how to count excess deaths?

Another terrible graph from Nature… With vertical bars meaning nothing. Nothing more than the list of three values and both confidence intervals. But the associated article is quite interesting in investigating the difficulties in assessing the number of deaths due to COVID-19, when official death statistics are (almost) as shaky as the official COVID-19 deaths. Even in countries with sound mortality statistics and trustworthy official statistics institutes. This article opposes prediction models run by the Institute for Health Metrics and Evaluation and The Economist. The later being a machine-learning prediction procedure based on a large number of covariates. Without looking under the hood, it is unclear to me how poor entries across the array of covariates can be corrected to return a meaningful prediction. It is also striking that the model predicts much less excess deaths than those due to COVID-19 in a developed country like Japan. Survey methods are briefly mentioned at the end of the article, with interesting attempts to use satellite images of burial grounds, but no further techniques like capture-recapture or record linkage and entity resolution.

ten recommendations from the RSS

‘Statistics have been crucial both to our understanding of the pandemic and to our efforts to fight it. While we hope we won’t see another pandemic on this scale, we need to see a culture change now – with more transparency around data and evidence, stronger mechanisms to challenge the misuse of statistics, and leaders with statistical skills.’

• Invest in public health data – which should be regarded as critical national infrastructure and a full review of health data should be conducted
• Publish evidence – all evidence considered by governments and their advisers must be published in a timely and accessible manner
• Be clear and open about data – government should invest in a central portal, from which the different sources of official data, analysis protocols and up-to-date results can be found
• Challenge the misuse of statistics – the Office for Statistics Regulation should have its funding augmented so it can better hold the government to account
• The media needs to step up its responsibilities – government should support media institutions that invest in specialist scientific and medical reporting
• Build decision makers’ statistical skills – politicians and senior officials should seek out statistical training
• Build an effective infectious disease surveillance system to monitor the spread of disease – the government should ensure that a real-time surveillance system is ready for future pandemics
• Increase scrutiny and openness for new diagnostic tests – similar steps to those adopted for vaccine and pharmaceutical evaluation should be followed for diagnostic tests
• Health data is incomplete without social care data – improving social care data should be a central part of any review of UK health data
• Evaluation should be put at the heart of policy – efficient evaluations or experiments should be incorporated into any intervention from the start.

abortion data, France vs. USA

As Le Monde pointed out at a recent report on 2019 abortions in France from Direction de la recherche, des études, de l’évaluation et des statistiques (Drees), showing an consistent rise in the number of abortions in France since 1995, with a rate of 15.6 abortions for 1000 women and the number around a third of the live births that year, I started wondering at the corresponding figures in the USA, given the much more restrictive conditions there. Judging from this on-line report by the Guttmacher Institute, the overall 2017 figures are not so different in both countries: while the abortion rate fell to 13.5‰, and the abortion/life birth ratio to 22%, the recent spike in abortion restrictions for most US States did not seem to impact considerably the rates, even though this is a nationwide average, hiding state disparities (like a 35% drop in Iowa or Alabama [and a 62% drop in Delaware, despite no change in the number of clinics or in the legislation]). In addition, France did not apparently made conditions more difficult recently (most abortions occur locally and the abortion rate is inversely correlated with income) and French (official) figures include off-clinic drug-induced abortions, while the Guttmacher institute census does not. The incoming (hasty) replacement of Judge Ruth Bader Ginsberg in the US Supreme Court may alas induce a dramatic turn in these figures if a clear anti-abortion majority emerges…

counting COVID-19 deaths (or not)

Two COVID-19 articles in the recent issue of Nature relating to data gathering issues. One on the difficulty to distinguish direct COVID deaths from indirect ones from the excess deaths, which “to many scientists, it’s the most robust way to gauge the impact of the pandemic” (which I supported). As indeed the COVID pandemic reduced people access to health care, both because health structures were overwhelmed and because people were scared of catching the virus when visiting these structures. The article [by Giuliana Viglione] supports the direct exploitation of death certificates, to improve the separation, quoting Natalie Dean from the University of Florida in Gainesville. Although this creates a strong lag in the reporting and hence in health policy decisions. (Assuming the overall death reporting is to be trusted, which is not the case for all countries.)

“This long-standing neglect has been exacerbated by the lack of national leadership during the pandemic.”

The other article is about the reasons why the COVID-19 crisis in the US is doubled by a COVID-19 data crisis. Mentioning “political meddling, privacy concerns and years of neglect of public-health surveillance systems” as some of the sources for unreliable data on the pandemic range and evolution. Hardly any contact tracking (as opposed to South Korea or Vietnam), a wealth of local, state and federal structures, data diverted and hence delayed (or worse) to a new system launched by the US Department for Health and Human Services (HHS) for an ill-used $10 million. And data often shared (or lost) by fax! “Lack of leadership,” to state the obvious….

updated (over)mortality curves