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UK surpasses Italy death toll but experts warn comparing countries is difficult

There are different ways of counting Covid-19 deaths, even within the same country.

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A man wearing a protective face mask and clothing in Westminster, London (Victoria Jones/PA)

A man wearing a protective face mask and clothing in Westminster, London (Victoria Jones/PA)

A man wearing a protective face mask and clothing in Westminster, London (Victoria Jones/PA)

The UK has passed Italy as the country with the most Covid-19 deaths in Europe, new figures show – but academics have warned that cross-country comparisons are “difficult”.

The latest data from the Office for National Statistics (ONS) shows that 29,710 deaths involving Covid-19 in England and Wales had been registered up to May 2.

Together with the latest equivalent numbers for Scotland (2,272 deaths registered up to April 26) and Northern Ireland (393 deaths registered up to April 29), it means a total of 32,375 deaths involving Covid-19 have now been registered across the UK.

But Foreign Secretary Dominic Raab told the Downing Street press briefing on Tuesday that 29,427 people in the UK who had tested positive had died.

The Government’s total is based on reported deaths of people who have tested positive for Covid-19, while the ONS total for registered deaths is based on all mentions of Covid-19 – including suspected cases – on a death certificate.

Both are now higher than the official number of Covid-19 deaths in Italy which stood at 29,315 as of 6pm on May 5, according to the Italian Ministry of Health.

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(PA Graphics)

(PA Graphics)

Press Association Images

(PA Graphics)

The full picture in both countries will not be known for some time, however.

With governments and health authorities across Europe taking different approaches to recording deaths – and the potential of some Covid-19 deaths not being recorded at all – it is impossible to know exact comparable death tolls at this stage.

And even in the UK, there are different ways of measuring deaths involving Covid-19.

The total number of Covid-19 deaths announced each day by the UK Government is not based on death registrations.

Instead it is the number of deaths that have been reported so far in all settings where there has been a positive Covid-19 test.

Professor Sir David Spiegelhalter, chairman of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said: “The one thing we can be certain of is that all these numbers are substantial underestimates of the true number who have died from Covid, and an even bigger underestimate of the number who have died because of the epidemic and the measures taken against it.

“I think we can safely say that none of these countries are doing well, but this is not Eurovision and it is pointless to try and rank them.

Approaches to recording deaths can vary greatly from country to country, such as the data entered on to a death certificateDr Michael Head, University of Southampton

“For example, apparently around half of Belgium’s deaths are people in care homes who have not been tested, and these would not feature at all in the daily UK figures.

“I believe the only sensible comparison is by looking at excess all-cause mortality, adjusted for the age distribution of the country.

“And even then it will be very difficult to ascribe the reasons for any differences.”

Dr Michael Head, senior research fellow in global health at the University of Southampton, said: “It is important to remember that cross-country comparisons are difficult.

“Approaches to recording deaths can vary greatly from country to country, such as the data entered on to a death certificate.

“The UK records direct and indirect causes of death plus also other contributing factors.

“There may be variation in how doctors record the impact of Covid-19 in any individual death on to those certificates, and this practice can vary from country to country – for example, are suspected Covid-19 cases included in the death statistics or is it purely confirmed cases?”

Italy went into lockdown on March 9 when Italian Premier Giuseppe Conte extended restrictions from the north to the entire country in an attempt to stop the spread of Covid-19, after the country’s death toll climbed to 463.

Boris Johnson placed the UK in lockdown on March 23, after the number of people who died in British hospitals after testing positive for the virus stood at 335.

I would say that making international comparisons is an unbelievably difficult thing to doProfessor Sir Ian Diamond

At the weekend, UK national statistician Professor Sir Ian Diamond said Britain has the “best reporting” of death data, as he also cautioned against making international comparisons.

Asked if the UK was heading for the worst death toll in Europe, he told BBC One’s The Andrew Marr Show: “I wouldn’t say that at all and I would say that making international comparisons is an unbelievably difficult thing to do.

“In this country, we have – in my opinion, and let me be clear I would say this, wouldn’t I – but I think we have the best reporting, the most transparent reporting, and the most timely reporting, because we include death registrations – we’ve been pushing our death registration reporting as fast as we possibly can.”

He added: “I’m not saying that we are at the bottom of any potential league table – it’s almost impossible to calculate a league table – but I’m not prepared to say that we’re heading for the top.”

Sir Ian also said indirect deaths that come on top of Covid-19 deaths are “not insignificant”, and warned that a “lengthy and deep recession” could lead to increased deaths.

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