Excess Deaths In England & Wales

I know someone who is tackling a Nursing home for having covid on her Mother's death certificate. She did not have it and the care home agree, but were told they had to put it down.
This cannot be a rare occurrence, I'm wondering why they have been happy taking a beating at press conferences for deaths in care homes that were nowt to do with covid?

That's why the excess death figures are so important for understanding what has gone on.

Thanks again Angoose - Are the figures split between England and Wales ?

Yes for total excess deaths, but no for settings.

Angoose 02 Jun 20 14:28 
That's why the excess death figures are so important for understanding what has gone on.
...........

The deceased is down as a covid victim Angoose, we can only guess at the number of similar cases. How do the excess death figures deal with made up covid numbers, will they show up?

saddo, COVID-19 is shown on the death certificate in one of two circumstances

[1] The person has tested positive
[2] A doctor believed there were grounds to believe that the untested individual had contracted COVID-19

Whilst there will undoubtedly be individual cases where a doctor presumed COVID-19 was present and it was not, there will also be cases where the contrary was the case.

I have no idea how the ONS will perform their investigation.
Can't imagine that they will be seeking evidence directly from individual doctors.

We'll see on Friday what they have concluded.

Regardless of cause, there have been far too many excess deaths in care homes.
I think that is something that we can all agree on.

At the beginning of this I remember a doctor on the radio say they had been told to put it on the certificate, no tests. He was not happy, and I think he said the instruction went to all GPs.

Who gave the instruction ?

Of course we agree too many, my burning question is that as bad as it has been, why they are happy to take the blame for non covid deaths on top. It's like a boxer with his hands down, something not right.

Good article in the Spectator from a pathologist who stated that 2 doctors made the decision on the death certificate that is now 1 due to this and in a lot of cases based on opinion

The only thing I can think of - Is it better politically to have higher COVID related death numbers but lower unexplained excess death numbers ?

I haven't been keeping up with this subject, so apologies if this has already been said, but as the reporting of Covid deaths are clearly unreliable, and, as Covid has undoubtedly led to thousands of other deaths, e.g. by people's treatment for cancer etc being affected, by people avoiding going to the GP/A & E, and the lack of diagnostics/testing/x-rays/mri scans etc., shouldn't we just be using the Excess Deaths figure as a much more accurate gauge of the true effect of Covid.  I would imagine that we are now in a time of year when there is less of a deviation from the mean in Total Deaths.

Blaming Covid is a much easier sell than admitting care home residents died from lack of access to NHS services during the lockdown when the hospitals stood empty.

Thanks for the summary Angoose.

You can also see a large decrease in the figure of non-COVID deaths in hospitals for this period of 11,976.


Will be interesting to see what the ONS have to say on the non-COVID deaths this Friday.

Report released by ONS and available at the following :

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/analysisofdeathregistrationsnotinvolvingcoronaviruscovid19englandandwales28december2019to1may2020/technicalannex

Nick Stripe of the ONS has created a thread on Twitter to provide some insights in to the data.

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

I'm certain that clearing the whole nation's hospitals has cost us. Three hospitals in our trust been doing very little for months, almost empty. Imagine the number of people who should have been through their doors in that time.

Hard to imagine that the withdrawal of treatment and screening services has not had a detrimental effect on current and future health outcomes.

Sharp increase in dementia deaths is hardly surprising for many reasons and not necessarily as a direct result of covid.  Large proportion of dementia sufferers are in specialist dementia care homes - now the family is not allowed to visit for months leading to patients feeling confused, abandoned and having nothing worth carrying on for;  homes being reluctant to use medical services for fear of risk of covid outbreak;  worse standard of care overall caused by homes being short-staffed due to sickness, carers having to keep their distance more, lack of family visits (again)

Latest figures released today for England and Wales, data now available for the first week in June for all four home nations

Shocking stuff - 64,000 excess deaths of which 52,000 are COVID related (which doesn't necessarily mean they died of COVID) so a minimum of 12,000 unexplained excess deaths ?

Wonder what spin the statisticians of both sides will put on these numbers ?

Pushing the elderly with milder cases of the virus back into care homes to keep the NHS free will be one of the major "lessons to be learnt" almost certainly.

There will be the inevitable public inquiry at the end of all this - Will no doubt take far too long to publish its findings though.