Tough measures but without seeing sufficient data

By Sophia Anastasiou

Total opacity and ambiguity even in the publication of data. From the beginning of pandemic of coronavirus in our country, even the tactics followed by the government of Kyriakos Mitsotakis as to the data it publishes daily on the COVID-19 characterized by significant deficiencies and insufficient statistical data, up to criminal double counting in the National Register of Covid-19 patients that has come to resemble a grocery store instead of a serious database. The information they provide Ministry of Health and EODY and the data that is eventually published and available is incomplete compared to that provided by other European countries. Even some African countries that have less technological capacity provide more data to their citizens than Greece.

With this tactic, not only has the second wave of the pandemic increased the distrust of citizens but legitimate questions have arisen as to whether the Committee of Infectious Diseases itself, and by extension the Greek government, are deciding on detailed and sufficient data for the measures they take. The latest are rife with holes, even logic. I wonder on what data the narrative was based, for example, that in public transport where people are packed like sardines and in airplanes with 100% occupancy no one sticks, while in open squares they do? I wonder how the number of nine people was decided at the festive revellers and the harsh local lockdowns? What data was secretly processed on behalf of the government by the shadowy Palantir and indeed on the basis of these, Mr. Mitsotakis also took decisions on the pandemic and the opening of the economy and of tourism; Is the image that the country presents to the outside world with the data it provides to the European authorities fictitious?;

What is announced

Let us first look at the data that the Ministry of Health and the EODY publish daily before comparing them with those of other countries. The following data, among others, are announced:

As regards deaths

- Total deaths of our fellow citizens since the beginning of the pandemic and deaths per day.

- The median age of patients who died.

- The broad age distribution of deaths and by gender.

As regards outbreaks

- Confirmed new cases per day and the total since the beginning of the pandemic.

- The geographical distribution of cases by regional unit.

- The average number of cases over the last seven days per regional unit and cases per 100,000 population.

- The daily variation of cases.

- The percentage of total cases by gender.

- The median age of all cases.

As for patients

- The number per day (and total) of hospitalised intubated patients and their percentage by gender.

- The age distribution of confirmed cases as a percentage of the total.

What is not announced

Now let's see what is not released in the official update compared to the data published by other European countries, such as the UK, Germany, France, Italy, Estonia, the Netherlands, Denmark, Spain, Switzerland, or other countries worldwide, such as Australia, the USA, Canada, New Zealand, etc.

As regards deaths

- Deaths by regional unit (per day and total). Although deaths per day and total deaths have been announced since the beginning of the pandemic, there are no data accessible to Greek citizens on deaths per regional unit, city or even district, as provided in foreign countries. What data has been made public is the subject of journalistic research and reporting. Unfortunately, are not open data accessible to both Greek and foreign journalists and scientists and of course to citizens.

- Accurate and detailed data on all deceased persons (age, sex) are not available, but are compiled in a broad age and sex table.

- Number of deaths within ICU and outside the ICU per day and in total.

- Number of inpatient deaths per day and overall and by regional unit and city.

As for the outbreaks:

- The number of active confirmed cases. Although the Ministry of Health and EODY have referred in some of their updates to «active cases», it is not in the form of open data.

- The number of «orphan» cases.

- The number of cases from tracing.

- The number of active confirmed cases in health workers (nurses etc.) and the total. This information is provided by, among others, Italy.

With the recent example of Kozani and earlier examples of other regions, there is a confusion as to the number of cases based on the date of taking a laboratory sample and the date of their announcement. In simple terms, older cases are added to the total, and it remains unknown whether they were notified while they were active or were moving freely everywhere.

As for patients

- The total number of inpatients and the number of admissions per day, per week, etc. Although at the beginning of the pandemic the government in some of its daily updates gave the total number of inpatients, in recent months it has stopped. What is disclosed is derived from the report.

- The total number of discharges and the number of discharges per day, per week, etc.

- The number per day of inpatients in simple Covid-19 beds, ICU beds and PACUs (enhanced care units) as well as detailed data (age, gender, etc.). The government only reports the number of intubated per day and by broad solar distribution and gender.

- The number of intubated by regional unit, city, hospital.

- The number per day of patients discharged from ICU beds (only the total is provided).

- The occupancy rate of hospital units. Well, in Greece we do not yet know with certainty what the total number of ICU beds is.

- The number of patients in home quarantine and the number of those either cured or not infectious (per day etc.)

Especially as regards the data of inpatients (admissions - discharges) per day, our country, although it is obliged to submit the relevant data to the ECDC, it does not do so as other countries do, such as Austria, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic and many others. In fact, several European countries, such as Cyprus, Austria, Sweden, Spain, Slovenia etc., provide detailed data on the number of inpatients per day in ICU beds.

As regards the indicators

- The positivity index by region. Although a positivity rate per week in a test set is reported, details are not consistently provided. It is one of the most important indicators to monitor the pandemic locally.

- The notorious index Rt. This is the most important indicator (how many people each vector transmits the virus to). Instead of being reported every day and by regional unit, especially by city, there is a report for the whole country only in the so-called «Covid-19 Observatory Progress Report» every 10-15 days. In other European countries, for example in Germany and Denmark, the Rt index is a key statistic with daily reporting and of course with full statistics per regional unit, city etc.

• In Greece, however, on the official government website on coronavirus (covid19.gov.gr), all these data seem to have been replaced by some charts from a state-owned deciphering company.

Opacity and shortcomings

In a Facebook post last October, the Professor of Health Policy at LSE Elias Mosialos had raised the issue of data provision in our country. He had even suggested which data should be communicated. Among other things, it called for to analyse and communicate the confirmed daily cases based on the day of sampling, the number of tests carried out on the basis of the day on which the samples are taken shall be announced at the same time: i.e. correlate the number of cases with an increase or decrease in the number of tests. Ideally, as in other countries, the test-positivity rates should be reported by age group. An estimate of the total number of active cases in the country should also be provided and more information on the cases (demographic characteristics, geographical distribution, clustering, possible location and mode of dispersal) should be given. The number of people hospitalised in hospitals should also be announced, based on the severity of the cases (moderate, severe, critical), the number of people admitted to intensive care units, and the number of deaths, together with the characteristics of those who unfortunately lost the battle.

And the Professor of Epidemiology at the Medical School of the University of Athens Athina Linou has criticised the way Greece records pandemic data. He recently stated that the country «falls short in terms of transparency of the pandemic. I am concerned that areas are being closed without having the data on cases.».

In the end, the only fact is that the government of excellence and the best CV in the country does not provide Greek citizens with the data that it should - to which the citizens of other European countries have access. And the question that arises is beyond serious: is the image of the country projected abroad and formed by data provided to the ECDC by the Greek government true or fictitious?;

In countries such as Germany and Denmark, the Rt indicator - how many people each vector transmits the virus to - is a key statistic with daily reporting and full statistics per regional unit, city, etc.