Monitoring the mortality impact of COVID-19 in Europe: What can be learned from 2009 influenza H1N1p mortality studies?

Does ‘Data fudging’ explain the autocratic advantage? Evidence from the gap between Official Covid-19 mortality and excess mortality

Governments can underreport Covid-19 mortality to make their performance appear more successful than it is. Autocracies are more likely to ‘fudge’ these data since many autocratic regimes restrict media freedom and thus can prevent domestic media from reporting evidence of undercounting deaths. Autocracies also enjoy greater leverage over reporting health authorities to either fudge data or adopt restrictive definitions of what constitutes Covid-19 mortality. Controlling for other factors that explain official Covid-19 mortality, excess mortality and the difference between the two, our results suggest that any apparent ‘autocratic advantage’ in fighting the pandemic is likely to only exist in official Covid-19 mortality. Analyzing the gap between excess mortality and official Covid-19 mortality we find that autocracies on average have a larger gap between official Covid-19 mortality data and excess mortality data, which points towards ‘autocratic data fudging’ of their official Covid-19 mortality statistics.

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Autocracies have greater incentives and opportunity to underreport Covid-19 mortality.

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Excess mortality provides a check on the reliability of official Covid-19 mortality.

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Autocracies seemingly experience lower official Covid-19 mortality rates.

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Autocracies exhibit a larger gap between excess and reported Covid-19 mortality.

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More autocratic countries are more likely to ‘fudge’ their Covid-19 mortality data.

Estimates of mortality associated with seasonal influenza for the European Union from the GLaMOR project

BACKGROUND

The European Centres for Disease Prevention and Control (ECDC) estimates that seasonal influenzacauses 4-50 million symptomatic infections in the EU/EEA each year and 15,000-70,000 European citizens die of causes associated with influenza. We used modelling methods to estimate influenza-associated mortality for the European Union by age group and country.

METHODS

We compiled influenza-associated respiratory mortality estimates for 31 countries around the world (11 countries in the EU) during 2002-2011 (excluding the 2009 pandemic). From these we extrapolated the influenza mortality burden for all 193 countries of the world, including the 28 countries of the EU, using a multiple imputation approach. To study the effect of vaccination programs, we obtained data from the EU-funded VENICE project regarding the percentage of persons over 65 who were vaccinated in each country; the data ranged from 2% to 82% between the 21 countries which provided estimates for the 2006/07 reference season.

RESULTS

We estimated that an average of 27,600 (range 16,200-39,000) respiratory deaths were associated with seasonal influenza in the 28 EU countries per winter; 88% were among people 65 years and older, and the rates of mortality in this age group were roughly 35 times higher compared with those < 65 years. Estimates varied considerably across the EU; for example, rates in the elderly ranged from 21.6 (12.5-35.1) per 100,000 in Portugal to 36.5 (16.4-62.5) in Luxembourg, a difference of nearly 70%. We were unable to find a negative correlation between vaccination coverage rates and influenza-associated mortality estimates in the elderly.

CONCLUSION

Our EU estimate of influenza-associated respiratory mortality is broadly consistent with the ECDC estimate. More research is needed to explain the observed variation in mortality across the EU, and on possible bias that could explain the unexpected lack of mortality benefits associated with European elderly influenza vaccination programs.

Understanding the Geography of COVID-19 Case Fatality Rates in China: A Spatial Autoregressive Probit-Log Linear Hurdle Analysis

This study employs a spatial autoregressive probit-log linear (SAP-Log) hurdle model to investigate the influencing factors on the probability of death and case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) at the city level in China. The results demonstrate that the probability of death from COVID-19 and the CFR level are 2 different processes with different determinants. The number of confirmed cases and the number of doctors are closely associated with the death probability and CFR, and there exist differences in the CFR and its determinants between cities within Hubei Province and outside Hubei Province. The spatial probit model also presents positive spatial autocorrelation in death probabilities. It is worth noting that the medical resource sharing among cities and enjoyment of free medical treatment services of citizens makes China different from other countries. This study contributes to the growing literature on determinants of CFR with COVID-19 and has significant practical implications.

Years of life lost by COVID-19 in Portugal and comparison with other European countries in 2020

BACKGROUND

The impact of the COVID-19 pandemic has been measured in different metrics, mostly by counting deaths and its impact on health services. Few studies have attempted to calculate years of life lost (YLL) to COVID-19 and compare it with YLL due to other causes in different countries.

METHODS

We calculated YLL to COVID-19 from week10 to week52 in 2020 for eight European countries by methods defined by the WHO. We calculated excess YLL by subtracting the average YLL from 2017 to 2019 to the YLL in 2020. Our analysis compared YLL to COVID-19 and the excess YLL of non-COVID-19 causes across countries in Europe.

RESULTS

Portugal registered 394,573 cases and 6619 deaths due to COVID-19, accounting for 25,395 YLL in just 10 months. COVID-19 was responsible for 6.7% of all deaths but accounted for only 4.2% of all YLL. We estimate that Portugal experienced an excess of 35,510 YLL (+ 6.2%), of which 72% would have been due to COVID-19 and 28% due to non-COVID-19 causes. Spain, Portugal, and the Netherlands experienced excess YLL to non-COVID-19 causes. We also estimated that Portugal experienced an excess of 10,115 YLL due to cancer (3805), cardiovascular diseases (786) and diseases of the respiratory system (525).

CONCLUSION

COVID-19 has had a major impact on mortality rates in Portugal, as well as in other European countries. The relative impact of COVID-19 on the number of deaths has been greater than on the number of YLL, because COVID-19 deaths occur mostly in advanced ages.

[Monitoring of COVID-19 by extending existing surveillance for acute respiratory infections]

Im Rahmen der nationalen Influenzapandemieplanung wurden in Deutschland neben dem Meldewesen gemäß Infektionsschutzgesetz (IfSG) weitere Überwachungssysteme etabliert. Ziel dieser Systeme sind die Beschreibung, Analyse und Bewertung der Situation bei akuten respiratorischen Erkrankungen (ARE), die Identifikation der hauptsächlich zirkulierenden Atemwegserreger und die Beschreibung des zeitlichen Verlaufs. Seit Beginn der COVID-19-Pandemie wurden die Systeme erweitert, um auch Infektionen mit SARS-CoV‑2 erfassen zu können.

In diesem Beitrag werden drei verschiedene Surveillance-Systeme für ARE vorgestellt: GrippeWeb, die Arbeitsgemeinschaft Influenza mit dem SEED^ARE-Modul (Sentinel zur elektronischen Erfassung von Diagnosecodes) und das Krankenhaus-Sentinel ICOSARI (ICD-10-code-basierte Krankenhaus-Surveillance schwerer akuter respiratorischer Infektionen). Mit diesen Systemen können ARE auf Bevölkerungsebene, im ambulanten und im stationären Bereich überwacht werden. Zusammen mit dem Monitoring der Mortalität liefern sie wichtige Hinweise zur Häufigkeit verschieden schwerer Krankheitsverläufe in der Bevölkerung. Um die Systeme für SARS-CoV‑2 zu erweitern, waren nur wenige Anpassungen notwendig.

Da die Falldefinitionen für ARE nicht geändert wurden, können in den beschriebenen Systemen historische Zeitreihen zum Vergleich herangezogen werden. Alle Systeme sind so aufgebaut, dass stabile und etablierte Bezugsgrößen für die Berechnung von wöchentlichen Anteilen und Raten zur Verfügung stehen. Dies ist eine wichtige Ergänzung zum Meldewesen gemäß IfSG, welches stark von Testkapazitäten und -strategien sowie veränderten Falldefinitionen abhängt. Die Surveillance-Systeme haben sich in der COVID-19-Pandemie auch im internationalen Vergleich als praktikabel und effizient erwiesen.

Malaysia and COVID-19: In Data We Trust

The recent spike of transmissibility of COVID-19 was evident by a large number of COVID-19 cases and apparent quick spread of SARS-CoV-2 in the state of Sabah, Selangor and Negeri Sembilan in Malaysia. The question remains as to what are the main contributory factors for the impending COVID-19 second wave in Malaysia and why the current surveillance system fails to show signs of the impending second - or the third - COVID-19 wave. In public health surveillance, data are the ultimate indicator, and in the era of big data and the Industrial Revolution 4.0, data has become a valuable commodity. The COVID-19 data keeper must fulfil some criteria to ensure COVID-19 data are useful. Researchers are obligated to share their COVID-19 data responsibly. The surveillance for COVID-19 is paramount, and the guidelines such as the one published by the World Health Organization 'Public health surveillance for COVID-19: interim guidance' must be referred to. Data must be taken seriously and shared to enable scientists, clinicians, epidemiologists and public health experts fight COVID-19.