Thread by @axelheitmueller, Attempt to understand differences / #Covid19 experience. Data comparability is challenging, and [...]

Attempt to understand differences

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom">/

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> #Covid19 experience. Data comparability is challenging, and inevitably some of this may need further scrutiny. However, I do think there are a number of issues which warrant a discussion

1/16 (sorry)

Comparing some key indicators (

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom">/

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany">):

Cases +test
220/173k

Gender
M 56/48%
W 48/52%

# ICU beds used at peak
54%~3.3k (England)/<10% ~ 2.8k
Note:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> 5x #ICU beds

Covid in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> hospital beds at peak 20k

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> had 5k of Covid+ hospitalised at peak (not the same as beds)

2/16

Mortality in ICU
46/28% (!)

Ventilated in ICU
64/66%

% of all death
>70yrs 86/86%

Care home deaths
25/33%

3/16

Excess death (see @ft @jburnmurdoch and @ChrisGiles_ for great analysis generally)

61%

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom">/6%

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany">
50k/4.8k

i.e. without Covid

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> would have had negative excess deaths(?) For

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> depends on how many of the excess deaths are actually Covid but untested
4/16

Conclusions:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> has 46% higher ICU and 10x excess mortality and more patients in ICU. Age and gender distribution broadly similar.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> has fewer cases even when compared to low testing levels in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> making it likely that true

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> number much higher.
5/16

Particularly likely given that only 20% of

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> cases needed hospital where most

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> testing took place.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> therefore likely to have seen much worse outbreak.

Potential hypotheses:
6/16

a)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> contained #Cvoid19 better/earlier and had fewer cases (

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> has higher cases even with low testing and potentially more in hospital). One conclusion might therefore be

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> simply has more cases, end of it.
7/16

b)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> had a more severe virus while

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> had milder and more asymptomatic cases – not sure there is much evidence for different severity of virus itself and we don’t yet know antibody levels at pop level though various studies underway
8/16

c)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> has fewer high-risk groups - BMI (

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> ranks 36,

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> 76 in world), BAME (

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> has hardly any) lower density (237/275 sqkm) London 4.5k/Berlin 3.9k sqkm; but

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> has higher per capita/km use of public transport (1.9/1.6k km/yrs)…
9/16

…no data on mortality amongst different occupational groups in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> to compare with recent ONS analysis https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/coronaviruscovid19relateddeathsbyoccupationenglandandwales/deathsregistereduptoandincluding20april2020">https://www.ons.gov.uk/peoplepop...
10/16

d) differences in treatment – need to know hospitalisation rates which we don’t have (people in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> and beds occupied in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom">) to understand ICU ratios. E.g.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> has 5x ICU beds, are more patients going to ICU earlier? 11/16

However, utilisation in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> at peak was only 50% of available i.e. no constraint. We also don’t have figures on nurse ratios though significant vacancy rate in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany">.
12/16

e) care home issue.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> has a very low excess mortality rate (6%). RKI estimates at least 1/3 of deaths occur in care homes, in UK~25%. However,

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany">&

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> suspect real # is higher. This doesn’t explain diff in ICU mortality and potentially relatively high hospitalisation rates.
13/16

On balance, qs comes down to why are

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇬🇧" title="Flag of United Kingdom" aria-label="Emoji: Flag of United Kingdom"> overall infection rates higher? Answer most likely a combination of late lockdown=more spread, ethnic mix, and susceptibility of underlying health issues (e.g BMI). Little evidence on differences in treatment. Needs deeper analysis.
14/16

All in all and given available data, UK seems to have a worse outbreak than Germany

15/16

Additional data needed mainly for

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany">:

Covid hospitalisation
Nurse ratios in ICU
Ventilation levels
Mortality by occupation
Immunity level via antibody test

@kakape @DIVI_eV @rki_de anything you can help with?

16/16

Final obs on data availability. Huge advantages in having central bodies such as @ONS and @ICNARC making downloadable data available but still gaps and quality issues. @DIVI_eV and @rki_de doing a sterling job but much harder in fragmented

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🇩🇪" title="Flag of Germany" aria-label="Emoji: Flag of Germany"> system and lots we don’t have.
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