Question: Follow up question based on yesterday’s graphic. It seems that “western democracies” have a much worse per capita death rate (New Zealand doesn’t count because they are a far away island that was able to close themselves off). What do we think is causing that? Is it that more developing or authoritarian countries either can’t or won’t share accurate death counts? Or do we think the rate of chronic health conditions are higher in richer countries thereby increasing the number of vulnerable people?
Answer: When it comes to variations in per capita deaths around the world, there are so many factors at play. This Q&A of 6/10 (#CFR) offers a good overview (pat myself on the back) of reasons case fatality rates may differ, and these reasons are also applicable to your question on per capita deaths. I’ll elaborate a bit more on differences between high and low-income countries. The reasons bulleted below help describe why deaths are or at least appear to be lower in low-income countries. [Note: I recognize that your question was about governance type rather than income level. I’m focusing here on income level because it’s a bit easier to parse. There is some research linking income level with governance type, but that relationship is still debatable.]
- Limited data in low-income countries. Very few low-income countries have functioning civil and vital registration systems, which means that in order to track deaths and cause of death, we must rely on surveys and indirect estimation. This makes it harder to track deaths in real time and oftentimes means that we have only a hazy understanding of the number of deaths and cause of death. It also means that countries with poorer reporting systems *appear* to be weathering the pandemic better, if we’re only basing judgement on statistics. It can also mean that some countries *appear* to be faring worse. For example, earlier in the pandemic, Belgium had one of the highest per capita death rates in the world, but this cross-country difference was largely attributed to Belgium’s comprehensive reporting system.
- Lack of transparency. We discussed a few data transparency issues related to China and Brazil in our Q&A of 6/26 (#Cross-country comparisons). We also discussed some data transparency issues in the United States in our Q&A of 7/15 (#Surveillance) [there are many more beyond that, will save for a different post]. Leaders concerned with maintaining power may be more inclined to keep information that paints them in a poor light away from the public. This would seem to be more a hallmark of authoritarianism, but even “western democracies” have had their share of challenges when it comes to COVID and data transparency. Back in May, for example, the government of the UK was refusing to disclose data from nursing homes aka “individual care homes.”
- Delayed introduction of COVID-19 in low-income countries. As shown in Figure 1 from this paper published a few days ago in Lancet Infectious Diseases, which describes how COVID traveled around the world during the pre-pandemic period, “During the first 11 weeks of the COVID-19 outbreak outside mainland China, cases were detected in half of all countries and locations globally, with an acceleration in case detection during weeks 9–11 of the outbreak. Although most countries and locations in the WHO European, Eastern Mediterranean, and South-East Asian regions reported confirmed cases by the time WHO characterised the outbreak as a pandemic, only a third of countries in the Americas and African WHO regions had reported cases, suggesting delayed introduction, delayed detection, or both.”
- Population age distribution. We know that COVID has a more severe impact on people of older ages. As a result, in countries with larger youth populations (generally low-income countries) we’d expect to see fewer per capita deaths.
Figure 1. Countries and Locations with Confirmed Cases of COVID-19 (12/31/19–03/10/20) (from Lancet Infectious Diseases)
