An article in the Daily Mail questions the official Covid death toll, citing examples of terminally ill patients having Covid recorded as the cause of death. Early in the pandemic, there was a lack of testing, and doctors certified some deaths through video calls. This has led to critics claiming that assumptions were made and Covid wrongly attributed as a cause of death. Ignoring the cause of death and looking at excess deaths these are approaching 150,000 since the start of the pandemic. So while some Covid deaths may have been wrongly attributed, a close look at the numbers would suggest the UK Covid deaths are not deliberately overstated.
What official figures exist?
Deaths within 28 days of a positive test
Throughout the pandemic, we have had daily reported figures on deaths within 28 days of a positive Covid test. This is a useful metric when in a public health emergency and quick surveillance is necessary. If we look at this metric at the start of the pandemic, it would undercount the true impact of Covid because of limited tested availability as the country grappled with the new virus. As time has moved on and testing capacity ramped up, this metric will overestimate the true impact of Covid. This is because it fails to distinguish the reason for the death, and with people dying every day from a range of causes, some of these would have tested positive for Covid in the month before the death.
Deaths with Covid mentioned on the death certificate
Each week, the Office for National Statistics (ONS) publishes the number of deaths in England and Wales where Covid-19 was the underlying cause, which most of us would understand as the primary cause of death. In addition, they publish deaths where Covid-19 was not the primary cause, but mentioned on the death certificate, so a factor in the death. Separate numbers are available for Scotland and Northern Ireland from their respective statistical agencies. These statistics are a better metric than those with a positive test. as Covid has to be listed on the death certificate to be included.
185,000 deaths in the UK with Covid mentioned on the death certificate
Focusing on deaths where Covid-19 was mentioned on the death certificate, the current death toll across the UK stands at just over 185,000. With Covid-19 being a virus that disproportionately attacks the elderly and most vulnerable, 81% of the deaths have been among people aged 70 and over, with an average (median) age of death at 82 years old.
There have been 163,511 deaths within 28 days of a positive Covid-19 test and in recent months since the Omicron wave hit the UK we are seeing more deaths within 28 days of a positive test than those with Covid mentioned on the death certificate, indicating the daily Government numbers are overestimating the impact of the virus.
People often ask how many deaths were due to Covid and how many happened to just have it mentioned on the death certificate. If we look at the ONS data, we see that while it varies by month, 88% of deaths where Covid was mentioned on the death certificate, it was the primary cause. This has fallen in recent months since the Omicron variant emerged with the variant more likely to be found in people due to the sheer number of people with it, but it being less likely to kill you. In recent weeks, just two-thirds of deaths with Covid on the death certificate had the virus as the main cause.
147,000 excess deaths since March 2020
The critics cite that the estimate of 185,000 deaths is an overestimate because of the ways deaths were certified through the pandemic. We can remove this factor to understand the true impact of the pandemic and look at deaths from all causes. Across England and Wales before the pandemic, we had an average of around 600,000 deaths per year over the period 2015 to 2019. We can look at the number of deaths in 2020, 2021 and 2022 and compare to this to assess ’excess deaths’.
Since the first registered Covid death in England and Wales, there have been around 132,000 excess deaths demonstrating that Covid has had an impact of leading to deaths that would not have occurred had the virus never hit these shores. Estimates in Scotland put excess deaths at just over 11,500 with just under 4,000 in Northern Ireland. Taking these collectively you get an excess deaths estimate of around 147,000 across the UK. This is close to 40,000 deaths lower than the total number of deaths with Covid mentioned on the death certificate.
The Covid death toll of 185,000 will most likely include people who would have sadly died in the virus’s absence and, as I previously explained, we saw fewer dementia deaths than average through some parts of the pandemic. Excess deaths give a better picture of the true impact of Covid, but as we move further on from March 2020, there will be people dying of other causes because of missed healthcare. I wrote last summer we were seeing deaths above average that were not Covid related.
While there may be some deaths with wrong assumptions made when certifying deaths, it is likely this will be marginal rather than significant. Even allowing for some of the excess deaths over the past year being through missed healthcare, Covid itself has contributed to a premature end to the lives of well over 100,000 people. Claims that the UK has overstated the true number of Covid deaths are widely exaggerated.