CLAIM

“We defied so many predictions … I know there will be many people looking now at our apparent success [tackling Covid-19]” – Boris Johnson on his return to work on April 27.

DOORSTEP ANSWER

IN its daily briefings, the UK Government headlines the number of hospital deaths from Covid-19 and only those where the patient has been tested positive for the virus. Deaths outside of hospitals, or deaths where no test for the virus has taken place, are disregarded. This manner of counting vastly underestimates the total mortality rate. This political insouciance undoubtedly led the Government to delay introducing social distancing measures and mass testing, resulting in the UK having the second highest global death rate from the virus.

UNDER-COUNTING THE UK COVID-19 DEATH RATE

THERE are reasons why assessing a true mortality count from Covid-19 in real time is less than straight-forward. Numbers in the UK are compiled independently by different national agencies: NHS Improvement in England; Health Protection Scotland; Public Health Wales; and the Public Health Agency (Northern Ireland). These work to slightly different criteria and with different time lags in publishing outcomes.

Again, deaths from Covid-19 can be obscured by other underlying medical complaints such as pneumonia – especially among the vulnerable elderly. As a result, outside of a hospital situation, Covid-19 may not be included on the death record if no test for the virus has been conducted. In many care homes, there has been no provision for such testing.

In Belgium, this problem is resolved by including in the national mortality count both assumed and proven cases of death from Covid-19, especially those occurring in care homes, whether tested or not. As a result, Belgium registers the highest per capita mortality rate for Covid-19 in Europe – 57 per 100,000 people. This may well be an overestimate, but Belgian officials have defended their approach, arguing it has saved lives by forcing the government to act more quickly. Social distancing measures were introduced in Belgium two weeks before the UK.

The UK could easily count virus-related (or suspected) deaths in care homes by instructing them to report figures on a daily basis to their local authority. Instead the Government chose to underplay – in practice ignore – Covid-19 deaths occurring outside of hospitals and to insist on recording only proven (tested) cases of the virus. This was not a marginal choice. In normal circumstances (ie pre-coronavirus) around 24% of all deaths in the UK occur in care homes.

Ignoring the mortality rate in care homes was bound to bias the result. This has proven so. Data from five European countries, collected by the London School of Economics, suggests that by mid-April care home residents accounted for between 42 and 57% of all deaths related to Covid-19. That is too large a cohort to exclude from daily tracking, as the UK does.

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ONS FIGURES – A MORE RELIABLE APPROACH

A MORE reliable source of data regarding Covid-19 mortality rates in the UK is provided by the independent Office for National Statistics. The ONS is the executive office of the UK Statistics Authority, a non-ministerial department which reports directly to Parliament. The ONS now publishes weekly counts of all deaths in England and Wales in which Covid-19 was mentioned on the death certificate.

The National Records of Scotland (NRS) provide similar weekly data, as does the Northern Ireland Statistics and Research Agency. This allows a UK mortality rate to be calculated based on registered deaths. While this is not perfect – there is limited testing for the virus – it offers a robust method of calculating Covid-19 mortality that includes fatalities in care facilities or at home.

How different are the ONS and UK Government (hospital only) mortality rates? Answer: they are dramatically different. On April 22, the Financial Times published data combining and extrapolating the ONS, Scottish, Welsh and Northern Ireland mortality figures using information provided on death certificates. This showed that the Covid-19 pandemic likely had caused 41,000 deaths in the UK, to that point.

This was nearly double the then latest official UK Government hospitals-only figure of 21,092 (as of April 28). This would put the total UK death count second only to the United States. To put this figure into perspective, total civilian fatalities in the UK in the Second World War were circa 67,000 over six years. It is therefore possible total Covid-19 deaths in the UK could reach the same level as wartime fatalities.

The latest ONS update covers registered deaths in England and Wales for the week ending April 17. This data proves that the death toll involving Covid-19 in England and Wales was actually 52% higher than the figures for deaths in hospitals released by the UK Government as of April 17. The ONS said 21,284 people overall had died as of April 17 with mentions of Covid-19 on their death certificate compared with the Government’s figure of 13,917 people who died in hospitals. Many of the increased fatalities were concentrated in care homes, where the ONS figures show deaths have trebled within the space of a few weeks.

The latest ONS figures also show that the total number of people dying in England and Wales topped 22,000 in the week ending April 17 – fully twice the norm and the highest weekly figure since modern records began in 1993.

However, if the true UK mortality rate (including non-hospital fatalities) is in excess of 40,000 then the UK Covid-19 death rate is something over 60 deaths per 100,000 – possibly the highest in the world.

This “excess” mortality is directly the result of Covid-19 and its side-effects. Around 40% of all deaths in England and Wales now involve Covid-19. In London, this climbs to 55.5%, with the English regions catching up.

IS THE UK DEATH TOLL WORSE THAN ELSEWHERE?

THE latest ONS mortality data takes the UK total death toll from the virus (as of April 17) beyond that reported by France – which also includes deaths in care homes – for the same period. It also takes the UK beyond the Spanish death total, according to Reuters calculations. Only the United States and Italy have a higher death total.

The United States has the highest number of deaths globally (as of April 27) with 56,175 deceased. This is likely to be an underestimate. Only recently has the US government required nursing homes to report numbers of Covid-19 deaths. America is followed by Italy with 26,644 deaths from 197,675 cases.

However, Italy has done far more testing in the community (followed by quarantine) than has the UK. This suggests their unreported deaths are probably smaller in proportion than in Britain.

According to data compiled by the reputable Johns Hopkins University in the US, on official, hospital-only numbers, the UK has 31.27 deaths from Covid-19 per 100,000 of population.

This would rank Britain globally high but still behind Spain (49.63), Italy (44.09) and France (34.17). However, if the true UK mortality rate (including non-hospital fatalities) is in excess of 40,000 then the UK Covid-19 death rate is something over 60 deaths per 100,000 – possibly the highest in the world.

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