COVID-19: The latest picture as at 15th January 2021

In our first COVID-19 blog of 2021 we look at the latest weekly data in the UK, covering the final weeks of 2020. While registered deaths fell over the last two weeks, the impact of the Bank Holidays (and associated closures of registration offices) over the Christmas period mean that these figures should be treated with some caution. A quirk in the calendar also meant that 2020 had an ‘extra’ week, for the first time since 2015. While deaths in a calendar year differ slightly from the sum of the individual reported weeks, we can nonetheless compare deaths over 2020 with previous years.

In the face of continued rise of both case numbers and hospitalisations, the New Year brought a further tightening of nationwide restrictions across the UK, after plans for easing over the Christmas period were scaled back. As pressure rises on hospital beds, amplified by the usual busier winter period, other non COVID-19 medical services are again being scaled back (we explored concerns around this issue in a previous blog).  In more positive news, with three different vaccines now approved for use in the UK, efforts are ramping up to rollout a nationwide vaccination programme.

COVID-19 in the UK: Current position

COVID-19 case numbers continue to grab most of the news headlines. While many of these cases show relatively mild symptoms, with some being asymptomatic, there will unfortunately be a proportion who require hospital treatment and, in the most serious cases, intensive care facilities. Sadly, while medical treatments have improved markedly since the start of the pandemic, a number of those admitted to hospital will tragically die. The progression from first infection, to developing serious symptoms requiring hospitalisation, to death occurring typically takes a number of weeks.

It is therefore very useful to look at the numbers of COVID-19 cases, as an indicator of imminent hospitalisation requirements, and to look at hospitalisation figures themselves as an indicator of future rises in COVID-19 linked deaths.

The chart below compares these three figures for the UK as a whole (averaged over the 7 days to the date shown to smooth out variations, such as weekends and bank holidays). We have focussed on the figures for the past few months, given the very low levels seen over the summer.

We can see how COVID-19 cases in the UK (purple line, left hand axis), having increased steadily since early September, fell somewhat in November following a tightening of restrictions across the UK. However, since the start of December there has been an even more rapid increase in cases. A combination of the more virulent strain of COVID-19, easing of restrictions over the festive period (albeit much more limited than planed initially), and a potentially reduced adherence (due to factors such as ‘lockdown fatigue’, progress on vaccines, as well as a desire to mix more over Christmas) may all be contributing to this rise, to varying degrees.

There will not be a direct correlation between cases and hospitalisations (solid green line, right hand axis), for example due to changing rates of infection across different age groups, who are likely to have differing levels of hospitalisation. However, hospitalisations have broadly followed case numbers (with some anticipated time lag) and are also now rapidly rising, with the 7 day average now higher than the previous peak in early April. As hospitals would typically be busier at this time of year, this is clearly concerning.

COVID-19 deaths (dashed green line, right hand axis) are also following similar patterns, although the rate of increase since early December is less dramatic, and closer to that seen over November. However, given the relationships discussed, if case numbers and hospitalisations continue to increase rapidly, it seems inevitable that we will see higher levels of deaths in the coming weeks.

Deaths directly attributable to COVID-19 have been stable

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 1st January 2020. 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. 

Following several months of increasing deaths which mention COVID-19 on the death certificate, the past few weeks have seen the numbers stabilise somewhat.  As discussed above, the rapid rise in cases and hospitalisations in December is likely to translate to higher deaths in the coming weeks, so there is likely to be further bad news to come.

Weekly deaths remain above average seasonal levels

We expect the last few weeks of the year to see a drop in registered deaths as a result of the Christmas and New Year Bank Holidays. However, 2020 was slightly different from previous years, for two reasons:

  • Week 52 of 2020 saw only one Bank Holiday (25th December), whereas in 4 of the previous 5 years there were two Bank Holidays (corresponding to Christmas Day and Boxing Day). So, while the weekly deaths have fallen by much less than the average (so ‘excess’ deaths have increased), this is in part due to the extra day available for registration.
  • For the first time since 2015 there were actually 53 weeks (except in Northern Ireland), with the last week covering the week ending 1 January 2021 (3 January 2021 in Scotland). The average deaths used in the above chart for week 53 have been set equal to those in week 52 (in both cases having two Bank Holidays) for ease of comparison.

Therefore, the numbers of deaths registered in the last two weeks should be treated with some caution. We would expect there to be some element of ‘catchup’ in deaths in the first week of 2021.

Deaths excluding those linked to COVID-19 continue to be below 5-year average levels as can be seen from the chart below.

The bars shaded in red indicate weeks where total deaths were above average seasonal levels. This effect was particularly evident at the same time as the COVID-19 pandemic first hit the UK over April and May and was explored as ‘missed’ COVID-19 linked deaths in our earlier blog. More recently weekly non COVID-19 deaths have been increasingly below seasonal levels. As noted above, the figures for the last two weeks should be treated with some caution.

We have illustrated how the chart may have looked had week 52 had 2 rather than 1 Bank Holiday, with a catchup in week 53, in dashed lines (similar to the approach taken when illustrating the potential impact of the Friday Bank Holiday in May).

Where are deaths occurring?

The group of charts below looks at the recorded place of death of deaths registered each week, for England & Wales. We have focussed on the period since mid-March, and again split out deaths which mention COVID-19 from those which don’t, with the dashed blue line showing the corresponding 5 year averages.

We can see from these charts that:

  • The majority of COVID-19 linked deaths occurred in hospitals, particularly in second wave at the end of the year. Over the summer deaths in a hospital setting were consistently below average for that time of year.
  • Care homes saw significant increase in deaths in the spring. While a significant proportion of these were COVID-19 linked, non COVID-19 deaths over that period were also significantly higher than normal (possibly due to undiagnosed COVID-19 etc). Deaths have subsequently been around average levels, even allowing for some resurgence in COVID-19 deaths at the end of the year. With care home residents in the highest priority group for vaccinations, hopefully there will be better news in 2021.
  • While only small numbers of deaths occuring at home have been attributed to COVID-19, nonetheless deaths have remained consistently above average levels for the rest of the year. This is a cause for concern, and may hint at people being reluctant to go to seek medical attention (perhaps to avoid being ‘a burden’ or through fear of catching the virus), as well as potential impacts of scaling back of many medical provisions (eg home visits). Previous analysis suggested that some causes of death were being redistributed (eg heart disease deaths fell in hospitals but rose at home over the period).

What is the final position for 2020?

Due to timing differences with the week definitions the total registered deaths in a given year will differ slightly from the sum of the individual weeks. For 2020, the ONS defined Week 1 as the week ending 3rd January 2020, while, as noted above, the final week was Week 53, the week ending 1st January 2021. Therefore, summing these 53 weeks would include 4 days of 2019 and 1 day of 2021. Nonetheless we can look at the sum of deaths over each week to get a feel for the relative mortality.

After a relatively light start to the year, cumulative deaths in the UK rose rapidly over April and May as the pandemic arrived, and by mid-June cumulative deaths for the year to date were almost 60,000 higher than the corresponding weekly average values over the past 5 year (the solid line in chart below). For much of the summer this figure was relatively stable, as weekly deaths were close to average levels.  However, the last few months of the year saw a resurgence in COVID-19 deaths, pushing the cumulative excess deaths figure for the year to around 83,000. Given a typical year sees UK deaths of around 600,000, this illustrates the scale of the impact of the pandemic, despite the significant social distancing measures put in place.

If we exclude deaths which mention COVID-19 on the death certificate, 2020 would actually have been a relatively light year ultimately (as shown in the dashed line in the chart) – continuing the trend seen in the first quarter. Hopefully as vaccines are rolled out more widely in the weeks ahead, the position for 2021 will begin to look much better.

“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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