Intended for healthcare professionals

Rapid response to:


Covid-19 and community mitigation strategies in a pandemic

BMJ 2020; 368 doi: (Published 17 March 2020) Cite this as: BMJ 2020;368:m1066

Read our latest coverage of the coronavirus outbreak

Rapid Response:

Re: Covid-19 and community mitigation strategies in a pandemic

Dear Editor

Mitigation strategies and Death Statistics in Perspective

As the Corona Virus deaths in Italy, Spain, France and UK rocket into many hundreds, there is a critical need to interpret Corona Death statistics in the context of the all-cause deaths.[1].

In 2018, there were 541,589 all-cause deaths registered in England and Wales, which equates to about one death every minute, 10,400 deaths per week and 45,000 deaths per month. [2].

There are three possible scenarios when the all-cause deaths are considered along with Corona Virus deaths.

If the usual all-cause deaths are static and the reported Corona Virus deaths are genuinely over and above expected, then it’s time to press the alarm, call the army, curtail personal freedom further, and declare war on the Virus.

If the overall total death rate is relatively static, when the usual all-cause deaths and Corona Virus deaths are considered together, then we have to wonder whether the initial UK strategy of quick herd immunity was indeed the right approach.

If all-cause deaths fall significantly while Corona Virus deaths are skyrocketing, we have to question our usual way of life. This pandemic can be a natural experiment to study modern work-life balance.

As work deadlines, office politics, dreadful commuting wanes and air pollution is reduced due to suspension of industrial activity and transportation, we may see a significant reduction in cardiovascular events, respiratory diseases and perhaps even suicides. [3] [4] [5]

Every life is precious. Every death is sad. We have to learn from every opportunity for greater good.


1 WHO Novel Coronavirus (2019-nCoV) situation report 61. 21 March 2020. (accessed 22 Mar 2020).

2 Deaths registered in England and Wales - Office for National Statistics. (accessed 22 Mar 2020).

3 Power MC, Kioumourtzoglou M-A, Hart JE, et al. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ 2015;350. doi:10.1136/bmj.h1111

4 Yin P, He G, Fan M, et al. Particulate air pollution and mortality in 38 of China’s largest cities: time series analysis. BMJ 2017;356. doi:10.1136/bmj.j667

5 Kivimäki M, Leino-Arjas P, Luukkonen R, et al. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002;325:857. doi:10.1136/bmj.325.7369.857

Competing interests: No competing interests

22 March 2020
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospitals NHS Trust
Nottingham NG5 1PB