In 2021 we have seen fewer people die from dementia, respiratory disease, and influenza/pneumonia than expected. Is this because people are not succumbing to these conditions, or having caught Covid-19 they died from this instead. I look at the numbers to explain more.
How are deaths recorded?
The daily announcement on Covid-19 deaths is the total who died having had a positive test within the previous 28 days, regardless of the circumstances of the death. Each week we also get information from the Office for National Statistics where Covid-19 was mentioned on the death certificate, and also where the death was due to Covid-19.
So far in 2021, based on information from death certificates, 87% of the deaths where Covid-19 was mentioned on the death certificate were because of Covid-19. This means that for 13% of deaths where Covid-19 was on the death certificate, it was another cause that was the crucial factor in the death. But are we ignoring other significant health conditions and putting Covid-19 as the major factor when recording deaths?
If Covid-19 had not emerged, would all people recorded as a Covid-19 death be alive today?
The quick answer to this question is no. Let me explain by looking at the latest monthly publication on mortality from the ONS. We can compare causes of death to the average deaths from that cause over the period before the pandemic, in this case, 2015 to 2019.
ONS breaks down the numbers for England and Wales separately and I am going to focus on England, as this is the bulk of the data. From January 2021 to July 2021from looking at data from death certificates, the leading cause of death was Covid-19, where 49,831 sadly succumbed to the virus. With Covid-19 being new in 2020, there were no deaths from Covid-19 over the period 2015 to 2019 in comparison.
But a closer inspection of the data shows that there are significantly fewer deaths among some of the leading causes in 2021 than we would have expected. For example, over the period from January to July, based on the pre-pandemic average, we would expect around 37,325 deaths over the seven months of this year from Dementia and Alzheimer’s disease. We have had just 31,409 deaths, which is 16% below average, and as we know, Covid-19 disproportionately affects the elderly, many of whom suffer from Dementia and Alzheimer’s disease. Similarly, we have seen a 32% fall in deaths because of Chronic lower respiratory diseases (12,791 vs 18,940), a 14% fall (15,539 vs 18,052) in Cerebrovascular diseases (includes strokes), and a 53% fall (8.070 vs 17,097) in deaths from Influenza and Pneumonia.
Hygiene measures and lockdowns to control the spread of Covid-19 have contributed to very little Influenza circulating so there is a rationale behind significantly fewer deaths from Influenza and Pneumonia. But for the other conditions where deaths are considerably below average, it is likely that many would have sadly died in the absence of Covid-19, but having caught the virus, Covid-19 was put as the underlying cause and not the health condition that in any normal year may have tragically taken them.
It would appear that some people are dying from Covid-19 who would have died anyway in the virus’s absence. This is an important point when interpreting the Covid-19 data, as we could not avoid all deaths. When the virus is circulating through the community, it will inevitably mean some people end up in hospital who have Covid-19 and some will sadly die. We know around 1 in 4 people admitted to English hospitals are for other conditions and not Covid-19, but they test positive for it.
Finally, as a counterbalance, one explanation for fewer deaths for some causes is that we saw more people die in 2020 than we would have expected had the pandemic not hit these shores. This will inevitably include some people who would have died in 2021, affecting the deaths reported this year. How much this is a factor is difficult to interpret.