COVID-19: The latest picture as at 24th November 2020

In this week’s blog, we explore the latest data on weekly deaths in the UK. Total weekly deaths have again risen, continuing the steady rise seen over the past few weeks, and are around 19% higher than average. This has been driven by the continued resurgence of deaths which mention COVID-19 on the death certificate, which contribute 20% of the deaths registered in the most recent week. Meanwhile, non COVID-19 linked deaths have remained below average, falling slightly on the previous week.

Since last week’s update on weekly deaths, England has set out plans for a revised three tier alert system to come into place when the nationwide lockdown finishes next week. Wales and Northern Ireland have continued with some nationwide restrictions. Meanwhile, 11 councils in Scotland were moved to the highest tier of regional restrictions for a three-week period, while a number of others are being watched carefully.

In more encouraging news, COVID-19 cases in the UK have fallen slightly over recent days, perhaps indicating that the tightened restrictions are beginning to have the desired effect. In addition, numbers for hospitalisations of COVID-19 patients appear to be stabilising, having been increasing for many weeks. Sadly, it is inevitable that a proportion of these new cases will require hospital treatment, and some of those will tragically die. Concerns remain that we could 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 13th 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 over 20% of deaths in the most recent registered week mentioning COVID-19 on the death certificate. The direction of travel is continues to cause concern, particularly given the high case numbers seen in recent weeks.

Weekly deaths increasingly above average seasonal levels

Total deaths remain above the 5-year average, for the tenth consecutive week, with the number of excess deaths increasing steadily over the past few weeks. 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 a number of 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.

Comparing cases, hospitalisations and deaths

The chart below shows the latest case numbers published by the UK government (as of the afternoon of 24th  November). The bars show the daily numbers of new COVID-19 cases across the UK, whilst the line shows the running seven-day average, smoothing through dips in new case numbers which tend to happen at weekends and bank holidays, for example.

The nationwide lockdown in England came into force on 5th November and is due to end on 2nd December, to be replaced by a return to an albeit stregthened three tier system.  Encouragingly case numbers appear to be beginning to fall over recent days, suggesting the tighter restrictions may be having the desired effect.

Wales brought in a two week ‘firebreak’ which finished on 9th November. Cases dropped significantly from the peak at the end of October, although show some concerning signs of rising again in the most recent data. Given COVID-19 linked deaths in the most recent week were at their highest level since early May, authorities will be keeping a close eye on the latest figures to assess whether tighter restrictions are thought necessary.

In Northern Ireland a four week circuit breaker was introduced from 16th October. Case numbers have also fallen signifcantly since late October. The NI Executive has recently announced that a further two week period of substantially stronger restrictions will be applied from 27th November. 

Meanwhile, Scotland has continued with its 5 tier alert system, recently moving councils across the populous central belt to the highest tier for a minimum three week period, and also making a late decision to postpone the planned move of Midlothian from level 3 down to level 2, as a result of a rise on case numbers in the area. Levels are reviewed weekly, and although cases are falling across much of the country, authorites are taking a deliberately cautious approach before downgrading any alert levels.

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) have been increasing fairly rapidly since early September, but more recently show signs of falling, as discussed above.

As expected, there has been 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.

Nonetheless, there are concerns that, even if COVID-19 cases are beginning to fall, as hinted at in some recent data, COVID-19 linked hospitalisations may continue at relatively high levels over the weeks ahead, 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 rest of the year, and the recent news around the potential for successful vaccines is encouraging.  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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