The second highest coronavirus death toll in the world? It’s a bit more complicated than that

The UK has now recorded 32,000 deaths with coronavirus, a figure that has just overtaken Italy, while the US total stands at about 70,000. This has already been seized on by Boris Johnson’s critics as proof that his response to the pandemic has been worse than anyone’s except Donald Trump.

However, the UK’s ranking in the league table of grief, and the reasons for it, are more complicated than that. Professor Chris Whitty, the chief medical officer for England, set some of them out at a government briefing last week.

First, different countries record deaths differently. Italy’s figure is likely to be an underestimate, as is China’s, currently standing at fewer than 5,000 deaths. Some countries are more likely to record Covid-19 or suspected Covid-19 with the death, and whether or not it is reported as the cause of death. A “death with coronavirus” is different from a “death from coronavirus”.

Second, the total figures take no account of the size of countries. The US, with a population five times that of the UK, has fewer deaths per million, while Belgium and Spain have higher rates. Nor do they take account of the age profile of the population, given that older people are more susceptible.

As Professor Whitty said, the figure needed to make comparisons is age-adjusted excess deaths from all causes per million. That means looking at the number of deaths above the average for the time of year (because deaths tend to be higher in winter), which strips out the need to establish whether coronavirus was the cause, and then to adjust for the size and age of the population.

An attempt by the Financial Times to measure excess deaths puts England and Wales, at 52 per cent higher than average this year, behind Italy (up 90 per cent), Spain (72 per cent) and Belgium (60 per cent), and the same as the Netherlands. France is 36 per cent higher than average, Sweden 23 per cent and the US 15 per cent. Other countries, such as Denmark, Germany, Israel, Norway and South Africa, have seen no significant increase in deaths compared with the average.

However, it is too early for such comparisons to be definitive, even where reliable figures are available. Although most countries have passed a peak in daily deaths, many more excess deaths are yet to come, and we do not know whether countries with low death tolls will be hit later, or whether those with high tolls will face second waves.

It will be longer still before we can be sure that the UK government’s response was inadequate. No one knows why some countries have been hit harder than others. Most of the supposed reasons have counter-examples: Italy and the US closed their borders early and were hit hard; Japan has a lot of old people and a low death toll. A New York Times investigation suggested international travel and random chance might have been two of the most important factors.

In the meantime, anyone who says it is “obvious” what the government should have done should wait. With hindsight, it seems likely that some measures would have reduced or delayed the spread of infections, but we cannot be sure. The only thing that could possibly have prevented people without symptoms from spreading it would have been a 14-day quarantine for all arrivals from abroad starting in January. I have been unable to find anyone who suggested such a thing at the time.