Measuring COVID-19 Deaths Among the Elderly in the OECD

A new analysis by the Canadian Institute for Health Information looks at one key aspect of the COVID-19 pandemic that has received some coverage from the mainstream media; deaths among the world's most elderly and vulnerable population.  In the study, the authors examined statistics for 16 of the world's most advanced economies (i.e. the OECD nations), focussing on three key areas; cases and deaths, baseline health system characteristics and policy responses.  The authors note that there are some limitations to the study when it comes to international comparisons due to differences in COVID-19 testing regimes and reporting practices as well as how each nation defines long-term care (LTC).  Here are the key findings with statistics being current to May 25, 2020.

 

Let's open this posting with this table showing both the number of COVID-19 deaths per million population and the number of COVID-19-related deaths in long-term care per million population:

Here is a list of nations showing the number of COVID-19 cases and deaths among long-term care residents that occurred in each nation:

 

Australia - 67 cases, 28 deaths

 

Austria - 788 cases, 119 deaths

 

Belgium - 8,746 cases, 4,616 deaths 

 

Canada - 15,063 cases, 5,324 deaths

 

France - 73,435 cases,  13,539 deaths

 

Germany - 14, 128 cases, 2,835 deaths

 

Hungary - 172 cases, 33 deaths

 

Ireland - 5,698 cases, 897 deaths

 

Israel - 407 cases, 163 deaths

 

Italy - 30,012 cases, 10,629 deaths (data from 52 percent of LTC facilities in Italy)

 

Netherlands - 3,543 cases, 853 deaths

 

Norway - 163 cases, 136 deaths

 

Portugal - 658 cases, 327 deaths

 

Slovenia - 276 cases, 10 deaths

 

Spain - 29,516 cases, 17,730 deaths

 

United Kingdom - 191,138 cases, 10,102 deaths

 

United States - 150,000 cases, 30,000 deaths

 

 

Here is a list of nations with the percentage of COVID-19 deaths among long-term care residents as a percentage of all COVID 19 deaths for each nation:

 

Australia - 27.5 percent

 

Austria - 18.6 percent

 

Belgium - 49.6 percent 

 

Canada - 81.1 percent

 

France - 47.7 percent

 

Germany - 34.1 percent

 

Hungary - 6.6 percent

 

Ireland - 55.9 percent

 

Israel - 58.2 percent

 

Italy - 32.3 percent

 

Netherlands - 14.6 percent

 

Norway - 57.9 percent

 

OECD Average - 42 percent

 

Portugal - 24.65 percent

 

Slovenia - 9.4 percent

 

Spain - 66.1 percent

 

United Kingdom - 27.4 percent

 

United States - 31.0 percent

 

As you can see, Canada had, by a wide margin, the highest proportion of COVID-19 deaths occurring in long-term care.  This is significantly higher than its OECD peers which had an average of 42 percent of COVID-19 deaths occurring in long-term care residences.  In part, Canada's elevated level of deaths in its long-term care residences is due to the fact that Canada's LTC population tends to be older than other nations with 74 percent of residents being over the age of 80 years.

 

Let's look at two other interesting aspects of long-term care which partially explains why certain nations have such a high percentage of LTC deaths:

 

1.) Nursing aides, personal support workers per 100 LTC residents aged 65 and older and the type of funding in LTC:

 

Australia - 4.9 - private - user fees

 

Austria - N/A - public - insurance

 

Belgium - N/A - public - insurance

 

Canada - 2.3 - mixed public/private

 

France - N/A - private - user fees

 

Germany - 2.4 - public - insurance

 

Hungary - 0.2 - public - insurance

 

Ireland - 2.9 - mixed public/private

 

Israel - 9.7 - mixed public/private

 

Italy - N/A - mixed public/private

 

Netherlands - 5.6 - public - insurance

 

Norway - 8.6 - mixed public/private

 

Portugal - 0.5 - mixed public/private

 

Slovenia - 1.1 - public - insurance

 

Spain - N/A - mixed public/private

 

United Kingdom - 1.2 - private - user fees

 

United States - 4.0 - private - user fees

 

In general, nations with a higher number of nursing and support staff and centralized regulation and organization of long-term care had lower numbers of COVID-19 cases and related deaths.

 

Another aspect that influenced COVID-19 infection and COVID-19-associated death rates in long-term care facilities was the date on which there was enforced restriction of visitors to LTC:

 

Australia - March 18

 

Austria - March 5

 

Belgium - N/A 

 

Canada - March 17

 

France - March 11

 

Germany - April 2

 

Hungary - N/A

 

Ireland - March 27

 

Israel - March 10

 

Italy - N/A

 

Netherlands - March 19

 

Norway - N/A

 

Portugal - March 20

 

Slovenia - March 10

 

Spain - March 20

 

United Kingdom - N/A

 

United States - N/A

 

These statistics, particularly in the case of Canada, point to systemic problems of understaffing issues, particularly in the nation's private sector long-term care facilities.  Rather than focussing on the raw numbers of COVID-infections and deaths, it would appear that the world's media would be better serving the public need by pointing out the obvious flaws in the model of care that is provided to each nation's oldest citizens.