Thread by @axelheitmueller

Attempt to understand differences 🇬🇧/🇩🇪 #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 (🇬🇧/🇩🇪):

Cases +test
220/173k

Gender
M 56/48%
W 48/52%

# ICU beds used at peak
54%~3.3k (England)/<10% ~ 2.8k
Note: 🇩🇪 5x #ICU beds

Covid in 🇬🇧 hospital beds at peak 20k
🇩🇪 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% 🇬🇧/6% 🇩🇪
50k/4.8k

i.e. without Covid 🇩🇪 would have had negative excess deaths(?) For 🇬🇧 depends on how many of the excess deaths are actually Covid but untested
4/16

Conclusions:

🇬🇧 has 46% higher ICU and 10x excess mortality and more patients in ICU. Age and gender distribution broadly similar. 🇩🇪 has fewer cases even when compared to low testing levels in 🇬🇧 making it likely that true 🇬🇧 number much higher.
5/16

Particularly likely given that only 20% of 🇩🇪 cases needed hospital where most 🇬🇧 testing took place.

🇬🇧 therefore likely to have seen much worse outbreak.

Potential hypotheses:
6/16

a) 🇩🇪 contained #Cvoid19 better/earlier and had fewer cases (🇬🇧 has higher cases even with low testing and potentially more in hospital). One conclusion might therefore be 🇬🇧 simply has more cases, end of it.
7/16

b) 🇬🇧 had a more severe virus while 🇩🇪 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) 🇩🇪 has fewer high-risk groups - BMI (🇬🇧 ranks 36, 🇩🇪 76 in world), BAME (🇩🇪 has hardly any) lower density (237/275 sqkm) London 4.5k/Berlin 3.9k sqkm; but 🇩🇪 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 🇩🇪 to compare with recent ONS analysis ons.gov.uk/peoplepopulati…
10/16

d) differences in treatment – need to know hospitalisation rates which we don’t have (people in 🇩🇪 and beds occupied in 🇬🇧) to understand ICU ratios. E.g. 🇩🇪 has 5x ICU beds, are more patients going to ICU earlier? 11/16

However, utilisation in 🇬🇧 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 🇩🇪.
12/16

e) care home issue. 🇩🇪 has a very low excess mortality rate (6%). RKI estimates at least 1/3 of deaths occur in care homes, in UK~25%. However,🇩🇪&🇬🇧 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 🇬🇧 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 🇩🇪:

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 🇩🇪 system and lots we don’t have.
END