"There are three kinds of lies: lies, damned lies, and statistics". Mark Twain used this wry expression in his "Chapters from My Autobiography "which was published in the North American Review in 1907.
Max Opray, the morning editor of Schwartz Media's The Saturday Paper published an alarming article in the May 7 – 13, 2022 edition of the paper which was based on recent data from the Australian Bureau of Statistics (ABS). He stated, in his upper page summary, that COVID-19 had become Australia's second leading cause of death after cancer. He also stated that more people have died from COVID-19 in 2022 than in the past two years combined. This raised some difficult questions which prompted me to do some further research.
"COVID-19 Mortality in Australia: Deaths registered until 31 March 2022" COVID-19 Mortality in Australia: Deaths registered until 31 March 2022 | Australian Bureau of Statistics (abs.gov.au) was released on the ABS website on 20 April 2022. Sure enough, the ABS registered 4,876 deaths "due to COVID-19" in Australia between early 2020 until 31st March 2022. The ABS registered 1,540 deaths "due to COVID-19" in January 2022, 951 deaths in February and 174 deaths in March 2022, giving a total of 2,665 deaths in the first three months of 2022 which is 55% of the total number of deaths "due to COVID-19" registered since early 2020 when the pandemic commenced. I found this quite surprising, given that the current Omnicom variant of Coronavirus is much less likely to cause hospitalization or death "due to COVID-19". So, what are the characteristics of these people whose death was registered as "due to COVID-19"?
The median age of those who died "from COVID-19" was 83.8 years (82.3 years for males and 86.0 years for females). It is interesting to remember that the median life-expectancy in Australia in the 2018 to 2020 Life Tables is 81.2 years for males and 85.3 years for females. The median age of death of those people whose deaths were coded as "due to COVID-19" was higher than their predicted life expectancy, according to the 2018 to 2020 Life tables.
Of the people whose deaths were coded as "due to COVID-19", 3,580 (73.4%) had serious pre-existing chronic conditions, including chronic cardiac conditions (coronary atherosclerosis, cardiomyopathies, and atrial fibrillation) in 37.2% of the deaths, dementia in over 30% of deaths, diabetes mellitus in 19.8% of deaths and cancer (mostly leukaemia and lymphoma) in 16.0% of deaths.
Most interestingly, in the 3,501 deaths where there was deterioration due to "acute diseases", pneumonia was recorded as an "acute disease outcome" in 68.9% of deaths. This means that 2,412 people whose deaths were registered as deaths "due to COVID-19" suffered from pneumonia which led to a significant deterioration during their terminal illness.
What was the cause of pneumonia in these 2,412 people? How many had a CT scan of the thorax which showed Acute Interstitial Pneumonia which would be diagnostic of a viral pneumonia due to COVID-19? How many had lobar pneumonia due to bacterial pathogens such as Streptococcus Pneumonia (Pneumococcus) which is known to be the commonest cause of pneumonia in our community, usually accounting for about 60% of cases of pneumonia in Australia? How many people had blood cultures or sputum cultures showing significant bacterial pathogens such as Streptococcus Pneumonia, Haemophilus Influenzae, Pseudomonas Aeruginosa and Staphylococcus Aureus? How many people had positive serology diagnostic of infection with Mycoplasma Pneumoniae or Legionella Pneumophilia? How many people had positive urinary antigen tests for Pneumococcus or Legionella species? How many people had co-infections with other acute viral pathogens such as Influenza, Parainfluenza, Human Metapneumovirus, Respiratory Syncytial Virus and Adenovirus which can all cause significant lower respiratory disease?
Although one cannot expect to find the answers to these questions from the ABS website, I was able to find some very interesting data on deaths "due to pneumonia and influenza". Measuring Australia's excess mortality during the COVID-19 pandemic | Australian Bureau of Statistics (abs.gov.au). There is graph in this publication which compares expected and observed deaths "due to pneumonia and influenza between 2016 and 31st December 2021. The graph shows that the ABS registered far fewer deaths than expected "due to influenza and pneumonia" from early 2020 to end -December 2021, which coincides with the COVID-19 pandemic. The ABS estimated that there had been 4,235 lower than expected deaths due to pneumonia and influenza during the pandemic. Considering that the incidence of influenza in Australia in 2020 and 2021 was lower than in previous years, one might expect fewer deaths due to influenza. However, one would not expect fewer deaths due to pneumonia.
As shown by the data above, 2,412 people whose deaths were registered before 31st March 2022 had both an acute viral infection with Coronavirus (COVID-19) and significant pneumonia which led to a significant deterioration in their condition during their terminal illness. What is the likelihood of dying from an acute infection with Coronavirus (COVID-19)? Overall, for younger, healthy people, it is less than 1%, but death "due to COVID-19" does become more likely with advanced age, frailty, dementia, obesity, and cardiovascular disease. The ABS website Regional population by age and sex, 2020 | Australian Bureau of Statistics (abs.gov.au) showed that people over the age of 80 years made up 8.4% of the population in 2020 which means that there were about 2 million people living in Australia who were over the age of 80 years in 2020. The ABS registered 1,828 deaths "due to COVID-19" between early 2020 and 31st March 2022 in people aged 80-89 years, which is about 0.1% of that elderly population. Even for elderly, vulnerable people, the likelihood of dying of Coronavirus (COVID-19) is still quite low.
What is the likelihood of dying from pneumonia if you are a frail, elderly person reaching the end of their predicted life expectancy? Having cared for many elderly people in this situation over the last forty years, I would estimate that the likelihood of death "due to pneumonia" in that situation is greater than 50%. In other words, death "due to pneumonia" in those circumstances is more likely than not.
Therefore, I believe that pneumonia is more likely to be the main cause of death in the majority of those 2,412 deaths, rather than infection with Coronavirus (COVID-19). Based on the evidence presented, I believe that it is probable that the 4,235 "fewer deaths than expected due to Influenza and Pneumonia" between early 2020 and 31st March 2022 can be partly explained by the fact that the ABS registered 2,412 people who suffered from significant pneumonia during their terminal illness as "death due to COVID-19". I believe that most of those deaths should have been registered as "death due to Pneumonia", with Coronavirus (COVID-19) being registered only as a factor contributing to the death.
On a positive note, I found some interesting data on the ABS website which records the Standardized Death Rate (SDR) (deaths per 1,000 standardized population) in Australia between 1980 and 2020. Deaths, Australia, 2020 | Australian Bureau of Statistics (abs.gov.au) The results for SDR's in 2021 and 2022 are provisional at this stage and may be subject to change. The data shows that the SDR in Australia has been declining since 1980 when the SDR for males was about 13 and the SDR for females was about 8 deaths per 1,000 standardized population. By 2010, the SDR had fallen to 5.7. In 2019, it was 5.3 and in 2020 it was 4.9 deaths per 1,000 standardized population (4.1 for females and 5.8 for males). Despite a "lethal" virus (Coronavirus causing COVID-19) and authoritarian lockdowns which are likely to produce unforeseen adverse health outcomes, the SDR in Australia in 2020 was lower than in 2019! Halleluiah!
Pneumonia, influenza, and other respiratory viruses such as Coronavirus have been responsible for the deaths of many frail, sick, elderly people for centuries, and this will always be the case. We need to look after our elderly, vulnerable population as best we can. However, we also need get back to "normal" so we can live our lives to the full, without suffering from fear and anxiety induced by the popular press and without unnecessary, unproven, authoritarian government restrictions and confusing, everchanging rules.
I feel like I have been through a gruelling inquisition in trying to answer difficult questions about confusing statistics. As Graham Chapman said on 22nd September 1970 in Season 2, Episode 2 of Monty Python's Flying Circus, "Nobody expects the Spanish Inquisition!"