The most important question about the Covid19 pandemic of the early 2020s is ‘how many people died?’. (The second-most important question relates to the impact of the pandemic on people’s ‘quality of life’.) The data here, available since last week, is the starting point for an answer to the first question. This data is as close as can be got to ‘pure facts’, ‘body counts’ in which no expert interpretation plays a role. (This contrasts with ’cause-of-death’ data which requires a doctor’s opinion.) This is raw data. Raw data is true.

There is not really such thing as a ‘global pandemic’, because a pandemic is, by definition, a global event. In a pandemic, individual countries may be understood as ‘administrative regions’. National differences of mortality during a pandemic will be a mix of fortune, prior circumstances, and quality of administration. Re ‘quality of administration’, ‘body counts’ – while most important – do not represent the whole story. We note here my second-most important question, above.

The data above will never be a global total, no matter how long we wait for laggard countries to report. Some countries simply don’t register deaths; these countries are mainly in South Asia and Africa. Some other countries do not share their death tallies with the rest of the world.

The data above is irrefutable, in that it is a simple count of deaths, covering two periods each of four years (209 weeks for those countries which report on a weekly basis). This contrasts with ‘official’ Covid19 death tallies which depend, in each administrative jurisdiction, on some interpretation of what counts as a Covid19 death. ‘Total deaths’ data does not distinguish direct from indirect pandemic deaths.

For most countries, regardless of covid, there would have been an increase in deaths in the most recent ‘quadrennium’ (four-year period) vis-à-vis its predecessor. The major single cause of such covid-unrelated increased deaths is changes in the numbers of ‘elderly’ people, with the precise age of ‘elderly’ being higher in some countries (say Denmark) compared to others (say Lithuania). A country with a high proportion of elderly people need not have a higher percentage increase in deaths from one period to another; however, in these times, most countries are experiencing faster annual increases in their elderly populations than in their younger people.

One complication here is that World War Two ended in 1945, meaning that in 2020, a person born in 1945 turned 75 in 2020. While we are very sure that most countries had higher birth rates after 1945 than before, we are less sure about which countries had the biggest post-war ‘baby booms’.

One question that may be asked is ‘why include 2019 with the other pandemic years?’, given that the pandemic started in 2020. There are two reasons. First, as we have eight years of data conveniently tabulated by ourwordindata.org, the simplest procedure is to compare one quadrennium against the other. The second reason is that death rates in one year may ‘inversely’ impact on the following year’s data. Countries which have above-average levels of epidemic influenza in the year-or-so before a pandemic are likely to have reduced deaths in the first year of that pandemic, because many of the people most vulnerable to infectious diseases have already died. Likewise, re the present pandemic, a benign influenza year in 2019 (such as in Sweden) would of itself postpone deaths until 2020.

Table 1 is not a ‘league table’ of administrative competence, jurisdiction by jurisdiction. Nevertheless, the data shows broad categories of national experiences, and interesting variations (and non-variations) between countries regarded as like. It is a factual unnuanced measure of the different experiences of the Covid19 pandemic in different countries.

Some data highlights:

Scandinavia

As with many social indicators, Scandinavian countries had the lowest amounts of ‘increased death’ arising from the covid pandemic. Within that Nordic group, Sweden is a clear ‘winner’. This is particularly interesting because Sweden gained much publicity in 2020 for its contrary approach to public health administration during the pandemic. Sweden’s state epidemiologist, Anders Tegnell, famously said that Covid19 was a “marathon, not a sprint”. The marathon is now over, and Sweden has at least taken ‘line honours’.

However we should note that Sweden’s second-worst month (for excess deaths) for the whole pandemic was December 2022. (Its worst month was April 2020.) This significant though largely unnoticed fact is also true for other Western European countries. For some the 2022-2023 festive season was the worst three weeks for the entire pandemic. So, we may be looking at Covid19 as an ‘ultra-marathon’ rather than a marathon; if so, we still have years to wait before we can conclusively evaluate the demographic consequences of this pandemic.

The countries which ‘did best’ in the pandemic were those able to confine most of their covid-diagnosed deaths to people who, had they not died of Covid19, very likely would have died from other causes during the pandemic quadrennium.

Western Europe

Countries in Western Europe outside of Scandinavia had increased deaths mainly in the six‑percent to ten‑percent range, with Belgium and Netherlands both just outside of that range (though on either side of it). Interestingly, in the first wave of Covid19, Belgium had many more recorded covid deaths (per capita) than Netherlands. But it was Netherlands which ended up with an ‘above 10 percent’ increase. Netherlands had a bad pandemic.

The United Kingdom came very much in the middle of the Western European ‘pack’.

Two other ‘western’ countries to note are Canada and Israel. Both have increased deaths higher than the European Union and United Kingdom countries.

Australasia

Australia and New Zealand have increased deaths very similar to Western European levels.  ‘Officially’, both have reported fewer covid deaths per capita than do these European countries. This may be due in part to unusually large increases in the elderly populations of Australia and New Zealand; if so, many of these recent additional deaths will be neither directly nor indirectly due to Covid19.

Eastern Europe and East Asia

Both these groups of countries have, for the most part, increased deaths in the ten‑ to twenty‑percent range. This, for East Asia at least, may be a big surprise to the many people who believed that East Asia set the exemplar for best public health policy during the pandemic.

In East Asia, South Korea is a country of particular concern. South Korea has not released weekly death tallies since July 2022; it used to be a reliable reporter of such data. Subsequent Covid19 case data from South Korea suggests that it has experienced two recent waves of Covid19.

Another country for which the Table 1 data may be understated is Hong Kong. December 2022 was known to be China’s worst month, and this showed in the alarming excess death toll for Macao (Hong Kong’s close neighbour) for that month. So the recent Hong Kong data may be substantially revised, or we may see a much bigger toll for Hong Kong in January 2023. (We should note that, in the United Kingdom, there are signs that many people who die in the end of any December have their deaths counted in the following January. Different administrative practices can may weekly data hard to compare across countries.)

For Eastern Europe, I have generally restricted this table to countries in the European Union, though I have included Serbia, showing that its experience is comparable to its European Union neighbours. Eastern Europe did particularly badly in the ‘official’ Covid19 death tallies, in large part due to their high proportions of elderly people. Eastern Europe is a major source of economic migrants. (And, with lower life expectancies than in Western Europe, the threshold age that defines ‘elderly’ in these countries is lower. We may note, as a matter of interest, that the typical life expectancy in Eastern Europe is comparable to New Zealand’s ‘Pasifika’ population.)

An interesting group of Eastern European outliers are the Baltic countries: Lithuania, Latvia, and Estonia. While these recorded high numbers of Covid19 deaths relative to their total populations, the percentage increase in deaths is not so large. This is due to their high but unchanging prevalence of older people. Indeed, their populations probably got slightly younger in 2020 and 2021, as previous high levels of youth emigration will have been stemmed by Covid19 public health controls within the European Union.

South America and the United States

The typical increase in deaths for South American countries is between twenty and forty percent, with Uruguay, Chile and Brazil looking best for those countries with available data. (Argentina is extremely slow at releasing its total death tallies.) Uruguay is easily best.

The high Covid19 mortality of the United States is very apparent in this simple tally of deaths. Indeed USA probably compares better with South America than it does with its European allies. The demography of the United States is like that of New Zealand in some respects, but like South America and Mexico in other respects. Western European (and Australasian) populations have life expectancies above 80. The USA and most South American countries do not. While Covid19 was a disaster for the United States, it may not be that the different public health responses within USA made much difference. It may be that certain known comorbidities – such as diabetes, drug dependency, mental unwellness – are more present in American than in European populations.

Further Interpretation

I have here confined my interpretation of the data to the points which would be best understood by a professional statistician. Further interpretation takes us into the realm of scientific speculation. The science – the testing of plausible explanatory hypotheses with adequate datasets – needs to be done.

The first question begged by the data presented here is why Sweden in particular (and Europe in general) have come out of the pandemic rather well (so far! the ultra-marathon is far from over). The second question is why East Asia has come out so poorly, despite early indications to the contrary.

Sweden coming out of the pandemic marathon so well, and East Asia so problematically, is the inconvenient counter-narrative which happens to be the truth – the poorly understood truth – of the matter.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Aotearoa New Zealand’s outgoing Director of Public Health says the quick sharing of scientific information and the widespread use of masks have both been critical parts of the country’s public health response.

Dr Caroline McElnay, who is leaving the role shortly, presented the regular covid-19 update with Director-General of Health Dr Ashley Bloomfield for the final time yesterday and gave her view on the pandemic response over the past couple of years.

She is stepping down from the role in the same week Dr Bloomfield announced he would also soon be leaving his role.

Dr McElnay had been in the job for five years and is travelling to Europe, but plans to come back to New Zealand. She said she is looking forward to going hiking — on long walks without cell phone coverage.

Dr McElnay said the country had learned a lot since New Zealand first went into lockdown more than two years ago.

Masks had become part of daily lives and would continue to remain an important tool, she said.

“They are a critical aspect of our public health response.”

Pandemic sped up science
The pandemic had changed the way many people worked, and also sped up science, she said.

“Scientists effectively show progress through publishing scientific papers, which makes the information then available to the science and health communities,” she said.

“Pre-covid that process often took months, but during covid it was clear sharing information was key. Information that could help understand the science behind the pandemic and assist in tackling it needed to be fast, so it could be used equally quickly.

“Applying that knowledge, which has improved as time has gone on, has held New Zealand in good stead.

“Vaccines and treatments that are effective at keeping people out of hospital were developed fast and advances in tracking and testing were equally quick.”

Watch the covid-19 update

The covid briefing. Video: RNZ News

This had allowed the fast spread of information to the scientific community and the public within days.

There had been frequent changes in advice and approach as experts and officials learnt more, she said.

New Zealand was very fortunate to have had a solid foundation of trust by the public in the country’s institutions, but she said she was also aware of the impact the pandemic had had on many people’s lives.

She noted there has also been a rise in misinformation, so officials had worked to increase the amount of trustworthy information available to the public.

She said the media standups would continue. This was her 299th in two years, she said.

Dr McElnay said she would travel overseas for some months. She said she was honoured to have held the role of director of public health.

“I want to finish by thanking you all, all New Zealanders, in getting us to where we are today on what has been a rollercoaster of a ride. And I’d also like to thank you in this room, the media, for your extensive coverage throughout the pandemic, helping to keep the public informed.”

Timing of departures
Dr Bloomfield said there had been speculation in the past 24 hours about the timing of his and Dr McElnay’s departures. He said Dr Jim Miller had already joined to act in the public health role while Dr McElnay’s replacement was appointed, while Dr Bloomfield himself would remain for four months.

The response to the virus had been a huge undertaking for many people, but “having said that Dr McElnay has been instrumental, and often the public face of the ministry’s response”, he said.

“A mammoth effort indeed. Personally I just want to fully acknowledge Dr McElnay’s calm and supportive and solution-focused approach over the last five years, but in particular she’s been a real rock for me over these past two years.”

Dr McElnay said she took on the role five years ago and decided at the time that five years would be a good length of time, and it had been challenging.

She said she got quite a few comments about her hair, and tried to avoid engaging with social media.

She personally did not feel burnt out but said burnout was a very real thing and workplaces and employees themselves needed to acknowledge that.

“Talk to your family and friends and talk to your health professionals.”

Collaboration ‘awe-inspiring’
A highlight of her time was seeing public health experts come together to come up with a plan back when covid-19 first struck our shores, she said.

Seeing the advice she and her colleagues gave be announced as official decisions reinforced the weight of responsibility that came with her job. She said it was “awe inspiring”.

The death toll in New Zealand had been staggeringly low — 466 as at today — and while every death was a tragedy, New Zealand had “such an amazing response”, she said.

“Every country has responded differently according to the context of that country.”

It was really the early closing of the borders as an island nation that really allowed such a strong response, she said.

Dr Bloomfield said the health system was now having to gear up to switch from responding to the acute illness from covid-19, to a longer-term care for people who have long-term symptoms.

Pressure on the healthcare system due to covid-19 was now easing.

Case numbers declining
The overall situation was improving, and as case numbers continue to decline it will also mean fewer staff members being off work, he said.

DHBs all have plans for how to catch up on care that has been deferred and ensure it is delivered, he said.

He was concerned enough about the possibility of a perfect storm of winter illnesses as well as covid-19 to have prepared a plan to prevent that.

Advice on a fourth booster was going to ministers this week, he said.

“The groups that other countries are offering a fourth dose to are largely older people and immunocompromised people of all ages.”

Dr Bloomfield also said he wanted to mark yesterday as World Health Day, the anniversary of the founding of the WHO in 1948.

• Ten new deaths were reported today — including someone aged between 10-19 — while the daily number of new community cases in New Zealand has dropped back below the 10,000 mark.
• There were 9906 new community cases reported today, down from the 11,634 community cases reported yesterday, while the number of people in hospital has dropped from 654 yesterday to 626 today, including 17 people in ICU.
• The death toll of people who have died with covid-19 is now 466.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

Aotearoa New Zealand’s Director-General of Health Dr Ashley Bloomfield — the man who has tirelessly steered the country’s covid-19 pandemic response for the past two years — is stepping down from his role at the end of July.

Public Service Commissioner Peter Hughes revealed Dr Bloomfield’s decision in a statement today.

Dr Bloomfield had signalled to the commissioner late last year he intended to step down before his term officially ended on 11 June 2023, Hughes said.

Speaking at today’s media briefing, Dr Bloomfield said he was most proud of the way the health system and public service had worked so well together to protect the public.

He said the three previous director-generals had also ended their five-year terms early, and he had been thinking for a while about when would be a good time to step down.

“It seems we’re at a good point in terms of the pandemic, the response is shifting, I’m also confident that the system is in good hands with the changes that are afoot, and most certainly my family will be very pleased to have a little more of my time.”

The Ministry of Health today reported 12,575 new community cases of covid-19, with 654 people in hospital and 15 further deaths. Twenty three people were in intensive care, down from 30 yesterday.

Outstanding job
Commissioner Hughes said Dr Bloomfield had done an outstanding job leading the government’s health response to covid-19 and the vaccination rollout.

“Dr Bloomfield has worked tirelessly for more than two years to keep New Zealanders safe from coronavirus,” Hughes said.

“Dr Bloomfield has demonstrated remarkable resilience and courage in leading the health system’s overall response to Covid-19. That response has saved lives.

“I thank Dr Bloomfield for his commitment to public service, his spirit of service to the community and his exceptional contribution to New Zealand’s covid-19 response. I know many New Zealanders will also be thankful for the job he has done.”

Hughes said Dr Bloomfield wanted to stay on until the country had a good hold on the virus, and that time was now.

In a post on Facebook, Prime Minister Jacinda Ardern said Bloomfield had been a true public servant in every sense, through his dedication, drive and calmness.

“He has been central to our COVID success as a nation, and he’s done it with humour and grace (I’ll keep the details of his sporadic mockery of me to myself!),” she said.

“When we spoke about his decision to move on, he mentioned that he wanted to spend time with his family, and that’s the least we owe him. So kia ora from across the Motu, Dr Bloomfield. We thank you.”

‘Give the man a beer’
Covid-19 Response Minister Chris Hipkins also posted on Facebook after the news was released, acknowledging Bloomfield for being a “reassuring figure” through the pandemic response.

“The amount of pressure he’s absorbed, and the level of commitment he’s shown over the past two years make that an easy decision to understand.

“We thank you Ashley for all you’ve done to keep us all safe. Give the man a beer, he’s truly earned it!”

As a Minister I want to thank Dr Bloomfield for advising the Govt on some of the most important decisions taken in peacetime.
As a doctor I want to acknowledge @AshBloomfield as a colleague who has made an unparalleled contribution to protecting the health of New Zealanders.

— Ayesha Verrall (@drayeshaverrall) April 5, 2022

An acting director-general will be appointed before Bloomfield finishes on 29 July, 2022.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz