COVID-19: The latest picture as at 11th August 2020

More restrictive lockdown measures remain in place in large parts of north west England and several local authorities with rising case numbers are being closely monitored. This week saw the reach of localised lockdowns extended across the UK, with Aberdeen becoming the first Scottish city to have a localised lockdown enforced. Against a backdrop where overall case numbers are starting to rise, concerns remain that we will see a resurgence of the current wave / a ‘second wave’. In this week’s blog we explore the latest data on weekly deaths, which have remained below seasonal norms for the seventh straight week. However, we remain concerned by continued early signs of a rise in non COVID-19 deaths. Many medical professionals have warned of the potential for medium and long term impacts on the health of the nation, given reductions in the numbers seeking treatment in medical facilities as a result of the pandemic. This is one of the concerns also raised in a July report prepared for SAGE looking at the direct and indirect impacts of COVID-19 on excess deaths and morbidity, which has now been made public. We also continue to see an apparent divergence in success in reducing COVID-19 deaths across the different nations in the UK, with Scotland and Northern Ireland outperforming England and Wales. Effective monitoring of the daily numbers of new positive cases, along with “track and trace”, will be extremely important in the weeks ahead, especially at local levels, to ensure spikes remain localised. Without this, some more widespread reversal of the easing of restrictions seems likely.

Weekly deaths remain below seasonal levels

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 31st July. In particular, they identify deaths where there is any mention of COVID-19 on the death certificate. Combining this information with similar data from the corresponding statistical bodies in Scotland and Northern Ireland, we can examine emerging patterns in the data. 

The latest data shows that for the seventh week running, the total registered deaths in the last reported week was below the average for the time of year.  The number of COVID-19 deaths also continues to decline, with the figure for the latest reported week being the lowest for 19 weeks, since the early days of the pandemic in the UK. The continuation of both these trends is welcome news.

Early signs of non COVID-19 deaths starting to rise again?

One of the concerns of many in the medical profession is the risk that we will see a rise in non COVID-19 deaths over time. This concern arises both from reductions in hospital services / capacity as well as emerging evidence that people have avoided seeking medical help and so are presenting later with conditions such as mild strokes, cancer symptoms etc…

While we did see a marked rise in non COVID-19 deaths at the same time as the pandemic started to impact in the UK in April (what we termed ‘missed’ deaths, shown in red in the chart below), in more recent weeks we saw non COVID-19 deaths return to the early 2020 trend of being below seasonal levels.  We have now seen eleven weeks of lower than average non COVID-19 deaths. However, the concern is that in recent weeks non COVID-19 deaths are not following the seasonal norms of modest decline, but instead have been creeping up.  

There is inevitably some volatility in these weekly deaths, so some caution is required in interpreting over short periods.  However, it could be that recent weeks are starting to show signs of the feared increase in non COVID-19 linked deaths and is something we will continue to keep a close eye on. 

Comparing COVID-19 experience across the home nations 

It is encouraging that COVID-19 linked deaths have continued to fall. From a peak of 39% of weekly registered deaths in mid April, in the latest week COVID-19 deaths contributed only 2% of the total deaths registered, and the 201 deaths registered is the lowest weekly figure since the end of March. (Albeit against a back-drop of rising new cases since mid July, which may mean the weekly COVID-19 deaths will sadly start to rise again.)

The UK has seen different approaches across each of the home nations in terms of their COVID-19 response. While lockdown was applied across the UK simultaneously, subsequent decisions around the pace and approach to unwinding the restrictions have varied. The charts below look at the how COVID-19 deaths, expressed as a percentage of the total weekly deaths, have varied across the constituent countries.

England saw the earliest and highest peak, and has generally seen the largest proportion of weekly deaths attributed to COVID-19 across the four nations.

In contrast, Scotland has the lowest proportion of deaths. Less than 1% of deaths were COVID related in recent weeks, compared to a peak of 36%.

Differences between the countries will depend on various factors, such as average ages and levels of urbanisation, as well as variations in the rates of unwinding lockdown restrictions. And as COVID-19 deaths fall to low levels, we are likely to see increased volatility from week to week. However, on the face of it, Scotland’s slower easing of restrictions appears to have made a significant difference in deaths from mid-May onwards.

What is the position for the year to date?

We estimate that the total death toll from COVID-19 in the UK, including both directly and indirectly related deaths, is currently over 71,000. 

After a relatively light start to the year, and a subsequent jump as a result of the pandemic, the cumulative deaths in the UK over the first 7 months of the year appears to have stabilised for the moment at around 60,000 higher than the corresponding weekly average values over the past 5 years. Excluding those deaths which specifically mention COVID on the death certificate, we would be looking at an ‘average’ year, with cumulative deaths just slightly above average.

It is reassuring that the level of excess deaths has levelled off, but this chart does serve as a reminder of the sudden and dramatic emergence of COVID-19 and its impact on UK mortality. Over the course of the year we have seen excess deaths of the order of 10% of the typical annual total for the UK. Whether we remain at broadly the 60,000 excess deaths level, drop down a little due to continued lower than average non COVID-19 deaths as seen over the last few weeks, or enter a fresh phase of rising excess deaths (potentially from a resurgence in COVID-19 and/or a rise in non COVID-19 deaths) continues to be hanging in the balance…

1A distinction is made by epidemiologists between a continuation of the current wave vs a second wave which would usually follow a period of absence of the virus and a secondary period of infections and deaths, possibly from a different strain.

2Scientific Advisory Group on Emergencies

“All of the team at Club Vita wish to extend our condolences to anyone who has personally been touched by bereavement in recent months. We know that these deaths leave behind people who are missing loved ones. Our thoughts are with you…”
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