COVID-19: The latest picture as at 29th September 2020

The extent of local lockdowns continues to increase, both in areas impacted across the UK, and the level of the restrictions on social interactions. Meanwhile large number of areas, including all 32 London boroughs, are now categorised as ‘causing concern’ by PHE. Our recent blog post explored the continued rise in case numbers across the UK, which has triggered this fresh round of restrictions.

As temperatures fall as we head towards winter, indoor interactions would normally be expected to increase in the weeks ahead. It will be increasingly important to keep a close eye on case numbers in the weeks ahead. Although much of the recent rise in cases has been driven by younger ages, who are less likely to need hospitalisation or die, the risk of wider community transmission remains of concern to public health officials since this could lead to material rises in hospitalisations and deaths.

Weekly deaths remain above seasonal levels

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 18^th September. In particular, they identify deaths where there is any mention of COVID-19 on the death certificate. Combining this information with similar data from the corresponding statistical bodies in Scotland and Northern Ireland, we can examine emerging patterns in the data.

The latest data shows that the total registered deaths in the last reported week were above the average for the time of year and less so than in the previous week.

Although COVID-19 deaths remain well below the levels seen at the peak of the pandemic, when over 9,500 deaths were registered in a week, they are at the highest level for 6 weeks, and have been creeping up over the past few weeks. At a time when case numbers are growing rapidly across the UK, any sign of COVID-19 deaths starting to rise is clearly cause for concern.

Non COVID-19 deaths close to average levels

Non COVID-19 deaths increased rapidly around the same time that the pandemic began to impact in the UK in April (what we termed ‘missed’ deaths, shown in red in the chart below), but over the summer had returned to the early 2020 trend of being below seasonal levels.

Since early July non COVID-19 deaths had been creeping steadily up (as seen in the decreasing purple bars in the chart), eventually rising to be higher than average in August. Given that many medical professionals remain worried about the risk of a rise in non COVID-19 deaths as a result of related reductions in the availability and uptake of medical care, there were concerns that this trend may be a sign of this feared rise coming through. Therefore the downwards trend over the past few weeks (noting that timings of the August Bank Holiday impacted recent weeks) is welcome.

There is inevitably some volatility in these weekly deaths, as well as the impact of events such as bank holidays, so some caution is required in interpreting them over short periods. We will continue to keep a close eye on the emerging picture over the weeks ahead.

What is the position for the year to date?

We estimate that the pandemic has led to in excess of 72,000 deaths across the UK, both directly and indirectly. After a relatively light start to the year, cumulative deaths rose rapidly over April and May, and by mid-June cumulative deaths for the year to date were almost 60,000 higher than the corresponding weekly average values over the past 5 year (the solid line in chart below). For the past 3 months the cumulative excess mortality has been broadly stable, as weekly deaths have been closer to average levels. With 14 weeks of the year remaining, the ‘excess’ deaths for the year to date are of the order of 10% of the typical annual total for the UK.

The chart above reminds us of the sudden and dramatic emergence of COVID-19 and its impact on UK mortality. Concerns remain that we could be entering a fresh phase of rising excess deaths in the weeks ahead. In particular, we note that:

• New COVID-19 cases continue to rise across the country; and
• Both daily new COVID-19 linked admissions to hospital, and the numbers of COVID-19 patients in mechanical ventilation beds have been increasing again over recent weeks (having doubled and trebled respectively in the two weeks from 10^th September to 24^th September).

The upwards trend in non COVID-19 death figures relative to average levels over July and August (out-with the bank holiday impact) also highlights the risk of broader health impacts arising from the pandemic.

As the level and geographic spread of restrictions being (re)introduced across the UK in recent days demonstrate, we continue to walk a delicate tightrope between maintaining services to protect broader public health and the economy, whilst targeting interventions in order to contain the direct and indirect loss of life from COVID-19.