Worst week for deaths since records began – but it doesn’t mean the lockdown is justified

The Office for National Statistics (ONS) mortality figures for week 16 (11-17 April) were published this morning at 9:30am. They make for grim reading.

This is the peak of the coronavirus epidemic in the UK. (As the ONS figures use date of registration rather than date of death the peak is shifted by a few days – though the report does have a graph for actual day of death this time, which is an improvement on previous editions). The figures will be coming down from next week (18-24 April), though it appears that the care home death curve is running behind the hospital curve by several days, which will lengthen the peak a little.

Figure 7_ The number of COVID-19 deaths in care homes continues to increase.png

It’s the worst week for deaths since comparable records began in 1993: 22,351 deaths, which is 11,854 more than the 5 year average (‘extra deaths’). Of these 8,758 or 74 per cent mention Covid-19 on the death certificate, meaning 3,096 or 26 per cent (over a quarter of the extra deaths) are non-Covid related. (Covid-19 could have been missed, but equally Covid-19 deaths could be with rather than from the virus.)

Less than a quarter of Covid deaths in week 16 (23 per cent or 2,050 deaths) occurred in care homes. This is interesting because reports from elsewhere in Europe suggest around 50 per cent of all Covid deaths occur in care homes. The reason the UK proportion is so much lower than elsewhere has not yet been explained as far as I know. Is it because Covid deaths in UK care homes aren’t being identified (58 per cent of the extra care home deaths – that is, 2,795 deaths – were from non-Covid causes, down from 67 per cent the previous week) or because in other countries care home deaths are being wrongly attributed to Covid rather than other causes, especially the impact of lockdown, isolation and change? The big question is what is killing the other several thousand extra care home residents in the UK each week?

In terms of cause of death more broadly, 37 per cent of week 16 Covid-19 deaths (3,220 of 8,758) mention pneumonia, leaving nearly two thirds as non-pneumonia. I previously suggested this might indicate a death with rather than from Covid-19, but reports since have suggested it might often be due to cytokine storm (a lethal immune system response), which if true is not good at all as it makes the disease more deadly to more people. England appears to be one of the worst affected countries, and unusually the virus is killing more younger people here than elsewhere. There is currently no accepted explanation for this. The Oxford Centre for Evidence Based Medicine (CEBM) have identified the UK, US, Italy, France, Spain and Belgium as the six worst affected countries, together accounting for three quarters of worldwide deaths so far. As possible explanations they are exploring environmental factors such as temperature and humidity

Deaths registered with Covid-19 to 17 April total 19,112. Since this includes the peak we can estimate the total number by the end of the epidemic will be a bit less than double this, say 30,000-35,000. This is deaths with rather than from Covid-19. This is as bad as (or slightly worse than) the worst flu years such as 2015.

As upsetting and unpleasant as this is, a deadly epidemic at this scale does not justify the unprecedented move of shutting down the economy and confining people to their homes, which has huge costs of its own, including in lives. In terms of whether a worse second wave will hit if the lockdown is lifted, it is worth repeating that the peak in deaths on 8 April corresponds to a peak in infections three weeks earlier, which is several days prior to the lockdown coming into effect, suggesting the lockdown is not what brought the epidemic under control. Rather it is much more likely due to a combination of the lighter measures introduced earlier, increased public awareness and a pre-existing resistance in the population to the virus.

2 thoughts on “Worst week for deaths since records began – but it doesn’t mean the lockdown is justified

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  2. Given that the UK is a significant global hub and that there was never any attempt to screen entrants, even from Coronavirus hotspots, it was always the case that the virus would quickly spread into and across the population. And as it was a brand new virus we had no knowledge of antivirals and other post infection treatments that might be effective. As with many other nations on the planet we were pretty much a sitting target.

    Slowing the spread by common sense advice to the public regarding droplet containment and surface hygiene, as well as advising vulnerable groups to stay isolated as much as possible, was the first attempt at giving a hopelessly unprepared NHS the time to prepare as best it could for a steep rise in patients. At that point the logic of testing for antigens to help protect staff and locate those infected in the population was rejected by government advisers. This was clearly a big error but, along with the PPE debacle, it seems to have been inevitable anyway because the government machine (which includes the civil service and NHS management) was both too slow to buy in testing facilities and incompetent in connecting with potential UK providers. On the other hand there was hope that herd immunity would naturally increase, not least because already known world data revealed a large majority of infected people were showing few or no symptoms. Although very nasty, and a killer for some victims (as with ‘flu), we are fortunate with the C-19 pandemic – it’s more of a warning of what could happen rather than a truly devastating mass killer.

    And that policy, with testing now being added in, broadly remains a sound approach; but it requires nerve and facing an unpalatable but inescapable truth that thousands of people (mostly among the most vulnerable groups) will die. But we lost our nerve and went for what may one day be universally accepted was an ill-conceived policy of lockdown.

    Of course there’s logic to lockdown: the tighter you do it the more you can slow spread. If you can reduce and keep R to below 1, eventually (theoretically) the virus will be eliminated. Essentially it’s a case of the nation rolling itself into a ball until the threat goes away. But the concomitant logic of lockdown is that it will do huge economic damage – damage so great that it will certainly cost lives and ruin untold more lives. And the longer lockdown continues, the greater the damage until the point when you’re looking at national collapse. In a population of 66 million that’s a horrifying thought.

    And the final bit of logic about lockdown is that, if you end it too abruptly, Covid spread takes off again and you’re right back to the original policy of letting herd immunity grow by letting the virus spread. Lives that you’ve saved earlier will simply be lost later. It may be said that you have gained a bit of time in which to discover new treatments and shorten the wait till a vaccine (hopefully) is produced and multiplied up so that everyone can be immunised. But there’s no guarantee about when or if that will happen.

    And ending lockdown is itself an organisational nightmare – not least sorting out the vast number of financial complications to be resolved. In theory you have to wait until you have enough antibody testing of the population before you can safely unwind lockdown; but the availability of testing is at the government’s gift / competence to deliver. The infantilising of the population under a bombardment of hyperbolic advertisements and constant repetitions of a mind-numbing mantra, together with the refusal to engage with any questions which challenge the government’s wisdom appears to have rendered many people no better informed than when the problem started, and terrified of ending lockdown.

    Perhaps the hard truth of all this is that whatever policy you follow you will lose roughly the same number of lives due to C-19 in the end. The problem with the lockdown route is that you will also have done massive damage to the economy as well. And who knows where that will leave us and our children in the years to come – with no Coronavirus lives having been saved and many others added for other causes?

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