Many of our DutchReview readers have been wondering why the mortality rate in the Netherlands is so high, with one of the highest in Europe. Meanwhile, people have taken to Twitter wondering what exactly the Netherlands is doing wrong.
But the figures can be misleading.
#coronavirus mortality rate c.f yesterday:-
Italy 12.32->12.47%
Algeria 11.52->12.16%
France 11.46->11.98%
UK 10.32->10.41%
Netherlands 9.89->9.93%
Spain 9.50->9.75%
Indonesia 8.71->8.39%
Belgium 7.35->7.84%
Egypt 6.65%=
Morocco (New)->6.38%
Sweden 6.12->6.89%
Global 5.44->5.56%— Andy Mullen (@AndrewJMullen) April 6, 2020
When looking at the coronavirus mortality rate, the number appears a bit worrisome. The Netherlands currently has one of the highest rates in Europe, up there with Spain, Italy and the UK, according to De Volkskrant. And for such a small country, that’s perhaps a little concerning — Germany, the Netherlands’s much larger neighbour, has far less deaths in comparison.
But, according to professor of theoretical epidemiology at Utrecht University, Hans Heesterbeek, comparing the mortality rate in the Netherlands to other countries is of little use at the moment. “This has to do with several factors. For example, it is not always determined whether someone dies from the coronavirus itself.”
Daily #Coronavirus update in the #Netherlands
115 deaths bring the total to 1766.
Dutch death toll curve heading towards 2000.
Real improvement or just less cases reported @rivm ? pic.twitter.com/1clTb8lFD2— Antonio (@agabriele) April 5, 2020
*NB: the data in the graph above was current as of April 5
What Heesterbeek hints at is that the number you see is a lot more complicated than it lets on. For a start, mortality rates are highly dependent on how many people are tested. In this article, we’ll be comparing mortality rates based on population size.
Mortality is not easy to measure
Not all coronavirus cases or mortalities caused as a result of coronavirus are registered. If a person does not report their illness and then passes away later as a consequence, their information is not necessarily reported to RIVM.
Healthcare is also important
The quality of healthcare is also important. Countries that are able to treat patients more quickly and effectively will have a lower mortality rate. For example, Germany has far more ICU beds compared to, for example, the Netherlands (25,000 compared to 1150 beds)
But beds aren’t the only criteria. The US, on the other hand, doesn’t have easily accessible healthcare for poorer groups of society. And, as De Volkskrant states, Dutch doctors are less inclined to bring elderly patients into intensive care. Three-quarters of patients that have died in the Netherlands were in nursing homes or at home. But this isn’t necessarily a criticism — it’s actually a part of Dutch approach to palliative care.
Dutch approach to palliative care
The topic of palliative care in the Netherlands would need an article entirely dedicated to the concept, but we’ll keep it brief for now.
Palliative care is focused on improving the quality of life for a person who is suffering from a life-threatening illness. The aim is to decrease suffering and painful symptoms and provide “social, psychological and spiritual support” so that patients do not spend the last few weeks of their life in a hospital hooked up to machines.
The patient has the right to choose this procedure, and the Netherlands is renowned for offering high standards of palliative care to patients.
It’s all relative
Countries have different ways of measuring stats
Reporting of statistics is variant per country. For instance, regarding China, there is speculation as to how reliable the data is. Already, the government was late in reporting the coronavirus outbreak to the world.
Given the unreliability of the official data, how can we judge the situation on the ground? #China #coronavirus https://t.co/b1p2fEXMyL
— J.V. (@elektrolito) April 2, 2020
Additionally, some countries may be better at testing than others, meaning their count is more accurate.
Regions versus countries
On another note, what also needs to be taken into account is regions versus countries as a whole. On a regional level, the death toll may appear higher than on a national level.
To put this into perspective, in China the nationwide mortality rate is two people in every million. But, in the Hubei region, where the city Wuhan is located, mortality totalled 50 people per million inhabitants.
Size matters
The Netherlands is a relatively small country (a population of roughly 17 million) and if you compare it to say, the state of New York (a population of roughly 19.5 million), it fares considerably well. The death toll in New York City alone (keep in mind the state of New York is far larger than those five boroughs that make up NYC) has surpassed 1,000.
Then again, the mortality in the region of North Brabant is higher than elsewhere in the country, making comparison increasingly difficult.
Vanaf vandaag toont de kaart bij de dagelijkse update het aantal ziekenhuisopnames (per woonplaats van de opgenomen patiënten). Deze data geeft een beter beeld van de verspreiding dan het aantal gemelde patiënten op de oude kaart.
Meer informatie: https://t.co/WzveDofipS pic.twitter.com/Ne1PnKfxNp
— RIVM (@rivm) March 31, 2020
On the RIVM’s map above, you can see that the southernmost areas of the Netherlands (roughly where North Brabant is located) has the highest concentration of hospital admissions (per residence of admitted patients). It doesn’t necessarily show mortality but gives an indicator of where the largest amounts of coronavirus cases are, which would likely be the places that experience the highest mortality. This is because there is a higher probability of becoming infected with the virus.
Other factors affecting the accuracy of the number
Data regarding whether the patient had previous complications as well as age should also be taken into account. In this regard, some countries have a larger elderly population than others, which makes people more susceptible.
Additionally, it is after all flu season, and flu, rather than the coronavirus outbreak, could have resulted in an increase in the death rate, especially around this time.
The virus will also naturally hit each country differently depending on aspects like poverty, population, maybe even weather as well as other illnesses that are circulating. In some areas it will grow exponentially (such as in Italy and Spain). The Netherlands may still be early on in the crisis. For now, however, the country resembles Belgium and France more closely, where the rate at which the death toll grows is more constant.
So how bad is the Dutch mortality rate?
While it is easy to point to a number on paper and insist the Dutch are doing something wrong, when it comes to counting coronavirus deaths countries have far too many differences for a fair comparison.
The amount of testing conducted in a country, access to healthcare, cultural approaches to palliative care, and different ways of measuring statistics are all factors affecting statistics. By looking solely at the numbers it’s impossible to gain a clear overview of how the Netherlands is doing compared to other nations.
Should the mortality rate in the Netherlands even be compared to other countries in the first place? Let us know your thoughts in the comments.
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“The death toll in New York City alone (keep in mind the state of New York is far larger than those four boroughs that make up NYC)”
NYC has five boroughs, not four.
Thanks for your comment, it’s been addressed!
What kind of Double Speak is this?
So you are trying to compare NL to NYC, one of the most highly dense cities in the world, you seemed rather smug in your “analysis” above. People are dying and NL is not doing well in relation to the rest of the world. The numbers in NL are not accurate just like everyone else, NL does not have enough test and refuses to test most people if it is mild.
NYC – 38,242 people per km2
NL – 488 people per km2
The point of the artica was that comparing statistics is difficult due to factors like different circumstaces of the population, due to different attitudes towards testing, life prolongation and other factors. So let us abstain from futile comparisons that are only meant to show how good, or bad, we are compared to others.
Maybe it is sufficient to note that Germany was, relatively, well prepared for the pandemic, and the US was not with a federal government long in denial and politicising and feuding with state authorities.
There are lessons to be learned for all countries. One of those lessons should be cooperation. All countries had possibilities to aid others and hardly any did to any extent, even hoarding supplies of PPE and equipment.
This is one of those article that shoots in all directions but fails to put forward a conclusion or at least a hypothesis or even to give any insight on why the mortality rate among those tested in NL is about 10%, when in several other countries, this rate is about 1/2 or less. The sad part is that data is easily available for a better discussion.
For instance, from the data available, in the EU countries for which the number of tests per thousand inhabitants is larger than 10, the mortality rate among those tested falls below 5% (except for Italy). When the number of tests per 1000 inhabitants is above 25, the mortality rate among those tested falls to below 2% (no exceptions). On the other hand, countries with a lower then 10 test per 1000 inhabitants are showing mortality rates above 9% among those tested (except for the Balkans, where rates are currently lower).
The data seems to indicate that there is a strong correlation between the number of tests per 1000 inhabitants and the mortality rates among those who are tested (which is not surprising). Thus, if the Dutch want to have better stats on this front, the easiest way is stop being cheap and test the population properly.
And in case you are wondering why one would want to spend money on this, it is because the better the stats we can accumulate from this outbreak, the better we will be prepared to face future crises of this nature (what works, what doens’t).
Why is the Netherlands not reporting recovered cases? Or are we meant to believe that not a single confirmed case has recovered in the past two weeks?
Actually, the Dutch mortality rate is twice higer of what has been officially reported.
Deaths are around 3.5k as of today, but if you actually check the CBS weekly death rate, you’ll see that in the weeks 12, 13, 14 and 15 of 2020 there’s more than 7k deaths above the average of the last 3 years.
This means that while 3.5k above the average belong to the official corona numbers, the remaining 3.5k deaths are just people that most likely died of corona but were not reported.
In a nation of 17M people, 7k deaths by corona means a mortality rate of 400 deaths per milion people. This number would move the Dutch mortality rate next to the Belgian and the Spanish one (both above 400 deaths per milion people), that are right now among the highest.