Excess deaths in England and Wales at the end of April shot up to 21% above average, after hovering around zero or below since the start of the Omicron wave, ONS data show.
There were 2,163 excess deaths in the week ending April 29th, the most recent week for which data are available. However, there were 1,125 Covid deaths, a similar number to the previous week’s figure of 1,042, leaving a sudden spike of 1,038 non-Covid excess deaths. Covid deaths were a similar proportion of total deaths in each of the two weeks: 9.0% in the most recent week and 9.8% the previous week.
The ONS report says the spike may be related to the bank holidays delaying registration: “The number of deaths registered in week ending April 29th is affected by the bank holidays in the previous weeks; similar patterns have been seen in past years in the weeks following the Easter bank holidays.”
So is it just a blip caused by recording delays, or does the fact that Covid deaths don’t seem to be similarly affected, as one might expect for registration issues, suggest something real? One to watch.
On May 5th, the World Health Organisation (WHO) issued a new report estimating global excess deaths at 14.9m for two years of the pandemic 2020-21 as the true COVID-19 mortality toll, nearly triple the official toll of 5.44m. “Excess mortality” is the difference between the number of deaths that would be expected in any time period based on data from earlier years and the number of deaths that have occurred. For countries with robust data surveillance, reporting and recording systems, this poses no real difficulty. Unfortunately, these conditions are not met in many countries. Therefore their excess mortality can only be estimated and the accuracy is a function of the reliability of the methodology and modelling used in the exercise. Given the overwhelming evidence about the flaws and deficiencies of Covid-related modelling over the last two years, and the damage caused by governments trusting modelling projections over real-world data, this should immediately throw up a forest of red flags about the WHO report.
A second reason to be sceptical is the less than stellar role of the WHO in its well-known Covid-related deference to China, the abandonment of its own summary of the state of the art science on managing pandemics from October 2019, its willingness to manipulate definitions of ‘herd immunity’ in relation to vaccines and natural immunity in order to fit with the experimental pharmaceutical and non-pharmaceutical interventions (NPIs) that came to dominate Covid policy around the world, and its self-interest in expanding its budget, authority and role in steering global health policies and management by means of a new international treaty.
First we had the Economist claiming to be able to work out how many had really died in the pandemic, then the Lancet joined in. Now it’s the turn of the World Health Organisation. While the Economist and Lancet claim the true toll is around 18 million (though find a very different distribution across countries), the WHO goes for 15 million. Once more we find that the (massive) gaps in reported data are filled in with modelling: “The methods rely on a statistical model derived using information from countries with adequate data; the model is used to generate estimates for countries with little or no data available.”
The estimates for India are particularly inflated and have drawn sharp criticism from the Indian Government. The WHO claims that India experienced 3,400 deaths per million over the two years (note the figures quoted in most reports as WHO estimates for 2020-21 are an average of the two years), which amounts to 4.69 million total deaths – almost a third of the global total. That’s nearly 10 times more than India’s official Covid death toll.
India’s official Covid death toll in 2020 is 148,994. The Government said this week that its official estimate of additional deaths in 2020 compared to 2019 is 474,806, which is 3.2 times higher than the official Covid toll. It hasn’t yet provided its estimate for additional deaths in 2021, but we know that the official Covid death toll for 2021 is 332,492. If we assume the same degree of undercounting then the number of additional deaths in 2021 would be 1.06 million. (Note that India has around 10 million deaths each year, so this represents about a 10% excess mortality in 2021.) Adding the two together gives 1.54 million additional deaths for 2020 and 2021. The WHO’s estimate of 4.69 million is three times higher than this. No wonder the Indian Government is disputing the findings.
In January to March 2022, 760 people died in Iceland, a sharp increase of 30% compared with the previous year. Excess mortality in the first quarter against the average for the past five years is 28%.
Chief Epidemiologist Thorolfur Gudnason, who recently fell seriously ill with COVID-19 despite triple vaccination, which according to him provides excellent protection against serious illness, says Covid may explain this increase. However, as 64 people have died with COVID-19 since the start of the year, this might explain at most a third of the increase of 168 deaths, as it is unknown what proportion of the 64 deceased actually died from Covid rather than with Covid but from a different underlying cause (in England and Wales this proportion is 64%, according to official data). Two deaths following vaccination were reported in the first quarter – though the under-reporting rate of vaccine injuries in Iceland is unknown.
What, then, explains deaths jumping by 28%, from an average of 592 over the previous five years – fluctuating between a minimum of 560 and a maximum of 620 – to 760 in 2022?
The explanation for most of those excess deaths is clearly not COVID-19, and the breakdown of deaths by cause is not yet available. Judging from weekly data available it seems the bulk of the excess mortality was among the over-70s. Mass vaccination was mostly over by autumn 2021, but in late November, December and January about a third of the population, predominantly people middle-aged and older, got their third dose of COVID-19 vaccine.
Swab tests suggest about one in every 16 people is infected, as the contagious Omicron variant BA.2 continues to spread. That’s just under 4.3 million people, up from 3.3 million the week before. The figures for the week ending March 19th, are thought to give the most accurate reflection of what’s happening with the virus in the community.
Rates were up in England and Wales, and Scotland reached a new high. Infections have started decreasing in Northern Ireland, however. The rates across the nations were:
• England: 6.4%, up from 4.9% last week – approximately one in 16 people • Wales: 6.4%, up from 4.1% last week – approximately one in 16 people • Northern Ireland: 5.9%, down from 7.1% last week – approximately one in 17 people • Scotland: 9%, up from 7.15% last week – approximately one in 11 people
A high number of infections means the U.K. can expect Covid hospitalisations to rise too, although vaccines are still helping to stop many severe cases, say experts.
According to the latest figures, there were 16,975 patients in hospital with the virus on March 23rd. About half will have been admitted for something else, rather than Covid, but tested positive.
In the week since March 19th, however, new daily infections appear to be slowing towards a new peak.
A new paper in the Lancet has attracted some interest, both because it claims to find that the pandemic death toll is over three times higher than official Covid death figures suggest and because it seems to confirm that restrictions made no difference to outcomes. The authors say that while “reported COVID-19 deaths between January 1st 2020 and December 31st 2021 totalled 5·94 million worldwide”, they estimate that “18·2 million people died worldwide because of the COVID-19 pandemic (as measured by excess mortality) over that period”.
However, the paper is heavily dependent on modelling, so despite the welcome implication for the ineffectiveness of lockdowns, caution is needed.
The paper aims to “estimate excess mortality from the COVID-19 pandemic in 191 countries and territories, and 252 subnational units for selected countries, from January 1st 2020 to December 31st 2021”.
The relevant data were not always available, however, so the authors “built a statistical model that predicted the excess mortality rate for locations and periods where all-cause mortality data were not available”.
Not all excess deaths are Covid deaths, of course. The authors say that although they “suspect most of the excess mortality during the pandemic is from COVID-19”, excess deaths also include deaths from lockdown, including “deaths from chronic and acute conditions affected by deferred care-seeking”. However, there are currently insufficient data to distinguish Covid deaths from other excess deaths, they say, and while audits in Belgium and Sweden have suggested that excess deaths and Covid deaths are of a similar magnitude, audits in Russia and Mexico have suggested otherwise, as a “substantial proportion of excess deaths could not be attributed to SARS-CoV-2 infection in these locations”.
The authors used an ensemble of six models to estimate expected and thus excess deaths: “Excess mortality over time was calculated as observed mortality, after excluding data from periods affected by late registration and anomalies such as heat waves, minus expected mortality. Six models were used to estimate expected mortality; final estimates of expected mortality were based on an ensemble of these models.”
The ONS announced last week that there were 49,807 deaths registered in England in January, which is 380 more than in December, but 10.2% less than the five-year average.
Age-standardised mortality rates for leading causes of death other than Covid were well below their five-year averages. However, the ONS now computes the five-year averages from 2016–2019 plus 2021, rather than 2015–2019, meaning that the latest figures are not directly comparable with those for previous months.
In the remainder of this post, I will use the five-year average from 2015–2019 – for the sake of consistency with previous posts.
January’s overall age-standardised mortality rate was 14.3% lower than the five-year average, and the second lowest on record. This represents a marked change from the previous two months, when the age-standardised mortality rate exceeded the five-year average. Here’s my updated chart of excess mortality in England since January of 2020:
The substantial drop in excess mortality in the month of January suggests, once again, that deaths were ‘brought forward’ by the pandemic. In other words, some of those who died during the Omicron wave would have died soon anyway.
This commonly observed phenomenon is known as mortality displacement. Looking at the chart above, it can also be seen in the summer of 2020 and the spring of 2021.
In fact, if you take the average age-standardised mortality rate from June of 2020 to January of 2022, and compare it to the five-year average, there was only 2% excess mortality over this time period. In other words, there’ve been hardly any excess deaths since the end of the first wave.
Note that the official death toll in England increased by more than 100,000 between June of 2020 and January of 2022.
The latest figures provide the strongest indication yet that the pandemic in England is over. Now we just have the collateral damage of lockdowns, mask mandates and vaccine passports to deal with.
The Health Advisory and Recovery Team (HART) reports this week on the unusually high number of heart attacks experienced in England since the end of May 2021 (see above). The data come from a weekly report from the ten ambulance trusts in England and show the number of emergency calls for cardiac or respiratory arrests. (The two are grouped together, HART explains, because it is not always clear whether a cardiac arrest was precipitated by a respiratory arrest.)
The two most significant points, HART says, are the dramatic rise in arrest calls since spring 2021 and the significant increase in the baseline (the dotted line) in the same period.
The baseline, of course, is crucial for establishing what is ‘normal’ and ‘excess’, yet the reports give no explanation as to why the baseline has risen so dramatically. As HART points out: “The expected number of daily arrest calls rose suddenly in March by about 50 per day – around 30% higher than before.” Why did the ‘normal’ or ‘expected’ number of arrest calls suddenly rise so dramatically in spring 2021? We should be told. It doesn’t appear that it would be explained simply by the inclusion of the 2020 data in the baseline.
It is doubly odd, HART notes, because there is no change in the baseline for other conditions such as overdoses, falls or injuries. The only other condition whose baseline has shifted significantly is the related category of “chest pain”, which, HART says, “has risen from a steady 1,600 per day to 2,000”. Nonetheless, the actual number of calls for chest pain has stayed around the previous baseline of 1,600, meaning the increased baseline makes it look like the figures are now running below average.
HART notes that prior to 2021 the peak daily calls were around 400 arrest calls in a day. However, during winter 2021-22 the peak surged beyond an unprecedented 500 in a single day (this isn’t shown in the chart above because the figures are a seven-day rolling average).
Using the 2019-20 baseline the number of arrest calls since May 2021 has been a huge 30% above expected levels, amounting to around 27,800 additional arrest calls – over 500 extra every day on average. This is significant because an estimated 90-97% of these people will have died as a result. A further comparison is that 2021 figures are up 20% on 2019, while 2020 figures are only up 6% on 2019.
Looking at excess deaths, it appears that a step change occurs around the same time, in late May 2021 (see below).
I’ve written before about the World Mortality Database, compiled by researchers Ariel Karlinsky and Dmitry Kobak. It provides estimates of excess mortality for all the countries around the world in which reliable figures are available.
These estimates aren’t as good as the age-adjusted excess mortality estimates that the ONS has computed for European countries, but they’re the best we’ve got for making international comparisons. (The reason they aren’t as good is that they’re based on all-cause deaths, rather than age-standardised mortality rates.)
At the present time, estimates are available for 117 countries, comprising a large share of the world’s population. What do they reveal about which countries have done well and which haven’t, during the pandemic?
All the countries with high levels of excess mortality are in Latin America and Central Asia. And the top three – with exceptionally high levels of excess mortality – are all Latin American countries with large indigenous populations, suggesting that such populations might be particularly susceptible to Covid.
More illustrative, though, is the bottomof the chart. And here one thing really stands out: of the 15 countries with zero or negative excess mortality, no less than 14 are islands (the other being Brunei).
And of the 18 countries with 1% excess mortality or less, fully 17 have either one or zero land borders. The Dominican Republic only borders Haiti; and Brunei only borders Malaysia. (The exception is Malaysia, which borders Thailand, Brunei and Indonesia.)
After two years of lockdowns, mask mandates, and vaccine passports, it seems the best strategy for dealing with Covid is… be a small country with few land borders.
Much has been made of Australia and New Zealand’s success in containing the virus – up until December of 2021. But clearly this owes much more to their geography than to the specific policies they imposed. After all, almost all the countries at the top of the chart imposed stringent lockdowns as well.
A fair summary of the evidence in the chart above would be: Lockdowns can work to contain the virus, at least for a time, if you combine them with strict border controls. But once the virus gets a foothold in your country, they make very little difference.
Another thing to notice is that the East Asian countries are still concentrated at the bottom of the chart, strongly suggesting that some cultural or biological factor – perhaps greater prior immunity – explains the success of that region.
What lessons are there for the next coronavirus or influenza pandemic? Containment may be viable strategy for small islands and peripheral states with few land borders. But for the vast majority of countries, it isn’t worth pursuing. Instead, those countries should plan for focused protection.
In most countries, reported infections have hit record highs during the Omicron wave, smashing previous records.
Fortunately, the variant has turned out to be up to 90% milder than the previous Delta variant, so the large outbreaks have not led to overwhelmed hospitals or heavy death tolls. Nonetheless, many countries have seen substantial waves of Covid deaths, notably Denmark, but also South Africa (where the deaths have continued to climb despite reported infections dropping off since mid-December), Austria, Germany, Switzerland and Norway (among others, including America).