Excess deaths

New Paper Claims Lockdowns Do Not Cause More Health Harms Than They Prevent, but It Misses the Big Picture

A new paper in BMJ Global Health purports to debunk lockdown sceptics’ claim that “the cure is worse than the disease”. However, it misses the big picture; in fact, it hasn’t shifted my priors one jot.

The paper contains no new data or analysis. Rather, it comprises a review of the existing literature. The authors focus on the claim that “lockdowns cause more health harms than COVID-19 by examining their impacts on mortality, routine health services, global health programmes and suicide and mental health”.

In other words, they attempt to show that lockdowns do not cause more health harms than they prevent. Notice: this is not the same as showing that lockdowns pass an overall cost-benefit test. Even if lockdowns were a net positive for public health, they could still be a massive net negative for society (taking into account their effects on the economy, education and civil liberties).

The strongest argument the authors make (with which I was already familiar) is that excess mortality in countries like Australia and New Zealand – which managed to contain the virus – was zero or negative last year. Since these countries did not experience an epidemic of COVID-19, but did see weeks or even months of lockdown, the lack of excess mortality suggests that lockdowns themselves do not cause many deaths.  

However, some lockdown sceptics would argue that – even if lockdowns don’t cause many deaths in the short-term – they do cause more deaths in the long-term, via missed cancer screenings, drug overdoses etc. And here the authors are much less persuasive.

They concede that “the connection between lockdowns and missed contact with health systems is very well established”. However, they claim this association “may be related to lack of capacity of healthcare services or impacts of the pandemic itself rather than measures taken by governments”.

There is “no doubt”, the authors admit, “that global health programmes have been disrupted”. But they argue such disruptions were caused by “multiple complex direct and indirect consequences of COVID-19, not just stay-at-home orders”.

So they acknowledge that lockdowns do have harmful long-term effects. And given that those long-term effects are yet to be quantified, the authors have little basis for concluding that lockdowns are “unlikely to be causing harms more extreme than the pandemic itself”.

Since the 8th of March, There Have Been 9,484 *Fewer* Deaths Than Normal

Today the ONS announced that there were 8,808 deaths in England and Wales in the week ending 2nd July 2021. This is 118 more than the previous week, but still 5.2% below the five-year average. Here’s the chart from the ONS:

Deaths in England and Wales have now been below the five-year average for 14 of the past 17 weeks. Over that time, there were 9,484 fewer deaths than you’d expect based on the average of the last five years. And recall that, due to population ageing, the five-year average understates the expected number of deaths. Hence the true level of “negative excess mortality” is even greater.

The number of deaths registered in the week ending July 2nd was below the five-year average in seven out of nine English regions. (Only the North East and North West saw positive excess deaths.) Compared to the five-year average, weekly deaths were 10.7% lower in the East of England, and a remarkable 12.1% lower in the South East.

The fact that “negative excess mortality” has now persisted for three consecutive months supports the hypothesis that deaths were “brought forward” by the pandemic.

It’s been widely noted that the link between cases and deaths has weakened substantially in recent weeks, thanks to the build up of population immunity. Although the number of daily infections has surpassed 20,000, the number of daily deaths remains in the low double digits. However, the situation is actually even more positive: measured by excess deaths, the pandemic hasn’t taken any lives since early March.

Reductions in Quality of Life Have Vastly Outweighed COVID-19 Deaths, Say Researchers

I noted recently that the British Government still hasn’t published a cost-benefit analysis of lockdown, more than a year after the first one was implemented. Instead, the task has been left to academics and others working outside of government, who’ve found that the costs almost certainly outweighed the benefits.

Now two economists based in Bolivia have attempted something similar at the global level. What they’ve done isn’t quite a cost-benefit analysis, as I’ll explain, but it puts the vast costs of lockdown into perspective.

Lykke Andersen and Alejandra Rocabado compared changes in the quantity and quality of life during the first year of the pandemic. They focus on a sample of 124 countries, which collectively account for 96% of the world’s official COVID-19 death toll.

To measure the quantity of life lost in 2020, the authors used the total number of excess life-years lost. And to measure the quality of life lost, they used the percentage reduction in the Google mobility index, averaged across different categories (retail, residential, etc.)

To simplify their analysis, the authors assume that “a 100% reduction in mobility for a year is equal to a lost year of life”. In other words, if average mobility fell by 20% in a country, then everyone in that country lost 1/5th of a quality life-year. This is a strong (and arguably unrealistic) assumption, but it’s useful for trying to get an overall sense of what happened.

The authors find that the world lost 48 million life-years due to people dying from COVID-19, but lost 1.25 billion quality life-years due to reductions in mobility. This means that the loss in quality of life was 25 times larger than the loss in quantity. The only three Western countries where the ratio was less than 2 were Denmark, Finland and Sweden.

How big is the 48 million number? As the authors note, “Every year, at least twice as many life years are lost due to children dying of diarrhea.” (Note that a child who dies of diarrhoea loses 50 or 60 life-years, whereas the average victim of COVID-19 loses only 5 or 10.)

One caveat is that data on excess deaths are not available for many developing countries, so in these cases the authors had to use official COVID-19 deaths, which are almost certainly undercounts. On the other hand, they used estimates of the average number of life-years lost per death that look to be on the high side. Overall, the 48 million number probably isn’t too far off the true amount.

Another point worth noting is that one can’t attribute the entirety of the 1.25 billion number to the impact of lockdowns. Some reduction in mobility would have happened anyway, due to voluntary social distancing. But even if it were cut in half, the total loss of quality life-years would still be 12.5 times larger than the loss in quantity.

Whether you buy their conclusions or not, Andersen and Rocabado’s paper is worth reading in full.

New Zealand Hospitals Flooded with Children Due to Immune Systems Weakened by Lockdown, Doctors Say

New Zealand and Australia are currently seeing a large number of children in hospital with respiratory illness, which doctors are blaming on the lockdowns for keeping them away from bugs. The Guardian has the story.

Wellington has 46 children currently hospitalised for respiratory illnesses including respiratory syncytial virus, or RSV. A number are infants, and many are on oxygen. Other hospitals are also experiencing a rise in cases that are straining their resources – with some delaying surgeries or converting playrooms into clinical space.

RSV is a common respiratory illness. In adults, it generally only produces very mild symptoms – but it can make young children extremely ill, or even be fatal. The size and seriousness of New Zealand’s outbreak is likely being fed by what some paediatric doctors have called an “immunity debt” – where people don’t develop immunity to other viruses suppressed by Covid lockdowns, causing cases to explode down the line. …

The “immunity debt” phenomenon occurs because measures like lockdowns, hand-washing, social distancing and masks are not only effective at controlling COVID-19. They also suppress the spread of other illnesses that transmit in a similar way, including the flu, common cold, and lesser-known respiratory illnesses like RSA. In New Zealand, lockdowns last winter led to a 99.9% reduction in flu cases and a 98% reduction in RSV  and near-eliminated the spike of excess deaths New Zealand usually experiences during winter.

Keeping children away from bugs means they don’t develop immunity and results in an “immunity debt” that must be paid sooner or later, a group of doctors explains.

Lockdowns “Did Not Lead to Reductions in Excess Deaths” – Study

A new study, published as a working paper for the leading U.S. think tank National Bureau of Economic Research (NBER), has shown (once again) that lockdown policies produced no discernible reduction of the pandemic death toll. If anything, they increased it.

The study uses excess deaths rather than Covid deaths to avoid the problems of different ways of counting Covid deaths, and also to capture policy deaths from lockdowns and other Government responses. It looks at the death tolls in 43 countries and all U.S. states to see how they varied with the length and timeliness of lockdown “shelter-in-place” (SIP) orders.

The authors find that longer lockdowns led to more excess deaths: “Countries with a longer duration of SIP [shelter in place] policies are the ones with higher excess deaths per 100,000 residents.” For U.S. states the finding was similar but less pronounced.

In U.S. states, earlier lockdowns were associated with slightly higher excess deaths rather than lower as lockdown theory would predict. In the comparison of countries, on the other hand, the predicted relationship was found.

To account for differences between countries and states (such as demographics) the authors carried out “event studies” to see how much each country or state’s excess deaths changed following lockdown from its pre-lockdown trend. This analysis showed that, prior to implementing lockdown policies, the trend of lockdown countries was towards having lower excess deaths than countries that didn’t implement lockdowns. However, after lockdown those trends were reversed so that lockdown countries started to have progressively worse excess deaths compared to no-lockdown countries.

Westminster City Council Advertises Contract for Building of Body Storage Facilities in Case of an “Excess Deaths Situation”

Amid warnings of a third wave of Covid infections in the U.K., fuelled largely by the fear of the Indian Delta variant and, of course, the prospect of new variants, such as the one recently discovered in Russia, Westminster City Council has advertised a new contract opportunity for the construction of “temporary body storage facilities” in the event of an “excess deaths situation”. Here is some of the information provided on the Gov.uk website.

The Authority seeks to procure a framework agreement for temporary body storage in the event of an excess deaths situation for the 32 London boroughs and the City of London, led by Westminster City Council. The framework agreement will appoint a single provider and will be for a period of four years. This will be a contingency contract, only called upon in the event that an excess deaths situation arises in the future and existing local body storage capacity needs to be augmented.

The over-arching aim of this tender is to provide a single framework supplier that will be able to provide temporary body storage facilities to house deceased in the event of an excess deaths situation. The deceased will be stored with dignity and respect, at locations to be determined based on local London needs at the time and will require some design elements to accommodate local site conditions and constraints, while being capable of rapid deployment, construction and commissioning to an agreed standard. This framework will be procured by the Authority as the pan-London lead, but all London local authorities may call off against the framework.

This will be a contingency cover framework and as such, there is no minimum guarantee of any level of spend or call-off under the framework agreement.

The Council estimates that the total value of this contract (excluding VAT) will be around £6 million and it is not set for renewal. But how likely is it that this is just another local government overreaction?

Worth reading in full.

Age-Standardised Mortality Rate Falls To Lowest Level on Record, Again

The ONS announced today that there were 35,401 deaths registered in England in May, which is 9% less than in March, and 10.7% less than the five-year average. As I keep mentioning, however, the best overall measure of mortality isn’t the number of deaths, but rather the age-standardised mortality rate.

In May, the age-standardised mortality rate was 12% lower than in April, and a remarkable 16.7% lower than the five-year average. Like April’s figure, it was the lowest on record for that month. In fact, it was the second-lowest figure on record for any month. (The only lower figure was last August’s age-standardised mortality rate.)

This means that the last two months have both seen recorded-breakingly low levels of mortality. (The ONS’s dataset goes back as far as 2001, and given that mortality has been decreasing more-or-less continuously for the past few decades, April and May’s figures were probably the lowest ever.)

This chart from the ONS shows the age-standardised mortality rate for the first five months of the year, each year, going back to 2001:

Although 2021’s figure was higher than the figure for 2019, it was 2.2% lower than the figure for 2015 and 2.5% lower than the figure for 2018. This means that – despite higher-than-expected mortality in January and February – the overall level of mortality in the first five months of 2021 was actually lower than three years before.

The past three months have “cancelled out” more than 70% of the age-adjusted excess mortality observed in January and February. If June’s age-standardised mortality rate comes in as low as May’s, the overall level of mortality in the first five months of 2021 will be below the five-year average.

Stop Press: MailOnline reports that COVID-19 was the 24th leading cause of death in England in May, and made up fewer than 1% of all fatalities.

Excess Deaths Have Been Running Much Lower Than Official COVID-19 Deaths in Europe

Many commentators, not to mention Government spokesmen, are still relying on ‘COVID-19 deaths per million people’ as a measure of the disease’s lethality. However, we know that excess mortality – the number of deaths in excess of what you’d expect based on previous years – provides a more accurate gauge of the pandemic’s death toll.

Unlike ‘COVID-19 deaths per million people’, this measure does not vary with factors like testing infrastructure or the criteria for assigning cause of death. (Though the best measure to use is age-adjusted excess mortality.)

In the U.K. and some other countries, excess deaths ran much higher than official COVID-19 deaths in the first wave, due to a lack of testing. However, since the start of this year, they’ve have been running much lower than official COVID-19 deaths in Western Europe.

As I noted in a previous post, Ariel Kalinsky and Dmitry Kobak have collected all the available data on excess mortality in one place. (Note: they use a linear trend over the last five years as the baseline, rather than a simple average, which yields more accurate estimates of excess deaths.)

The latest version of their study includes a chart showing excess deaths and official COVID-19 deaths over time in sixteen different countries:

In Peru, Mexico and South Africa, excess deaths have been running substantially higher than official COVID-19 deaths since the start of the pandemic. By contrast, in all but four of the European countries, excess deaths closely matched official COVID-19 deaths up the end of 2020.

However, since the beginning of 2021, excess deaths have been running lower – often much lower – than official COVID-19 deaths in every European country. In Austria, Belgium, Germany, the Netherlands, Sweden, Switzerland and the U.K., excess deaths have been negative (i.e., below the baseline) for multiple consecutive weeks. 

Some of these disparities could be due to reporting delays for all-cause deaths. However, the authors “excluded the most recent data points whenever there was an indication that the data were substantially incomplete”, so such delays are unlikely to be a big contributor. And in any case, the largest disparities between excess and official deaths are not seen in the most recent weeks. 

Overall, Kalinsky and Kobak’s findings indicate that excess deaths has become untethered from official COVID-19 deaths in Europe, and the latter measure is now substantially overstating the pandemic’s death toll. 

Deaths in England and Wales Have Been Below the Five-Year Average for 11 of the Past 12 Weeks

On Tuesday the ONS announced that there were 9,628 deaths in England and Wales in the week ending 28th May 2021. This is 232 fewer than the previous week, and 3.1% below the five-year average. Here’s the chart from the ONS:

Deaths in England and Wales have now been below the five-year average for 11 of the past 12 weeks. Over that time, there were 8,212 fewer deaths than you’d expect based on the average of the last five years. And note that, due to population ageing, the five-year average understates the expected number of deaths. So the true level of “negative excess mortality” is even greater.

The number of deaths registered in the week ending May 28th was below the five-year average in seven out of nine English regions. (Only the North East and North West saw positive excess deaths.) Compared to the five-year average, weekly deaths were 7.5% lower in the East of England, and 8.1% lower in the South West.

As I’ve noted before, the most likely explanation for persistent “negative excess mortality” in England and Wales is that deaths were “brought forward” by the pandemic.

Given these figures, and the fact that around 80% of adults now have COVID antibodies, it is difficult to see what possible grounds there could be to delay the full reopening. Indeed, the costs of remaining lockdown measures must be so vastly disproportionate to the benefits that the Government’s dithering – as Daniel Hannan has noted – is surely a function of status-quo bias. 

Did Care Homes Achieve Focused Protection in the Second Wave?

Contrary to popular understanding, Britain’s second wave of COVID-19 was less deadly than the first: although there were more deaths within 28 days of a positive test, age-adjusted excess mortality was lower. 

One possible explanation is that fewer people were infected in the second wave (even though the infection fatality rate remained constant). However, data from the Coronavirus Infection Survey suggests that roughly the same number of people were infected in the two waves. About 7% of people had antibodies at the end of the first wave, and about 14% had antibodies toward the end of the second wave (before the vaccination program had gotten fully underway). 

Incidentally, some people may have been infected without developing antibodies. I’m using the number who developed antibodies as a proxy for the total number who were infected in each wave.

Another possible explanation is that we became better at treating the illness. Evidence suggests that thousands of lives were saved by corticosteroids like dexamethasone, but these may not have been widely used in the first wave. Yet another explanation is simply that there were fewer frail elderly people alive at the beginning of the second wave, meaning that the average elderly person who became infected was less likely to die from the disease. 

However, there’s possibly a fourth reason why the second wave was less deadly than the first, namely that care homes achieved a degree of focused protection.

In the first wave, a disproportionate number of those who died were care home residents. This is partly because elderly patients who’d caught the virus in hospital were discharged to care homes when they were still infectious, resulting in deadly outbreaks. Hence more effort was made to shield care home residents in the second wave. 

According to the ONS, there were 27,079 excess deaths in care homes during the first wave, but only 1,335 during the second wave:

This finding is supported by two recent academic studies. One study, published in Environmental Research, found that the percentage of COVID-19 deaths among care home residents was lower in the second wave in eight out of 11 countries with available data, including the UK. 

Another, unpublished study observed a major spike in excess mortality among care home residents last spring, but no increase during the final weeks of 2020.

While it’s too early to say exactly which factors explain the reduction in mortality between the two waves, the evidence presented here suggests that effective shielding of care home residents may have been a major contributor. Though it should be noted that care home occupancy was lower in the autumn and winter, which probably accounts for some of the disparity in excess deaths.

Perhaps if more attention had been paid to shielding in the first wave, Britain would have come through the pandemic with a lower death toll. 

This post has been updated.