When I went to the Birth Unit yesterday morning one of the midwives told me she had been distressed by what the on-call anaesthetist had told her was the predicted death rate from coronavirus for people of her age. I told her that I did not agree with what he said. When I got back to the office I checked the reported statistics at the worldmeter website. The information is in the table below…
Note: This table has been simplified for this website. Not all reported deaths have been confirmed and so this table is just guide from data on reported deaths available. Also this is a dynamic table that will vary from day to day as the pandemic continues. For instance, there has just been in USA the death of infant less than 1yr old who was coronavirus positive. An investigation was under way to determine the cause of death and whether the child, who was younger than one year, had other health issues (1). It is reported as a child not a newborn baby who died.
The global death rate for her age group is much lower than what she had been told by this anaesthetist. I phoned her and told her this and she was very grateful to me for giving her more accurate information. I also said to her the actual death rate for her age is likely far less than what has been calculated in the table above for the reasons explained below.
It is impossible to have great accuracy in establishing for coronavirus the true number of cases and true death rates. A main reason is because of under checking for coronavirus in all countries, including Australia. In Australia there is only checking when the person fulfills certain criteria. Australia’s statistics will not be accurate because of this.
In most countries there is only checking for coronavirus when people are symptomatic. There is not checking of people who are asymptomatic or who have minor symptoms or who don’t volunteer for checking when they have symptoms. In many countries, because of limited detection kits, many symptomatic people who want to be checked are not checked and so the data for these symptomatic unchecked people will not be entered in that country’s statistics. The statistics are distorted and suggest a lower infection rate and worse mortality rate than is the case.
It may be there are far more people with no or mild symptoms in the community than those with symptoms suggesting coronavirus. That means while the incidence will be greater than reported the overall percentages of those who are unwell with coronavirus and the mortality rate will be less than that reported.
A good example of this is in Germany. There has been more extensive checking of the community, irrespective of whether someone is asymptomatic. Germany is testing as many as 120,000 people a week (2). There has been 57,695 positive results and 433 deaths, giving a mortality rate of 0.75%, which is far less than other European countries.
Italy has a high death rate of 10.84%. This has been attributed to the large elderly population, only the most severe cases are being tested and limited protective gear available (3).
Another consideration when comparing countries is their health care facilities and available of appropriate personal protective equipment (PPE). In Australia we have excellent health care facilities and considerably more PPE per head of population than is the case in most other countries. We are better resourced to cope with this pandemic than most other countries in the world.
If someone becomes unwell because of coronavirus their chances of survival in Australia are greater than other countries where there is not the same quality of health care facilities. Hence our overall coronavirus mortality rate (0.37%) is less than most other western countries. So, the age mortality rate for Australia would be less than that shown in the table above, which uses world data.
Another factor that will impact mortality rate is significant co-morbidities., Worldmeter has calculated the following data in the table below based on global numbers and without consideration of age or of individual countries health care facilities….
Note: This table has been simplified for this website. Not all reported deaths have been confirmed and so this table is just guide from data on reported deaths available. Also this is a dynamic table that will vary from day to day as the pandemic continues.This list is not complete. For instance, people who are on immunosuppressant therapy would have an increased mortality risk.
These percentages would be considerably less in Australia because of our excellent health care facilities. But this table illustrates another point that age alone as the determinant is not that helpful. For example, a person in their 50’s with good health and no significant co-morbidities living in Australia would have far been chance of surviving than a person in their 50’s with co-morbidities living in a country that does not have good health care facilities.
So, on a very positive, I reassure my patients if they develop a coronavirus infection while pregnant it is very unlikely, they or their baby will die. The global age data for mortality above states a death rate of 0.2% and no newborn infant has died in the world. Their death risk is less than 0.2% because of limited population testing and the excellent health care facilities in Australia. As well my patients are at an age where it is unlikely that they will have significant co-morbidities. Gestational diabetes does not count as significant co-morbidity, that will increase risk.
On another positive note Australian Government reporting suggests we are reaching our incidence of new cases peak and the incidence of new cases is starting to fall. While it is early days this new trend is very encouraging. This is shown in the table below (dated 31 Mar 2020) from the Australian Government website Coronavirus (COVID-19) current situation and case numbers
The Federal Government measures appear to be working. This is wonderful news. The Government containment measures need to be continued otherwise the number of new cases will increase again. There has been similar good news in China, Taiwan, South Korea and Singapore. These countries have all adopted aggressive containment measures.