Covid-19: Deaths in the community approach 20 000 in the UK
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2449 (Published 17 June 2020) Cite this as: BMJ 2020;369:m2449Read our latest coverage of the coronavirus pandemic
The number of deaths involving covid-19 that have occurred in the community has passed 20 000 in the UK, according to new figures.
Office for National Statistics (ONS) data from the start of the epidemic up to the week ending 5 June revealed that more than a third (36.3%) of all 47 387 deaths involving covid-19 in England and Wales have occurred in community, as opposed to hospital, settings.1 There have been 2146 deaths in the community in Scotland2 and 384 in Northern Ireland.3
Of the community deaths in England and Wales, 29.6% have occurred in care homes, 4.5% in private homes, and 1.4% in hospices, with the remainder taking place in other community locations. Across the UK the number of deaths involving covid-19 in care homes alone has surpassed 16 000.
Commenting on deaths in care homes, Ian Hudspeth, chair of the Local Government Association’s Community Wellbeing Board, said, “While it’s clear we’re now past the peak of the virus in care homes, it’s still concerning that nearly a third of all deaths from covid-19 continue to happen in these settings.” He said that the government “needs to ensure that councils and social care services have the resources they need for the months ahead.”
But while non-covid-19 deaths in both care homes and private homes have increased in the 12 weeks since the start of the epidemic, with 12 000 more in each of these environments, non-covid-19 deaths in hospitals have fallen. There were 11 000 fewer deaths than would be expected during the period in hospitals, according to David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, who was speaking at a Science Media Centre press conference on 16 June.
Regional variation
Jason Oke, senior statistician at the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said that the ONS data over the first 23 weeks of this year showed almost a threefold regional variation in deaths from covid-19. London had 25.2% of all recorded deaths resulting from covid-19, followed by the north east of England where 16.7% of deaths were related to covid-19. The lowest rate was in the south-west (9.1%).
During the peak week of deaths during the outbreak, Oke said that covid-19 was responsible for 56% of all deaths in London—the highest of any region in England or in Wales, where it ranged between 35 and 45% of deaths. The latest weekly figures show that deaths involving covid-19 continue to fall—the north east now has the highest proportion of covid-19 deaths (20%) and London the lowest (13%).
Death certification
However, to make better sense of the impact of covid-19, experts said data are needed to distinguish between deaths where the virus was the main cause, and those where it was a contributing factor.
Oke referred to comments made by John Lee, a former professor of pathology, early on in the pandemic, before the full impact of the virus was known.4 Lee believes covid-19 may be over-represented on death certificates, raising the possibility that a number of people may have died with covid-19 rather than from it.
“The death certificate distinguishes between these options but to our knowledge ONS has not released the data,” said Carl Heneghan, director of the Centre for Evidence Based Medicine at the University of Oxford. He called on the agency to release the data in order to better understand its impact.
“Right now, that would be an incredibly helpful analysis,” said Heneghan. It would allow researchers to look across age groups and different comorbidities to find out whether covid-19 was an immediate or underlying cause of death, he added.
The UK may be approaching the end the covid-19 epidemic as the number of excess deaths diminishes to a level that lies within the range expected from previous years.
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