COVID-19: The latest picture as at 18th August 2020

In this week’s blog we explore the latest data on weekly deaths, which have remained below seasonal norms for the eighth straight week. However, despite a welcome drop this week, we remain concerned about the risk of a future rise in non COVID-19 deaths, which many medical professionals have warned about, given reductions in the numbers seeking and receiving medical treatment as a result of the pandemic. We also explore the difficulties in defining COVID-19 deaths, as highlighted by the recent decision of Public Health England to adjust the definitions used to categorise deaths as COVID-19 deaths in England, which resulted in a marked drop in the headline number. It is important to remember that, regardless of the timing approach, the published figures only include those who have had a positive test, whereas the weekly figures published by the ONS, and corresponding bodies in Scotland and Northern Ireland, use a broader definition of deaths which mention COVID-19 on the death certificate. Combining these ‘missing’ deaths with the rise in non COVID-19 deaths is a better measure of the true impact of the pandemic on the UK.

Weekly deaths remain below seasonal levels

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 7th August. 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 eighth 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 20 weeks, since the early days of the pandemic in the UK. The continuation of both these trends is welcome news.

Keeping an eye on non COVID-19 deaths

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 the weeks and months ahead. This concern arises both from reductions in hospital services / capacity as well as evidence that people have avoided seeking medical help, and so are presenting later with conditions such as mild strokes, cancer symptoms etc, where early diagnosis can make a marked difference to their long-term prognosis.

While we saw 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), since mid-May non COVID-19 deaths had returned to the early 2020 trend of being below seasonal levels.   However, in more recent weeks non COVID-19 deaths have not followed the seasonal norms of a modest decline from week to week, but instead have been creeping up (as seen in the decreasing purple bars). It is therefore welcome that the latest reported week saw a further decline compared with the seasonal average.   

There is inevitably some volatility in these weekly deaths, so some caution is required in interpreting them over short periods.  We remain cautious about the risk of the feared increase in non COVID-19 linked deaths and it is something we will continue to keep a close eye on. 

What is the position for the year to date?

After a relatively light start to the year, the cumulative deaths in the UK rose rapidly as a result of the pandemic to almost 60,000 higher than the corresponding weekly average values over the past 5 years by md June, before falling slightly over recent weeks. Excluding those deaths which specifically mention COVID on the death certificate, we would be looking at a fairly ‘average’ year, with cumulative deaths for the year to date just slightly above average. 

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. Without these ‘extra’ deaths, 2020 would instead be a light year, with deaths well below average.

It is reassuring that the level of excess deaths levelled off, and has started to fall, but this chart does serve as a reminder of the sudden and dramatic emergence of COVID-19 and its impact on UK mortality and how quickly a further serious outbreak could emerge. 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 further due to continued lower than average 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…

Counting COVID-19 deaths

There has been a lot of coverage over the past few weeks around the figures quoted by Public Health England (‘PHE’) in respect of COVID-19 deaths in England.  Until recently, the daily COVID-19 death figure published by PHE was based on those who had previously returned a positive COVID-19 test, regardless of how long ago the test had been taken. 

However, the issue with such an approach is that those who tested positive but subsequently died of something unrelated (e.g. a road traffic accident) would still be classed as a ‘COVID-19’ death.  As death numbers fall, this had the potential to become an increasing issue over time. In addition, this approach was at odds with the corresponding figures in the other home nations, who only included deaths where there had been a positive test up to 28 days before death.

The PHE have, from 12 August 2020, started publishing two alternative classifications of COVID-19 deaths in England, namely:

  • Individuals who had a positive COVID-19 test up to 28 days before death; or 
  •  Individuals who had a positive COVID-19 test either up to 60 days before death, or if it was more than 60 days, mentioned COVID-19 on the death certificate. 

Both these approaches give COVID-19 death figures which are lower than under the previous approach, where no time limit was applied (as shown in the green lines in the chart).  While they will both reduce the risk of incorrectly counting deaths from other causes, there may be some individuals who are genuine COVID-19 deaths who are excluded, particularly on the 28-day measure (for example if someone was in ICU for over 4 weeks before dying). It does, though, also bring consistency with the approach taken in other parts of the UK (Health Protection Scotland, Public Health Wales, and the Department of Health in Northern Ireland), who have all been using the 28-day measure. 

While many of the headlines over the last week about the PHE’s change of approach spoke of ‘overestimates’ of COVID-19 deaths, in fact the PHE figures have understated the true impact of the pandemic.  The weekly figures for COVID-19 deaths published by the ONS for England & Wales (as well as the NRS in Scotland and NISRA in Northern Ireland) are significantly higher, as they include all  deaths where COVID-19 is mentioned on the death certificate, regardless of whether there has been a formal test. The purple line on the above chart shows the published weekly figure from the ONS, which can be compared to the corresponding figures from PHE.

“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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