Anyone who follows the supposed official numbers of people dying of coronavirus will find inexplicable discrepancies in the numbers from country to country. For example, the data for June 6 on the Worldometers website record 111,636 deaths in the United States and 4,634 in China, the country in which the virus originated. China? A country of 1.4 billion people? Really? India, a country with 1.3 billion people, reports only 6,933 deaths, as contrasted with Belgium, a country of 11.5 million people, which had 9,580 deaths. Seriously?

What about Germany, population 83.7 million, with 8,766 deaths, as contrasted with Spain, population 46.7 million, with 27,135 deaths, or Italy, population 60 million, with 33,846 deaths? How can this be? How do they count these deaths? Do they have political agendas?

Of course the website’s data collection methods could be faulty, and some have accused it of numerous discrepancies, but other websites have similar numbers. The key question is whether these are a potpourri of deaths from coronavirus, deaths among people who also have coronavirus, deaths of people who are assumed to have coronavirus, or even whether the deaths were of people proven by accurate tests actually to have coronavirus. We will come back to the various types of tests used, their timing and their accuracy.

Countries such as China and Russia are motivated to demonstrate as few deaths as possible from coronavirus. Remember, little Belgium has reported something like twice as many cases as either one of these great countries, but it most likely is telling the truth! China has a powerful political reason to deny that it is ground zero of the pandemic. In fact, the numbers they have released represent such a miniscule fraction of their enormous population that they are completely implausible. Of course China did not have universal testing—or anything close to it—in the early part of the pandemic. Of course they did not know about the major complications, nor did they have any experience in treating it, but even later on, when they knew all of this, their numbers stayed impossibly low. This is pure politics. Russia on the other hand came late to the pandemic, and their epidemic is on a earlier part of the curve, so the final numbers will not come in for some time. Still, there are other reasons for their low numbers.

Russia has bragged that they only attribute a death to coronavirus if it has been proven by actual tests. In fact, patients who die of pneumonia, stroke, kidney failure or blood clots are signed off as having died of that specific problem, even if they have tested positive for coronavirus. Since coronavirus notoriously can cause any or all of the above, they thus reclassify a substantial number of coronavirus deaths as due to the complication, not the coronavirus itself. It is like saying that a patient with a heart condition did not die because he was hit by a car; he died of heart failure. Complicating the science is the political reality that Russian President Vladimir Putin has touted Russia’s low death rate of coronavirus, and there is a strong country-wide incentive to keep the numbers as low as possible.

The United States has had by far the highest number of coronavirus deaths in the world. To start with, testing was not universally available at the onset of the pandemic in the United States, so we did not even have real numbers. Many were just assumptions. Next, even after we began to have widespread testing, the epidemic became intertwined with U.S. politics. Opponents of the president are motivated to raise the numbers as high as possible in order to discredit the administration. Recently Michigan deliberately raised the reported death count by including all those whose “probable cause” was coronavirus, even if they were not verified by testing. Our national and state numbers also are regularly hiked up after past death records are scrutinized for cases that can be reclassified retrospectively as coronavirus. This serves another purpose. The higher the case count, the more subsidy to the state and the hospital.

Many factors come into play across the world. The pandemic started early in Italy, because the garment industry in northern Italy was closely linked to China, causing Italy to be one of the first affected. At that time, testing lagged behind. Treatment was still trial and error. Equipment and supplies were in short supply. The epidemic was a veritable plague with bodies piling up everywhere, and it is difficult to imagine that the numbers were accurate. Still, they were in line with those in Spain and France. Germany is an outlier, but we are told that their epidemic started among young healthy people–presumably with few preexisting conditions—who had gone to Italy to ski. Also, Germany—being Germany—is extremely meticulous about only ascribing deaths to coronavirus if they have been tested.

So how reliable is the testing? There are two types of tests. Viral testing shows whether or not the patient has a current infection. Antibody testing demonstrates whether the patient previously had an infection, but these antibodies do not show up until one to three weeks after the initial infection, so timing matters. Both of these have false positives and negatives. Many companies have devised different versions of both types. Some of these test systems have been nearly worthless. China sent millions of tests to several countries in Europe, and the tests were found to be so bad that the Slovaks said they were only worth throwing into the Danube. Spain reported that the Chinese tests were only 30 percent accurate.

Moreover, criteria for who should be tested have varied. When tests were in very short supply, they were only administered to people who were demonstrably sick, thus missing many others who simply appeared to have a cold. As more tests became available, they were given to more people who did not have symptoms, and thus the apparent death rate for people test-proven to have the virus went down. In a country like India, poverty, a vast geographic size and a population of over a billion greatly complicate the task of identifying cases, doing widespread testing, and treating severely ill patients. The quality of medicine varies from excellent in private hospitals in Mumbai to sketchy at best in small rural hospitals that are badly strapped for supplies. Poor roads, a complex social structure and superstition greatly hamper the activities of the most dedicated social workers and medical personnel. Cases go uncounted and many may go untreated under these circumstances, which, incidentally, are true in other Asian countries, as well as in Africa. All of these countries will report numbers that surely undercount the actual deaths from coronavirus.

We have not even addressed the quality of medical care. Even in the United States, with some of the best medical care in the world, the learning curve for doctors has been steep. At first we were frightened because we did not have enough ventilators. Then we learned that 80 percent of those put on a ventilator would die, that the pressures that we used for ventilators were damaging the fragile lungs of these patients, that simple positioning of patients on their stomachs would help. We began to discover medicines that ameliorated the course of illness, none yet that cure reliably, but several that help, a lot. Some countries have learned fast, as we have in the United States. Some are way behind. All of this affects the numbers.

At first we did not even know about the numerous complications of coronavirus, whether or not to count all of them as coronavirus deaths, how to treat them, how to predict them. Meanwhile, numbers were totaled up while we were learning, while politicians tried to garner credit for their good work or to escape blame for bad results. Meanwhile, we went from having no tests to having multiple possible tests, some better than the others. It is complicated.