The Telegraph‘s front page led today with the story that nearly a quarter of deaths (23%) registered “with Covid” in the latest official data for England and Wales were not “due to Covid” but were due to another underlying cause, according to the information entered on the death certificate. This percentage is up on earlier figures. The same figure for the original wave up to August 31st in England and Wales was just 8% (4,159 out of 52,327).
However, there is good reason to think both figures are too low. A Freedom of Information enquiry (pictured below) found that for Northern Ireland, the proportion of deaths that mentioned Covid but identified an antecedent condition (or conditions) as the cause of death for the period March 1st to November 20th was 38% (494 out of 1,301).
Why would Covid be the underlying cause of 62% of Covid deaths in Northern Ireland but 92% in England and Wales for broadly the same period? It wouldn’t, of course. The difference is how the deaths are recorded.
One reason may be because doctors in England and Wales were given a stronger steer to record Covid as the underlying cause of death. The British Medical Association told doctors early in the pandemic:
In those cases where the doctor is confident on medical grounds that a particular cause of death is likely then that should be entered on the MCCD [death certificate]. COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the MCCD, even without the results of a positive test, and it is important that likely COVID-19 deaths are reported as such via the registrar.
No similar guidance appears to exist for Northern Ireland.
Even 38% may be too low, however. A review by a county in Sweden in August found that 85% of the 122 Covid deaths investigated were due to a different underlying cause.
The Östergötland region has examined all deaths that have died at home or in special housing with confirmed COVID-19. Records from 122 people have been reviewed, which is 51% of the 240 people who had died in the county when the review was done.
The cause of death in the cause of death certificate has been COVID-19, but the review shows that other diseases may have contributed or been the decisive cause of death – for example, heart disease, lung disease or dementia.
111 of the deceased outside the hospital had extensive comorbidity and 11 moderate comorbidity. Half were 88 years or older.
COVID-19 was estimated to be the direct cause of death in 15% of deaths. For a majority of the deceased – as many as 70% – COVID-19 was a contributing factor rather than a direct cause. In 15%, the cause of death was judged to be other diseases, then most often heart disease.
The definition of a “Covid death” has been a consistent issue throughout the crisis, with the Government even knocking thousands of deaths off the running total in August after changing the definition following criticism. It has been frequently observed that different standards have been applied to Covid deaths than to other similar diseases – a frail elderly person who died with an acute respiratory condition such as influenza would not, prior to the pandemic, usually have had influenza recorded as the underlying cause of death, whereas Covid will often be recorded as such in similar circumstances. This novel practice has inflated the pandemic death toll and fed the narrative of fear.
Overall death totals (from all causes) are generally a much better guide to the impact of the pandemic – though even there deaths due to interventions become mixed up with the Covid deaths. Trying to get to the bottom of the true Covid death toll will not be an easy task at all.