Ecuador is a long way down the list, with only 14,000 reported deaths, and 790 deaths per million people, ranked 30th in the world. Excess mortality shows us that the official figures for both Peru and Ecuador are a long way from accurate.
It’s a sobering reminder of just how dangerous Covid-19 can be. And, once again, it highlights how lucky New Zealand has been, to experience a normal Christmas in our South Pacific bubble. Stay safe, everyone.
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