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Covid-19: High level of non-covid deaths may reflect health system pressures

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n44 (Published 07 January 2021) Cite this as: BMJ 2021;372:n44

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Excess deaths were higher than deaths involving covid-19 in the week leading up to Christmas, the first time this has occurred during the second wave of the pandemic, show the latest provisional figures. Experts said that this may reflect the pressure on care pathways for patients with non-covid conditions.

The number of deaths in the week ending 25 December 2020 was 11 520, which was 3566 higher than the five year average for that week, show the Office of National Statistics data for England and Wales.1 The 2912 registered deaths involving covid-19 (and 2497 as the cause of death) were roughly similar to the numbers in preceding weeks.

The ONS urged caution in interpreting the figures. Excess deaths were likely to be overestimated because only one bank holiday occurred that week, whereas there were two in four of the five preceding years used for comparison, which would have introduced more significant reporting delays.

Speaking to The BMJ, Jonathan Pearson-Stuttard, from Imperial College London, explained that in previous weeks during this second wave the number of deaths involving covid-19 has been about 20-60% higher each week than excess deaths. In the week to 18 December, for example, there were 1463 excess deaths and 2557 with covid as the cause of death.

“So, more than half of those covid-19 deaths were statistically in [people who] would have been expected to die in that week ordinarily,” he said. “This week, the reverse was true: excess deaths were greater than deaths involving covid (3566 excess deaths versus 2912 involving covid and 2497 with covid as cause of death), so around 650 deaths did not involve covid.”

The excess deaths figure being higher than the number of deaths caused by covid-19 was “potentially worrying” if it is seen in further ONS updates. This was important, “as it may suggest an increase in excess deaths [resulting from] indirect impacts of the pandemic upon health system pressures that impact care pathways for non-covid-19 conditions,” Pearson-Stuttard said.

He added, “As hospitalisations have increased substantially over past weeks, and look set to continue, this could have a profoundly negative impact upon common causes of death such as heart disease, stroke, cancer, and dementia in the short and longer term. The trend of excess deaths in the community has continued throughout the pandemic, which is again of real concern and speaks to the ongoing indirect impacts of the pandemic on mortality.”

In contrast to non-covid excess deaths, covid related deaths were likely to be significantly underestimated in the ONS figures. Kevin McConway, professor of applied statistics at the Open University, said, “The ONS figures do not yet reflect the large increases in confirmed cases of covid-19. To some extent that’s because it takes time, typically a few weeks, between someone being infected and their death, if, sadly, that occurs.”

Deaths under-reported

The ONS figure for the number of actual deaths occurring in the week ending 25 December and registered up to 2 January was 9800, again likely to be an underestimate because of delays in registration over bank holidays. Using a statistical model that allows for the time taken for deaths to be registered, the ONS projected that the number of deaths actually occurring in the week ending 25 December in England and Wales was between 12 683 and 16 574.

Commenting on the figures, Veena Raleigh, senior fellow at the health think tank the King’s Fund, said, “It is impossible to quantify the impacts of individual factors on the spread of the virus, but the failure to respond more quickly, even if it meant making unwelcome decisions, has undoubtedly been a contributor.”

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