COVID-19: The latest picture as at 3rd November 2020

In this week’s blog we explore the latest data on weekly deaths in the UK. Deaths which mention COVID-19 on the death certificate continue to trend upwards, contributing to an increasing proportion of total weekly deaths. Meanwhile, non COVID-19 deaths remain fairly close to the seasonal average. With both cases numbers and hospital admissions rising, we explore how they are sadly likely to indicate a further rise in COVID-19 deaths in the weeks ahead.

Since last week’s update on weekly deaths, the UK Government has announced that a month long lockdown will come into force across England from Thursday (5th), replacing the “three-tier” alert system for local restrictions that has been in place for the last few weeks. Wales is in the middle of its two week “firebreak” (due to end on Monday 9th), and Northern Ireland’s four week “circuit breaker” continues (due to end on Friday 13th). Meanwhile, Scotland has this week introduced its own tiered alert system of regional restrictions, but has so far resisted imposing nationwide restrictions. In making these decisions, government officials will consider a number of statistics, including the rates of positive COVID-19 cases, which have continued to rise in recent weeks, as well as numbers for hospitalisations, which are also rising. These figures are likely to be indicators of future COVID-19 deaths, with a lag between case numbers and admissions, and a further lag until tragic COVID-19 deaths. With deaths directly related to COVID-19 continuing to rise steadily, albeit more slowly than in the initial stages of the pandemic, concerns remain that we could see many more deaths as we head into winter.

Continuing increase in deaths directly attributable to COVID-19

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 9th October. 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 some 9% of deaths in the most recent registered week mentioning COVID-19 on the death certificate. The direction of travel, with some signs of acceleration, is clearly concerning - particularly in light of continued increases in cases across much of the country and the imminent arrival of winter bringing further pressures on NHS services.

As more widespread and stringent restrictions continue to be implemented, we will continue to monitor the data to see whether a slowing of the trend in case rates and deaths is apparent in the weeks ahead.

Weekly deaths remain slightly above average seasonal levels

Total deaths remain slightly above the 5-year average, for the seventh consecutive week. The direction of travel is concerning, as the number of excess deaths has been increasing recently. This increase has mainly been driven by the steady rise in deaths directly attributable to COVID-19 over that period. If we exclude such deaths, the weekly deaths would be very close to 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, even before including the COVID deaths. This effect was particularly evident in the UK over April and May and was explored as ‘missed’ COVID-19 linked deaths in our earlier blog.

Given the statistical ‘noise’ in weekly death figures, caution is required when looking at this data over relatively short periods. It will, however, be important to monitor how these figures evolve over the winter months, where deaths would be expected to increase in any given year.

Comparing cases, hospitalisations and deaths

Much of the attention has, understandably, been on case numbers in recent weeks. While the past few months have seen rapid growth in cases, as discussed in our case watch blog, part of this will be due to the significant increases in capacity compared to earlier in the pandemic, as well as the track and trace system enabling more targeted testing.

While for many people, COVID-19 symptoms may be relatively mild, or even asymptomatic, there will unfortunately be people who require hospital treatment and, in the most serious cases, intensive care facilities. In some cases, we might expect there to be a delay between first diagnosis of COVID-19 and any deterioration that requires hospital treatment. And sadly, while understanding of the symptoms and appropriate medical treatments have improved markedly since the start of the pandemic, a number of those admitted to hospital will sadly die – again we would expect there to be some delay between initial hospitalisation and deaths occurring.

It is therefore very useful to look at the numbers of COVID-19 cases, as an indicator of imminent hospitalisation requirements. These hospitalisation figures themselves could be 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, since only very low levels were seen over the summer.

We can see how COVID-19 cases in the UK (purple line, left hand axis) have been increasing fairly rapidly over recent months. There has been an element of lag, as expected, 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, much of the initial rise in cases seen in September was a result of outbreaks in student populations, who are less likely to require hospital treatment (although risk passing on infections to more vulnerable relatives). Nonetheless, there are concerns that, even if recent tightening of restrictions have the desired impact of slowing, and ultimately reversing, the rise in COVID-19 cases, COVID-19 linked hospitalisations are likely to increase over the weeks ahead, at a time when NHS services would, in normal circumstances, expect to face increased pressures over winter. Time will tell whether there will be further bad news on COVID-19 deaths throughout the rest of the year – we will be sure to keep our eyes on the emerging data to quickly identify any early 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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