How much worse is Covid19 for older people in Victoria? Reflections #47

In Victoria, if you are over the age of 85, you are around three times more likely than the average person to have tested positive for Covid19.

I’ve been following the Royal Commission into Aged Care quite closely as it examines some quite horrendous stories about the experience of many Victorians in aged care as Covid19 swept into their residential aged care homes. One comment in particular piqued my interest:

Former chief medical officer Brendan Murphy has testily rejected claims heard by the aged care royal commission that deaths from COVID-19 in Australian residential aged care were among the highest in the world.

Dr Murphy took issue with claims by the commission’s senior lawyer Peter Rozen and leading geriatrician Joseph Ibrahim that aged care residents made up around 70 per cent of COVID-19 deaths in Australia.

He said the fact that deaths in aged care “make up a high proportion of our very very low death rate by international comparison is a completely meaningless statistic.”

Australia is definitely not alone here. There have been horrendous stories from aged care around the world. In March, the army moved into aged care homes in Spain and found residents “dead and abandoned”. In New Jersey in April, an aged care home was so overwhelmed with deaths they ran out of room in their morgue. A paper from the US that I linked to recently starts by pointing out that

Nursing homes and other long term-care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in U.S. nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March.

Statistics from around the world, particularly in aged care, have been problematic, with many countries not counting deaths in aged care homes as Covid19 deaths. In my view, the statistics are too variable in quality to be able to be categorical about Australia compared with other countries. But that doesn’t make the Australian experience a good one.

There are two important statistics here. First of all, how likely is someone to become infected Covid19? And second, what is the death rate if you become infected? In everything below, I’ve taken statistics from 15 August 2020.

This graph shows a comparison of the average age structure of the population with those who have tested positive for Covid19 in Victoria (to date, but the vast majority of the cases are from the current outbreak since May). The line that jumps out is the line for those over 85. They are 2% of the population, but 6% of the Covid19 cases – three times their share of the population.

Until you get to the 85s, the pattern is not that surprising. Those in their twenties and thirties are more likely to be Covid19 positive than average – probably because they are much more likely to be doing things that will lead to infection – both going out to bars, restaurants etc, but also working in more casualised jobs with lots of public contact (security guards, waiters, supermarkets etc). Those over 50 are less likely to be Covid19 positive, for much the same reason – less likely to be going out, and more likely to be in jobs they can do while socially isolating.

But the over 85s stick out. It is hard to think of any other reason for that massive jump than aged care homes poorly protecting their residents from infections in the community – a casualised workforce in intimate contact with residents, without adequate infection control.

So in my view, this graph very much supports the hypothesis that aged care facilities have been the cause of over-representation of older people in the infection statistics. And for good measure, the graph for female specific infection rates is even more stark (my hypothesis there is that they are more likely to be in aged care at older ages than their male spouses, as they are often the carers for their older and sicker spouses until outliving them, and needing someone else to care from them).

But what about death rates?  Death rates (generally called Case Fatality Rates (CFR)) are very hard to measure.

They depend on accurately identifying both cases and deaths. Given the CFR for Covid19 is vary variable with age, the mix of ages in any given population will also skew the rate. In Victoria, given the amount of testing that is occurring (with around 1% of all tests being positive), there are still probably some missing asymptomatic cases, but there are unlikely to be more than in any other set of CFRs we could look at. And sadly, in Victoria, there are probably more deaths to come from the existing cases. In comparing death rates below, the most similar is probably South Korea, where testing has been similarly comprehensive.

The overall case fatality rates for Victoria so far are 1.7% for females, and 2.1% for males, which is a total of 1.9% for the whole population. For the over 80s, Victoria’s CFR is 16% – 16% of Covid19 cases over 80 have died so far (13% for female cases and 23% for male cases).  Victoria’s death rates look very broadly similar to comparative countries here. Although China’s CFRs are lower (9% CFR over 80), the age structure of their population is very different. And Italy (28% CFR over 80) was much more overwhelmed in treatment than either South Korea (24% CFR over 80) or Australia, and also was not testing the population comprehensively, so probably missed some mild cases.

Overall, there is quite strong evidence that our elderly have been put in harms way for Covid19 (rather than shielded) by the way in which aged care works in Australia, with the over 85s more than three times likely to test positive for Covid19 than the population as a whole. But there is no evidence to suggest that their treatment has any worse outcome once they are infected, potentially better, possibly because the medical system has quickly learned new methods to treat this new virus.

Link

In the continuing discussion about the economics of lockdowns, Sweden and Denmark are often compared (as they are next to each other). This study uses bank transaction data to tease out the differences, concluding that

The analysis exploits a natural experiment to disentangle the effects of the virus and the laws aiming to contain it: Denmark and Sweden were similarly exposed to the pandemic but only Denmark imposed significant restrictions on social and economic activities. We estimate that aggregate spending dropped by around 25% (95% CI: 24 to 26%) in Sweden and, as a result of the shutdown, by 4 additional percentage points (95% CI: 3 to 5 percentage points [p.p.]) in Denmark. This suggests that most of the economic contraction is caused by the virus itself and occurs regardless of social distancing laws.

Life Glimpses

Inspired by my regular commenter Marta, I took a virtual trip to the gardens of Kyoto, with my mother and Marta recently. We had a guide (who normally does half day tours of some of Kyoto’s less famous gardens) , who, from his own house in Kyoto, talked us through videos and maps he had prepared for us from his previous visits. Of course it wasn’t as good as the real thing, but I did get an increased appreciation of the very subtle ways in which Japanese gardens are designed, that I would have almost certainly missed I if I was lucky enough to be wandering around in real life.

It doesn’t quite make up for the Tokyo Olympics (where we should have been) but was a very enjoyable way to spend a Saturday evening. I’ve been checking out a few other online options too.

Bit of Beauty

After the schools reopened, the cupcake production here reduced substantially. But they still make an occasional appearance. In this case, they were the stakes in a bet we had on Joe Biden’s vice presidential pick. The winner (who had of course chosen Kamala Harris) got to choose the dessert for the losers to make, and chose black forest cupcakes. They weren’t our absolute favourite (a little bit too sweet) but still very tasty.