Intended for healthcare professionals


Covid-19: UK deaths approach 50 000, but rate declines

BMJ 2020; 369 doi: (Published 03 June 2020) Cite this as: BMJ 2020;369:m2212

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  1. Shaun Griffin
  1. London

Deaths from cancer in the UK are expected to overtake those from covid-19 this week, as mortality related to the virus continues to decline week on week, although the total number of covid deaths is now approaching 50 000.

In the year to 22 May covid-19 was mentioned on 43 837 death certificates in England and Wales,1 3779 in Scotland,2 and 709 in Northern Ireland,3 showed figures from the Office for National Statistics (ONS) and devolved nations. Excluding any covid related deaths since then, these figures, combined with hospital deaths in England since 22 May, bring the total to more than 48 300.

However, the weekly death toll from covid-19 continues to decline. The week to 22 May had 2589 deaths, the lowest number in seven weeks and 1221 fewer than the previous week.

Cancer deaths overtake covid-19

In the wake of this decline, deaths from cancer are now predicted to outnumber those from covid-19 this week, said Steven McIntosh, a director at Macmillan Cancer Support. The expected weekly deaths from cancer would be 3182, compared with a combined figure for covid-19 of 2872 for the week ending 22 May.

McIntosh said, “These new figures . . . are a stark reminder that cancer has not gone away during this pandemic. The impact of coronavirus continues to cause major delay and disruption to cancer services across the UK. It has created a ‘ticking timebomb’ of undiagnosed and untreated cancers, leaving many people with cancer living in fear.”

Earlier this week Cancer Research UK warned that around 2.4 million people in the UK were waiting for cancer screening, further tests, or cancer treatment.

Calls for new ONS approach

The number of deaths in England and Wales was 51 466 higher than the five year average over this period, said the ONS weekly report. However, in a press briefing at the Science Media Centre, experts challenged the use of the five year average and suggested a new “trend based” analysis.

Jason Oke, from the Nuffield Department of Primary Care Health Sciences, University of Oxford, explained that the past 10 years had included other years where the number of excess deaths had been similar to the non-covid excess deaths this year, and some years they had been far fewer than predicted by the five year average.

For example, some 12 000 excess deaths occurred in 2013 and 8500 in 2018—these relatively high numbers being partly attributable to flu—and 6000 fewer deaths in 2010. Oke’s analysis also revealed an upward trend when he compared registered deaths in England and Wales with week 21 in the decade up to 2019. Because of these trends “we should now interpret the excess deaths with caution,” he said, predicting that non-covid deaths had in fact been overestimated by using the five year average.

Carl Heneghan, director of the Centre for Evidence Based Medicine, University of Oxford, said that the trend based approach he had developed with Oke predicted almost 30 000 excess deaths, 20 000 lower than the ONS figure. “Our data show that the excess is still large but not as high as the simple way of averaging the five year data,” he said.

Heneghan called on the ONS to rethink its five year average, as the current approach “does not take into account nuances such as the ageing and growing population,” which would predict a continued upward trend in excess deaths, irrespective of other factors.

As older people are affected more significantly by covid-19, he said, “we have to think differently about outcomes,” adding that, “if the UK had a population age profile like Ireland there would have been 10 000 fewer covid related deaths here.”

Age groups

David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication, University of Cambridge, also noted a huge range in risk among different age groups. “People aged above 45 have been exposed on average to an additional 50% excess risk of death during the pandemic compared with normal,” he said, adding that this relative excess risk had a “massively different impact in older people” who already had a much higher baseline risk of dying than younger and middle aged people.

Spiegelhalter believed that the ONS five year average was “crude but still useful,” although he noted that non-covid deaths this year were already tracking below the five year average before the pandemic started, “with the weather and levels of circulating flu making a big difference.”

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