Covid-19: The missing and the missed deaths….(part 1)

However, it is clear from the latest weekly digest from the ONS that the daily press conference tally is materially underestimating the true scale of Covid-19. The gap can be attributed to both “missing” and “missed” deaths. In this blog we explore the first of these two critical issues.

The missing deaths…

The daily numbers being reported in the media are those on the official government site. These cover deaths in specific locations and often only include those who were tested positive for Covid-19 prior to death. This misses a significant number of Covid-19 deaths.

For example, England’s contribution to the daily tally only includes hospital deaths, and it only includes those deaths where the individual tested positive for Covid-19. Deaths at home, or in care homes, are omitted. As are deaths of those with symptoms of Covid-19 but for whom no test was carried out. However, the hospitals report the statistics direct to the Department of Health and Social Care, reducing the lag between a death occurring and it being included in the total.

In contrast, the data for Scotland covers all deaths regardless of location – but it still requires a positive test for Covid-19. Further, its reporting is based on receipts of death registrations ; which tend to lag the actual deaths by many days.

England’s system prioritises speed, whilst Scotland’s slower publication should be closer to the true picture.

So how big an issue is this in understanding the tragedy unfolding?

Data published today by the ONS (along with previous publications from the respective national statistical agencies of Scotland and Northern Ireland) casts some light. These latest statistics include Covid-19 deaths registered up to the 25^th April, where there is a mention of Covid-19 somewhere on the death certificate, and includes both hospital and non-hospital deaths.

Focussing in on the 17^th April (the end of the last week included in the ONS publication) we can look back to compare what we now know had happened in terms of deaths, with the official statistics published the following day. This provides an indication of the level of “missing” deaths for each of the home nations.

These charts highlight that the true level of deaths directly attributable to Covid-19 is likely to be at least 50% higher than the statistics found on the official government site.

Once we allow for residual lags in reporting this is likely to rise to over 60%. That would put the current toll in excess of 34,000; and rising.

Please note that this figure is before any addition for the unexplained extra deaths we’re observing where COVID may have played a part, but was not mentioned on the death certificate. Tomorrow, we will discuss the evidence pointing towards these “missed” deaths.

Have deaths peaked?...

These missing deaths also highlight how important understanding the wider death toll is to ending lockdown. With the daily deaths being reported in the news seemingly going into decline, the calls for rapid cessation of lockdown have become louder.

But whether we are at, or past, the peak is less clear when we look at the pattern of the “missing” Covid-19 deaths. The purple line in the chart below is this daily deaths data that makes the evening news, focussing on England as the dominant contributor to the UK total.

We can see how the official daily deaths tend to be lower at weekends (and Easter bank holidays), but crucially have appeared to start falling gradually since early April.

In contrast the green line is the “missing deaths” (referred to above) which were omitted from the official statistics for each on those dates. These extra deaths also appear to be fairly level since early April, but show no sign of going into decline. We may still be riding the peak of the pandemic…

What do we know about these extra deaths?

The death registrations data includes information on where a death took place. The lag in registering deaths means we don’t know exactly how the extra deaths shown in the green line above are split. But we do know at least 2,906 of the 7,367 “missing” Covid-19 deaths that had happened in England by 17^th April were in care homes. Depending on the lag in the hospital death registrations, it may be that as many as 5,000 Covid-19 deaths had already happened in care homes in England by 17^th April.

What we do know is that care homes have seen a wave of Covid-19 deaths, with this wave appearing to have started later than the hospital deaths. Give the mounting concerns around availability of PPE in care homes, alongside the challenges care homes can face in isolating those symptomatic of Covid-19, it seems likely that we will continue to hear sad news of tragedy emerging in UK care homes.

The “missed deaths”….

In today’s blog we have focussed on the under-reporting in the headline statistics of deaths directly related to Covid-19. However, deaths without mention of Covid-19 on the death certificate have also been on the rise. Tomorrow, we will explore these “missed deaths” and how they may be linked to the pandemic….