Excess deaths

Only Half of Excess Deaths in England and Wales Since July Linked to Covid

The Office for National Statistics (ONS) has reported that 22,000 excess deaths have occurred in England and Wales since the beginning of July, with 56% of the total figure (roughly 12,000) being linked to Covid. However, in some parts of England, Covid has been held responsible for causing only one in five excess deaths, with the Head of Mortality Analysis at the ONS saying that “health service disruption” may have played a key role in bringing this about. The Telegraph has the story.

As few as one in five excess deaths in parts of England can be attributed to Covid, official figures show.

Since the start of July, 22,542 more deaths than usual for this time of year have been recorded across England and Wales.  

Of these deaths just 12,551, about 56%, have been linked to coronavirus, according to the ONS.

However, this figure drops to 19% in West Berkshire, where just 17 of the 90 excess deaths listed Covid as an underlying cause.

Other areas, mainly in the South West and South East of England, have seen just one in three deaths above average linked to Covid, including Somerset, Torbay, Dorset and Herefordshire.

In previous waves, almost all excess deaths could broadly be explained by Covid.

Some 59,324 excess deaths were recorded between March 13th and June 20th last year. In 81% of these, Covid was an underlying cause.

And between September 4th and March 5th this year, there were more Covid deaths than excess deaths. This trend was due to lockdowns offsetting other illnesses common over the winter, including flu.

The reverse in this trend in this most recent wave comes as England and Wales saw its 87th consecutive week of excess deaths in the home.

Since the start of the pandemic, over 78,000 more people than usual have died in a private residence, contributing to more than half of the 125,494 excess deaths recorded across all settings.

Sarah Caul, head of mortality analysis at the ONS, says reasons for this may include “health service disruption” or “people staying at home rather than being admitted to other settings for end-of-life care”.

Worth reading in full.

October’s Age-Standardised Mortality Rate Was Equal to the Five-Year Average

The ONS announced last week that there were 43,435 deaths registered in England in October, which is about 1,000 less than in September, and 7.1% more than the five-year average.

This is a marked change from last month, when total deaths were 19.4% above the five-year average. Looking at the breakdown by leading cause of death, it is also quite different from September’s:

Last month, several non-Covid causes of death were above their five-year averages, notably dementia and Alzheimer’s, as well as ischemic heart disease. In October, by contrast, all non-Covid causes other than “Symptoms signs and ill-defined conditions” are below their five-year averages.

This suggests that my concerns about the delayed impact of lockdown on mortality may have been misplaced. In other words: last month’s elevated rates of death from non-Covid causes may have been a blip, rather than the start of trend toward rising mortality.

October’s overall age-standardised mortality rate was approximately equal to the five-year average – 0.1% lower, in fact. Again, this is a marked change from last month, when the age-standardised mortality rate was 11.2% higher than the five-year average.

Since age-adjusted excess mortality is the best gauge of how mortality is changing, the fact that October’s value is about equal to the five-year average indicates that any impact of lockdown on mortality must be relatively small. Here’s my updated chart of excess mortality in England since January of 2020:

Various newspapers have reported a large excess of non-Covid deaths in England over the past four months. However, these claims appear to be based on absolute excess deaths, rather than age-adjusted excess mortality.

In October, there were more than 2,000 non-Covid deaths in excess of the five-year average. Yet as I already mentioned, age-adjusted excess mortality was approximately zero – and that includes the Covid deaths. This means that the most of the ‘excess’ non-Covid deaths we’ve seen recently are due to population ageing over the last two years.

All in all, October’s figures are more encouraging than September’s, giving no indication that mortality is unusually high. Let’s just hope it stays that way.

Nearly 10,000 More People Have Died Than Usual Since July from Non-Covid Illnesses

Almost 10,000 extra people have died from non-Covid illnesses in England and Wales since the summer, according to the Office for National Statistics. MailOnline has more.

Experts have demanded an urgent investigation into whether the deaths were avoidable and if the current NHS crisis and emergency care delays are to blame.

There have been around 21,000 more deaths from all causes than average since July, according to Office for National Statistics data up to November 5th.

Oxford University’s Professor Carl Heneghan, an eminent expert in evidence-based medicine, said he suspected many of the excess deaths were “potentially reversible”.

He told the Telegraph: “This goes beyond just looking at the raw numbers and death certificates. We need to go back and find if these deaths have any preventable causes. This could be the fallout from the lack of preventable care during the pandemic.”

Worth reading in full.

Are Vaccines Driving Excess Deaths in Scotland, a Professor of Biology Asks

Professor Richard Ennos, a retired Professor of Evolutionary Biology at Edinburgh University, writes:

In Scotland this summer there has been excess mortality for the past 21 weeks with the total excess now exceeding 3,000 deaths. I and others have written to MSPs about the dreadful situation asking for a thorough analysis of what is responsible. In response we have been sent a reply from Anita Morrison, Head of Health and Social Care Analysis and Support, that I reproduce below. Five possible explanations are given, none of which reflect favourably on the Scottish Government’s public health policy. To paraphrase her reply, 45% are due to COVID-19 and the rest are accounted for by one or more of:

  1. COVID-19 deaths that were not recognised.
  2. Unintended consequences of the Scottish Government’s non-clinical response to COVID-19 (masks, social isolation etc.).
  3. Problems with access to the health and social care services (presumably due to Scottish government policy of withdrawing these).
  4. Patients not accessing services that were available (presumably because they were too scared of catching COVID-19 due to Scottish government exaggeration of the risks).
  5. Some other cause that has not been identified.

What follows is my reply to Anita Morrison to point out that her response is a damning indictment of Scottish Government public health policy whose outcome should ultimately be measured by the metric of excess deaths.

Putting the Pandemic’s Death Toll Into Perspective

There are two ‘official’ death tolls on the Government’s COVID-19 dashboard. 138,852 is the number of deaths within 28 days of a positive test. 162,620 is the number of deaths with COVID-19 on the death certificate.

The main reason the latter is larger than the former is lack of testing during the first wave. In the spring of last year, about 15,000 people in whose death COVID-19 was a contributing factor died without being tested.

So is 162,620 the pandemic’s true death toll? No. And that’s because it includes a large number of deaths that probably would have happened anyway.

How do we know this? Because if we calculate the excess deaths – the number of deaths in excess of what we’d expect based on previous years – we get a much lower number.

The official death toll for England and Wales, based on death certificates, is 147,031. Yet if we add up all the deaths since the start of March 2020, and subtract the average over the last five years, we get a figure of 117,476 (about 20% lower).

What’s more, due to population ageing, the average over the last five years understates the expected number of deaths. Hence the true number of excess deaths is about 15% lower. Taking this into account, the pandemic’s total death toll in England and Wales is about 100,000.

However, when it comes to events like pandemics, estimating the total death toll isn’t the best way to gauge the impact on mortality. Consider an example.

Japan and Mexico have about the same population, but there are more deaths each year in Japan. How can this be, when everyone knows Japan is a very long-lived country? The reason is simple: there are more elderly people in Japan, so there are more people at high-risk of dying each year.

A better way of comparing the level of mortality in Japan and Mexico is to use the age-standardised mortality rate or life expectancy. Both of these measures take into account the risk of dying at different ages, as well as the age-structure of the population. (In 2019, Japan’s life expectancy was 84, whereas Mexico’s was only 76.)

Last year, the U.K.’s age-standardised mortality rate rose by 12.8%. Although this is the largest one-year change since 1940 (the first year of the Blitz), the level to which mortality rose was lower than in 2008. And even the change should be put into context: 2019 was a year of unusually low mortality.

I previously estimated that the life expectancy in England and Wales last year was 80.4 – down from 81.8 in 2019. (Other researchers have reported similar figures.) So despite tens of thousands of excess deaths, life expectancy was still around 80.

U.K. Suffers High Death Toll Despite Massive Spending to Combat Covid

There follows a guest post by a subeditor and long-time Daily Sceptic reader who is keeping his identity anonymous. He has spotted that spectacular healthcare spending and impressive vaccination rates have not brought the U.K. obvious rewards against Covid. (Sweden is highlighted in the graph above because, by imposing the fewest restrictions, it is the closest Europe has to a control.)

Recent figures for European countries from the World Mortality Dataset, depicted in the graph above, reveal that island nations have fared particularly well during the pandemic: Iceland, Cyprus, Ireland and Malta have all recorded low levels of excess deaths. However, there is one noteworthy exception – the U.K.

In fact, even the third poorest country in Europe, Kosovo, riven by war in the late 1990s, and only an independent state since 2008, has performed better. This is despite the Balkan country having, per capita, a fraction of our health service facilities, staff and expertise.

The double-vaccination rate in Kosovo, currently 30% of the population, is a long way behind the U.K. on 66%.

Excess mortality is widely regarded as the best measure of a country’s success in coping with a prolonged health crisis, such as a bad flu season, as it allows for differing evaluations of the causes of death, notably whether they have been ‘with’ or ‘of’ Covid, and disregards arbitrary time limits, such as within 28 days of a positive PCR test. All other deaths, such as those brought on by lockdown measures, are also, of course, included in these statistics.

This evidence shows that spending billions of pounds above normal on health services and staff, and enticing a large proportion of a population to get vaccinated, do not necessarily correlate with a lower number of deaths.

August’s Age-Standardised Mortality Rate Was 2.5% Higher Than the Five-Year Average

The ONS announced on Tuesday that there were 40,460 deaths registered in England in August, which is approximately the same number as in July, and 9.9% more than the five-year average.

As you can see on this chart, weekly deaths remained above the five-year average for most of the month. Then in week 35, the August bank holiday artificially lowered death registrations:

Deaths being roughly 10% higher than the five-year average sounds like quite a lot. And in fact, the number of deaths registered in August of 2020 was 5.6% less than the five-year average.

Of course, infections were at a local minimum last August, and some of the deaths that would have occurred then had been brought forward by the pandemic. By contrast, August of 2021 coincided with the tail end of the Delta wave, and infections remained elevated throughout the month.

Consistent with this interpretation, COVID-19 was the third leading cause of death in August (a month when mortality is usually low) and deaths from eight of the nine other leading causes were below their five-year averages.

But as I always note in these updates, age-adjusted measures provide a much better guide to changes in mortality than the absolute number of deaths. In August, the age-standardised mortality rate was about the same as in July, and was only 2.5% higher than the five-year average.

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

As in the preceding two months, cumulative mortality to date was lower than the corresponding figures for both 2015 and 2018. In other words, the first eight months of 2018 – a year with no pandemic – were more deadly than the first eight months of 2021.

Overall then, 2021 is still a fairly normal year for mortality in England. As a matter of fact, it’s the sixth least deadly year on record! This could change, however, if the winter brings a particularly large wave of COVID-19 or seasonal flu.

This post has been updated.

Why Has There Been a Rise in Non-Covid-Related Heart Attacks Since the Vaccine Roll-Out?

There follows a guest post by the academic economist who regularly contributes to the Daily Sceptic.

We have known for some time that the vaccines can lead to myocarditis, a condition that causes the heart muscle to swell. Myocarditis is typically a serious illness and in its worst cases can cause cardiac arrest and death. There are also some indications that the risk for myocarditis from the vaccine may be higher in younger people and especially in younger men – a group that is not seriously at risk from COVID-19.

This was clearly not an effect picked up by the clinical trials. We already know that the clinical trials have proved misleading when it comes to protection against infection – and there are also indications that the trials may have been misleading on how well the vaccine prevents hospitalisation and death. Since the vaccine was launched, independent macro-level data has consistently proved more scientifically reliable than micro-level trial data.

So, can we get any numbers on macro-level heart failure? Yes, in fact, we can – and the results are disturbing. The Government publishes a weekly report on excess mortality in England and it includes a breakdown by cause. One of these causes of death is heart failure. Usefully, the data also tells us how many of the deaths from heart failure were due to COVID-19. Using this data, we can calculate excess deaths from heart failure not caused by COVID-19. Let us compare the period in which the vaccine has been active, to the period in which it was not.

Here we see that excess deaths from heart failure that were not caused by COVID-19 are more than 12 times higher in 2021 than they were in 2020. Could these be myocarditis deaths induced by the vaccine? Possibly. There is no way to be totally sure. But the results are worrying and merit further investigation.

One statistical trick we might use to tease out causality is to take the ratio of COVID-19-induced excess heart failures to non-COVID-19-induced excess heart failures and compare this to the number of people vaccinated under-30 – i.e., the group most vulnerable to vaccine-induced myocarditis. (Note: there is no age-specific data on non-Covid-related heart attacks.)

Can Lack of Obesity Explain Low COVID-19 Death Rates in East Asia?

An unresolved puzzle of the pandemic is why COVID-19 death rates have been so low in East Asia. We know this can’t be due to different ways of counting COVID-19 deaths because it shows up in comparisons of excess mortality.

The most recent published estimates of excess mortality, taken from a paper in eLife by Ariel Karlinsky and Dmitry Kobak, are shown below. In this analysis, excess deaths since the start of the pandemic are given as a percentage of annual baseline mortality (see grey numbers).

Excess mortality in Europe ranges from –4% in Norway to 43% in North Macedonia, and most countries are in the 10–30% range. In East Asia, by contrast, excess mortality ranges from –11% in Mongolia to 4% in Hong Kong. (Note: excess deaths in East Asia may have increased slightly in more recent months.)

As I’ve argued before, it’s unlikely this difference is due to lockdowns as Japan has seen negative excess mortality despite having some of the least restrictive policies in the world. In 2020, for example, there were zero days of mandatory business closures and zero days of mandatory stay-at-home orders.

So what can explain East Asia’s low COVID death rates? One factor that’s often mentioned on social media is their low rates of obesity. As I’ll explain, however, this can’t explain more than a small part of the difference between East Asia and the rest of the world.

To begin with, obesity’s effect on the risk of death from COVID-19 – conditional upon on infection – is actually quite modest. (By comparison, the effect of age is enormous.)

While it’s often said that most COVID-19 patients in the U.S. are overweight or obese, this is isn’t very surprising. After all, most U.S. adults are overweight or obese. For example, a CDC study published in March found that 50.8% of COVID-19 patients were obese. Yet the figure for adults as a whole is only slightly lower, at 42.4%.

Earlier this year, the BBC radio program More or Less (which deals with statistics in the news) calculated that if the global obesity rate dropped to zero, the total number of COVID-19 deaths would fall by only 7%.

If you look at the chart above, there is no obvious clustering of highly obese countries on the first two rows. For example, the obesity rate in Peru – which has seen excess mortality of 153% – is less than one in five.

What’s more, two recent studies estimated that there have been around 4 million excess deaths in India. This equates to excess mortality of around 40%, which would place India on the top row of the chart above. Yet the country has an obesity rate of only 3.9% – one of the lowest in the world.

All this suggests that something other than lack of obesity explains the low COVID-19 death rates in East Asia.

Stop Press: For an alternative view on the relationship between obesity and COVID mortality, see this post on Swiss Policy Research.

July’s Age-Standardised Mortality Rate Was Equal to the Five-Year Average

The ONS announced on Monday that there were 40,467 deaths registered in England in July, which is 4.8% more than in June, and 7.6% more than the five-year average. In fact, the number of deaths registered in England was above the five-year average in all four weeks of last month.

These increases make sense, given that there has been a small uptick in COVID-19 deaths associated with the ‘Delta wave’. Although COVID-19 was only the ninth leading cause of death in July, deaths from the first eight causes were all below their five-year averages.

However, because the English population is ageing, the absolute number of people at risk of dying each year is going up. You’d therefore expect to see a greater number of deaths each year, even without a pandemic. What’s more, people who die from COVID-19 tend to be slightly older than those dying of other causes, so the average COVID-19 death is associated with fewer life-years lost.

For these reasons, it’s more informative to track age-adjusted measures of mortality. In July, the age-standardised mortality rate was only 1.3% higher than in May, and was approximately equal to the five-year average. (The exact figure was marginally higher, but the percentage difference was only 0.4%.)

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

Although 2021’s figure was higher than the figure for 2019, it was 3.6% lower than the figure for 2015 and 2.0% lower than the figure for 2018. This means that – despite higher-than-expected mortality in the winter – the overall level of mortality in the first seven months of 2021 was still lower than three years before.

As a matter of fact, the age-standardised rate from January through July was only 0.8% higher than the five-year average. Another month without many excess deaths and 2021 will officially be an ‘average year’ for English mortality.