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Covid-19: Why is Northern Ireland’s death rate so high?

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2129 (Published 31 August 2021) Cite this as: BMJ 2021;374:n2129

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  1. Chris Baraniuk
  1. Belfast

Medical experts in Northern Ireland are striving to pinpoint why the country has such a high death rate from covid-19, as its current seven day death rate per 100 000 people is more than twice as high as in the wider UK1 and 10 times as high as in the Republic of Ireland.2

Among the stories that have hit local headlines lately are that of Samantha Willis, a 35 year old woman who died of covid-19 and had given birth to a baby girl while in hospital. Willis’s funeral and her daughter’s baptism were held at the same church service. Her husband told local media3 that his wife, who was unvaccinated, never had the chance to hold her daughter in her arms.

Northern Ireland’s chief scientific adviser, Ian Young, has said that while there have been cases of young, unvaccinated people dying from covid-19 recently, the majority of deaths remain among elderly people.

Vaccine uptake in the country is slightly lower than in the rest of the UK: 76.9% of people aged 16 and over in Northern Ireland have had two doses of a covid vaccine,4 compared with 77.2% in England, 79.5% in Scotland, and 83.3% in Wales. Young said that officials in Northern Ireland estimated that around 5% of the population there, roughly 90 000 people, were staunchly opposed to getting the vaccine.

Mark Tully, professor of public health at Ulster University, noted that Northern Ireland had higher levels of chronic disease and social deprivation than other parts of the UK, which could also be influencing its death rate.

Many of Northern Ireland’s hospitals have reported being at or over capacity for months now,5 with a mix of covid-19 and other conditions, although Young said he believed that the health service was still coping well with the influx of patients. “I don’t believe there is any difficulty there,” he said.

The spread of covid was the main driver of the recent increase in deaths, he added, as “whenever we see a large number of cases then deaths inevitably, sadly, rise.”

Easing restrictions

The highest number of covid cases reported in a single day in Northern Ireland to date was 2397, on 20 August this year.6 Young said that the recent spread of the SARS-CoV-2 virus was not linked to any single event or outbreak but rather was down to “widespread community transmission.” Experts say that the reasons for this are multifaceted.

“We certainly have seen declines in the use of face coverings,” said Tully, who is voluntary co-chair of the Behaviour Change Group at Northern Ireland’s Public Health Agency. “We’ve also seen an increase in the number of contacts between people here as well, slightly higher than the rest of the UK.” He said that this finding was based on data from contact tracers, as well as Google mobility data7 and other sources.

Tully also argued that local politicians had at times sent out “mixed messages” regarding the necessity of social distancing restrictions. “[That has] probably led to a certain amount of apathy towards the pandemic,” he explained.

But he said that it remained a puzzle why Northern Ireland’s figure of infections per 100 000 people1 was nearly 80% higher than the UK’s as a whole and more than 100% higher than the Republic of Ireland’s. “Everyone’s scratching their head around this,” he said.

Connor Bamford, a virologist at Queen’s University in Belfast, noted that there had not been large outbreaks of variants other than the main delta variant, such as the “delta plus” variant. “It doesn’t seem to be the main driver of this,” he said.

Young suggested that some vaccine induced immunity may be beginning to wane earlier in Northern Ireland, since the rollout of vaccinations had happened fairly quickly there. This could be associated with higher transmission of the virus. Social distancing restrictions were also eased earlier in Northern Ireland than in the Republic of Ireland.

And, while Young said he was hopeful that there would be a slight reduction in case numbers during the next week or two, schools are now returning, and there is little chance of social distancing restrictions being reinstated8 soon.

“We are concerned that there will be an increase in case numbers and, in turn, hospital admissions, ICU pressures, and deaths as we move into the autumn,” said Young.

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