The UK’s Office For National Statistics has just released a report which “Examines death registrations not involving coronavirus (COVID-19), to understand the apparent increase in deaths”. It nonetheless suggests that a significant number of the UK’s recent “excess deaths” that make no mention of Covid-19 on the death certificate might well have been caused by the SARS-CoV-2 virus. In section 5 concerning “Deaths due to dementia and Alzheimer disease” the ONS point out that:
The sudden rise in deaths due to dementia and Alzheimer disease is so sharp that it is implausible that the full increase observed could have happened by chance. The absence of large rises in deaths due to this cause that mention conditions that could exhibit similar symptoms to COVID-19 suggests that if COVID-19 is involved in the increase in deaths due to dementia and Alzheimer disease, the usual symptoms of COVID-19 were not apparent. This could fit with recent clinical observations, where atypical hypoxia has been observed in some COVID-19 patients. In someone with advanced dementia and Alzheimer disease, the symptoms of COVID-19 might be difficult to distinguish from their underlying illness, especially with the possibility of communication difficulties.
The terms “Covid-19 Hypoxia” and “silent hypoxia” have been used in the medical literature for quite some time, amongst other things to suggest that “overuse of intubation” for Covid-19 patients should be addressed.
We await further news on the attribution of UK deaths to the many effects of the SARS-Cov-2 virus with interest.
Today is a Tuesday, which means that The Office for National Statistics have just released their latest weekly “death certificate” data, which brings us up to May 22nd. The “main points” are:
A total of 43,837 deaths involving COVID-19 were registered in England and Wales between 28 December 2019 and 22 May 2020 (year to date).
In England, including deaths that occurred up to 22 May but were registered up to 30 May, of those we have processed so far, the number involving COVID-19 was 42,210; the comparative number of death notifications reported by the Department of Health and Social Care (DHSC) on GOV.UK was 32,666 and NHS England numbers, which are deaths in hospitals only, showed 25,875 deaths.
In Wales, including deaths that occurred up to 22 May but were registered up to 30 May, of those we have processed so far, the number involving COVID-19 was 2,122; the comparative number of death notifications reported by the DHSC on GOV.UK was 1,260 and Public Health Wales (PHW) numbers, which come from the same source as the DHSC figures but are continuously updated, showed 1,275 deaths.
In England, the number of deaths involving COVID-19 in care homes that were registered by 22 May was 12,142, while in Wales the number of deaths was 591.
The Care Quality Commission (CQC) provides numbers of deaths involving COVID-19 in care homes in England that were notified between 10 April and 29 May, which showed 11,186 deaths, of which 531 occurred in the week up to 29 May.
The Care Inspectorate Wales (CIW) provides the number of deaths involving COVID-19 in care homes in Wales that occurred between 17 March and 29 May, which showed 462 deaths, of which 35 occurred in the week up to 29 May.
Here’s the “graphic” representation of those numbers:
Here is an alternative view on weekly “death occurrences in England and Wales” over recent years from EuroMOMO:
Publishing the number of death occurrences is outside EuroMOMO’s terms of reference, but their “Z-scores” provide a graphic illustration of how badly England in particular has been doing over the course of the 2020 Covid-19 epidemic.
The number of deaths registered in England and Wales in the week ending 29 May 2020 (Week 22) was 9,824; this was 2,464 fewer than in Week 21 but 20.2% (1,653 deaths) higher than the five-year average.
Of the deaths registered in Week 22, 1,822 mentioned “novel coronavirus (COVID-19)”, the lowest number of deaths involving COVID-19 in the last eight weeks; this accounts for 18.5% of all deaths and is 767 deaths fewer than in Week 21.
People aged 90 years and over continued to have the highest number of COVID-19 deaths in Week 22.
In Week 22, the proportion of deaths occurring in care homes decreased to 25.5% while deaths involving COVID-19 as a percentage of all deaths in care homes decreased to 28.2%.
In Week 22, the number of deaths in care homes was 819 higher than the five-year average, while in hospitals the number of deaths was 30 fewer than the five-year average; the total number of excess deaths involving COVID-19 continued to decrease.
Here’s a graphic representation of the overall “excess death” numbers:
By way of explanation:
The number of deaths was around or below the five-year average up to Week 12. The number of deaths increased between Weeks 13 and 16 before decreasing between Weeks 17 and 22, with the exception of Week 20 where the deaths increased.
The number of death registrations in Week 20 was impacted by the early May Bank Holiday, which took place on Friday 8 May 2020 (in Week 19). The number of deaths registered on the early May Bank Holiday fell to 88 deaths compared with 2,950 deaths registered on the previous Friday (Friday 1 May 2020). Trends seen in Week 19 and Week 20 should therefore be interpreted with caution, as deaths not registered on the early May Bank Holiday were likely registered in the following week (Week 20). Week 22 also included the late May Bank Holiday but as this was on a Monday, we have seen less of an effect on death registrations.
The number of death registrations involving the coronavirus (COVID-19) decreased from 2,589 in Week 21 to 1,822 in Week 22. Of all deaths registered in Week 22, 18.5% mentioned COVID-19; this is down from 21.1% in Week 21.
Similar patterns can be seen for England and Wales separately, with the number of deaths in England decreasing from 11,586 in Week 21 to 9,228 in Week 22, which was 1,621 deaths higher than the Week 22 average. Of the Week 22 deaths, 18.6% (1,715 deaths) involved COVID-19 in England.
In Wales, the number of deaths decreased from 692 deaths in Week 21 to 587 deaths in Week 22, 41 deaths higher than the Week 22 average. Of these Week 22 deaths, 17.9% (105 deaths) involved COVID-19 in Wales.
[Edit – June 10th]
Today’s Downing Street Briefing was somewhat unusual. Boris Johnson was master of ceremonies, and what’s more he was accompanied by some scientists! Boris began by referring to “the progress we as a country have made against our 5 tests for adjusting lockdown”
Instead of listening to what was said, let’s take a look at some of the data that was referred to shall we?
The overall aim is evidently to “reduce the rate of infection to manageable levels” whilst “not risk[ing] a second peak of infections that overwhelms the NHS”. Boris hopes that the latest lockdown “adjustments” will be “underpinned by NHS Test and Trace”, so let’s also see how that’s coming along shall we? As luck would have it the Independent Sage committee also reported this yesterday:
From 29 April 2020, DHSC are publishing as their daily announced figures on deaths from COVID-19 for the UK a new series that uses improved data for England produced by Public Health England (PHE). These figures provide a count of all deaths where a positive test for COVID-19 has been confirmed, wherever that death has taken place. Figures for Scotland, Wales and Northern Ireland have already begun to include deaths outside hospitals, so this change will ensure that the UK-wide series has a shared and common definitional coverage. This updated statement explains what the new data are and how they differ from both the data series previously published by DHSC and the figures produced by the ONS.
Separately, to improve the timely availability of data on deaths in care homes involving COVID-19, the ONS and the Care Quality Commission (CQC) agreed to publish from 28 April 2020 provisional counts of deaths in care homes, based on statutory notifications by care home providers to CQC. A separate explanatory statement about these new data has been published jointly by the ONS and CQC.
Summarises the information from the surveillance systems which are used to monitor the Coronavirus Disease 2019 (COVID-19) pandemic in England.
The report is based on week 16 (data between 13 April and 19 April 2020) and where available daily data up to 22 April 2020.
COVID-19 is the disease name and SARS-CoV-2 is the virus name.
The report includes sections devoted to UK “Community surveillance”, “Primary care surveillance”, “Secondary care surveillance”, “Virological surveillance” and “Mortality surveillance”. In the latter section it points out that:
In week 16 2020 in England, statistically significant excess mortality by week of death above the upper 2 z-score threshold was seen overall, by age group in the 15-64 and 65+ year olds and sub nationally (all ages) in all regions (North East, North West, Yorkshire & Humber, East & West Midlands, East of England, London and South East & West regions) after correcting GRO disaggregate data for reporting delay with the standardised EuroMOMO algorithm (Figure 18). This data is provisional due to the time delay in registration; numbers may vary from week to week.
The recent “spike” appears to be statistically significant! However despite that, this report and the rest of the virtual paperwork emanating from the UK Government still fail to address the question we posed last week:
How will the UK Government build on the amazing community solidarity we have seen in the past few weeks and reassure the citizens of the nation that lifting the lockdown won’t result in further out-of-control outbreaks?
Whilst we continue to wait for an answer, here are the new “positive test” daily death numbers from the DHSC:
As of 9am 29 April, there have been 818,539 tests, with 52,429 tests on 28 April.
632,794 people have been tested of which 165,221 tested positive.
As of 5pm on 28 April, of those tested positive for coronavirus across all settings, 26,097 have sadly died. pic.twitter.com/Qw1GB5s3Wc
They do of course beg the question of how many “untested” deaths due to Covid-19 are occurring. Regular readers will be aware that we have been following the modelled future death projections of James Annan. Here’s his first update using the DHSC’s new numbers:
Twitter threading isn’t the best..here is what I get with the new time series of all reported deaths (still a huge undercount, but includes deaths outside hospitals) pic.twitter.com/1xWX4A8v1O
The provisional number of deaths registered in England and Wales in the week ending 24 April 2020 (Week 17) was 21,997, a decrease of 354 deaths registered compared with the previous week (Week 16); this is the first decrease in the number of deaths since the week ending 20 March 2020 (Week 12) but is 11,539 more than the five-year average for Week 17.
Of the deaths registered in Week 17, 8,237 mentioned “novel coronavirus (COVID-19)”, which is 37.4% of all deaths; this is a decrease of 521 deaths compared with Week 16 (39.2% of all deaths).
The number of deaths in care homes (from all causes) for Week 17 was 7,911, which is 595 higher than Week 16. The number of deaths in hospitals for Week 17 was 8,243, which is 1,191 lower than Week 16.
In London, over half (50.5%) of deaths registered in Week 17 involved COVID-19; the North West and North East also had a high proportion of COVID-19 deaths, accounting for 38.8% and 38.0%, respectively, of deaths registered in these regions.
In Wales, there were 413 deaths registered in Week 17 involving COVID-19, accounting for 36.7% of all deaths registered in Wales.
Of deaths involving COVID-19 registered up to Week 17, 71.8% (19,643 deaths) occurred in hospital with the remainder mainly occurring in care homes (5,890 deaths), private homes (1,306 deaths) and hospices (301 deaths).
Here are those numbers in graphic detail:
[Edit – May 12th]
The latest weekly Covid-19 update has been issued by the Office for National Statistics. Here’s the summary on Twitter:
33,337 / 21,647 = 1.54
[Edit – May 19th]
The latest weekly update from the ONS has been published:
Our weekly deaths data for England show of all deaths occurring up to 8 May (registered up to 16 May), 37,154 involved #COVID19
For the same period ▪️ @DHSCgovuk reported 28,250 COVID-19 deaths ▪️ @NHSEngland reported 23,528 hospital deaths
Deaths in care homes made up 36.0% of all deaths in Week 17, 35.7% in Week 18 and 33.6% in Week 19 (Figure 7). Between Week 18 and Week 19, the number of deaths in care homes decreased by 33.7% to 4,248. However, the proportion of care home deaths that involved COVID-19 continued to increase, and 39.2% of all deaths in care homes involved COVID-19 in Week 19.