Following comments copied from Twitter written by ONS Statistican - Nick Stripe
THREAD – “Non-COVID” excess deaths
Between 7 Mar & 1 May there were 130k deaths registered across E&W. This was 46.4k deaths above 5-yr averages
According to death certs 12.9k (28%) of this “excess” did not mention COVID. 98% are now fully coded enabling detailed analysis
Possible explanations include:
1. COVID was present but undiagnosed, particularly in the presence of other co-morbidities and the absence of a positive test
2. Reluctance to seek care or a delay in receiving care for people with serious health conditions
3. Reduced hospital capacity affecting ongoing care for people with underlying conditions
4. An increase in stress related causes due to lockdown
5. An increase in death registration efficiency introducing a process effect
Our analysis shows:
- Many deaths where COVID was not mentioned were displaced from hospitals to care homes and private homes
- Age-standardised mortality rates (ASMRs) for “non-COVID” deaths were generally higher in regions with higher COVID ASMRs
- Excess deaths where COVID was not mentioned were predominantly in the very eldest
- Men accounted for more at first but from mid-April this switched to women
- Analysis by leading underlying causes of death shows all leading causes above or at their 5-yr averages
- Most notably, they show v significant increases in deaths due to Dementia & Alzheimer Disease and for deaths due to old age & frailty (“signs, symptoms and ill-defined conditions”)
Deaths with these causes account for two thirds of all “non-COVID” excess deaths. Dementia increases are so sharp it’s implausible that they are unrelated to COVID. They generally affect the very old, they would tend to impact women to a greater extent than men simply due to pop structure. Especially once care home epidemics took hold with ltd testing
People with dementia are more likely to have communication problems describing symptoms
Some evidence has been observed for atypical hypoxia in frail COVID patients – well preserved lungs but severely compromised pulmonary gas exchange without signs of respiratory distress
No reason to believe that COVID-19 has been knowingly omitted from death certs. Symptoms may not be apparent.
But we cannot discount the impact of changes to normal routines for vulnerable care home residents following lockdown. These could have had adverse consequences too
The balance of evidence so far points to undiagnosed COVID in the elderly being the most likely explanation for a majority of excess deaths that did not mention CV on certs. This fits: demography, locations, esp where testing was sparse, causes of death & timings of peaks
Some potential evidence for a delay in receiving care. Normal care pathways have been disrupted and we can see increases in deaths due to diabetes, sepsis and asthma outside hospital settings
But some of these are risk factors for CV so could also support under diagnosis
There is some evidence for deaths involving, for example, cancers and renal failure being displaced from hospitals
Little evidence yet of signif increases in overall deaths due to reduced capacity. But these may increase over time as impacts of treatment delays emerge
For stress-related causes there is some evidence of increases due to e.g. hypertension. But due to the need for coroners’ inquests for deaths caused by drugs, violence or suicide, any increases for these will not yet have been registered. Need longer to observe any changes
Some evidence of increased efficiency due to registration process changes. The % of deaths registered by coroners has reduced, but within the context of many more deaths in total. Any effect is likely to be marginal and again this may change as more inquests conclude.
Note- excess deaths during May are so far all accounted for by COVID being mentioned on death certificates.
This may reflect improving knowledge of its complex effects, increased testing, and the fact that some earlier deaths will have been brought forward by COVID