COVID-19: The latest picture as at 1st December 2020

In this week’s blog, we explore the latest data on weekly deaths in the UK. Total weekly deaths have continued the rise seen over the past few weeks and are around 21% higher than average for the time of year. The cumulative level of ‘excess’ deaths in the UK is now approaching 70,000 for the year to date.

The rise in weekly deaths has been driven by the continued resurgence of deaths which mention COVID-19 on the death certificate. This makes up 21% of the deaths registered in the most recent week. We are however seeing some signs that this rate of growth in COVID-19 deaths may be slowing somewhat. Meanwhile, non COVID-19 linked deaths have continued to be below average for the time of year.

Since last week’s update on weekly deaths:

  • England is due to move to a revised three tier alert system on Wednesday as the nationwide lockdown comes to an end, with most of the country being placed in the top two tiers.
  • Wales is bringing in further restrictions on hospitality from this Friday (4th).
  • Northern Ireland entered another ‘circuit breaker’ for a two week period from Friday 27th November.
  • 11 councils in Scotland remain in the highest tier of the five-tier regional restrictions, and are due to remain there until Friday 11th December at least. A number of other areas are being watched carefully, with levels formally reviewed on a weekly basis.
  • As we enter December, plans have been announced to allow ‘Christmas bubbles’ which will enable some limited mixing of households over the festive period.

In more encouraging news, COVID-19 cases in the UK have continued to fall over recent days, perhaps indicating that the tightened restrictions are beginning to have the desired effect. The numbers for hospitalisations of COVID-19 patients have also started to fall. Given that a proportion of new cases will require hospital treatment, and some of those will tragically die, we expect a lag between each stage. Concerns remain that, despite the encouraging direction of travel of each indicator, we could yet see many more COVID-19 linked deaths in the weeks ahead.

Deaths directly attributable to COVID-19 continue to increase 

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 20th November. 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. 

COVID-19 deaths have been increasing steadily over recent weeks, with around 21% of deaths in the most recent registered week mentioning COVID-19 on the death certificate. While the direction of travel continues to cause concern, there may be signs that the rate of growth in deaths is slowing. Case numbers are also now falling, although there will inevitably be some lag before deaths linked to these recent new cases occur. We will be paying close attention to the death figures in the weeks ahead.

Weekly deaths increasingly above average seasonal levels

Total deaths remain above the 5-year average, for the eleventh consecutive week, with the number of excess deaths increasing steadily over the past few weeks (albeit more slowly in the most recent week). This increase has, however, been driven by the continued rise in deaths directly attributable to COVID-19, as mentioned above. Weekly deaths excluding those linked to COVID-19 have been close to, if not below, average for the past few weeks, 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. Since then weekly non COVID-19 deaths have been much closer to, and for the past four weeks below, seasonal levels.

Given the statistical ‘noise’ in weekly death figures, caution is required when looking at this data over relatively short periods. However, the downward trend seen over the past few weeks is nonetheless welcome, particularly at a time of rising COVID-19 deaths. It will, however, be important to monitor how these figures evolve over the next few months, where deaths would be expected to increase in any given year over the winter.

What is the position for the year to date?

After a relatively light start to the year, cumulative deaths in the UK rose rapidly over April and May, 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 the cumulative excess mortality was relatively stable, as weekly deaths were close to average levels.  However, as mentioned above, deaths have been above average for the past few weeks, and as a result the cumulative total has begun to creep upwards again, with the year to date figure now approaching 70,000. 

The chart above reminds us of the sudden and dramatic emergence of COVID-19 and its impact on UK mortality.  As we enter the last few weeks of the year, excess deaths are already over 10% of the typical annual total, with the potential for more bad news to come.

Comparing cases, hospitalisations and deaths

While case numbers grab most of the headlines, we know that many people infected with COVID-19 have relatively mild symptoms, with some cases being entirely asymptomatic. However, there will unfortunately be a number of more severe cases which 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 (with averaging over 7 days applied in each case to smooth out variations, such as that occurring at 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) increased fairly rapidly since early September, but more recently have fallen relatively sharply, as discussed above.

As expected, there was some lag between the increase in cases and corresponding rises in hospitalisations (solid green line, right hand axis), with a further lag in the rise in deaths. There will not be direct correlation between these figures, for example impacts may depend on the changing rates of infection across different age groups, who are likely to have differing levels of hospitalisation.

It is therefore encouraging that COVID-19 linked hospitalisations are also now falling, albeit more gradually, particularly as we are now at a time when NHS services would, in normal circumstances, expect to face increased pressures during winter.

Time will tell whether there will be further bad news on COVID-19 deaths throughout the last few weeks of the year. We will be sure to keep our eyes on the latest data to quickly identify any emerging signals.

“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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