How many Covid-19 deaths have there been in England? The answer is complicated
There is no doubt that the pandemic has resulted in many deaths; However, new claims have emerged in the past week that the true number of people who have died from Covid-19 in England and Wales is much lower than previously thought. These claims have been shared widely on social media and even reinforced by a senior Member of Parliament. Can it really be true that new data shows that Covid-19 has killed far fewer people than we previously thought?
To arrive at an answer, we must first look at the different methods used to count deaths from Covid-19 in England and Wales. There are two main sources for this data: the first, which was published by the UK Health Security Agency (UKHSA) and which features prominently The government’s coronavirus dashboardis a simple count of all deaths that occur within 28 days of a positive Covid-19 test.
The second, released by the Office for National Statistics (ONS), is based on death certificates listing Covid-19 as the cause of death. Based on a medical assessment of the circumstances of each individual death, ONS numbers represent the gold standard.
The UKHSA figures will include some deaths that are clearly unrelated to Covid-19 – for example someone who has a mild case of Covid-19 and is involved in a car accident three weeks later – and some Covid-19 deaths exclude someone who has been hospitalized for more than 28 days. The UKHSA data gives us a picture of what is happening now – albeit an imperfect one – while the ONS data takes several weeks to process.
We also need to understand how death certificates work in England and Wales. When someone dies, a doctor issues a death certificate. This includes a field for the “disease or condition that leads directly to death” – often referred to as the “underlying cause”. It also includes the option to list one or two diseases or conditions that were not the underlying cause but contributed to death (“contributing causes”).
Data released by the ONS shows that in 2020 and 2021 combined, 157,889 deaths where Covid-19 was mentioned on the death certificate were recorded. Of these, 139,839 cited Covid-19 as the underlying cause. In nearly 90 percent of cases where Covid-19 was a factor in a person’s death, it was considered by medical professionals to be the main cause of death. So where does the figure of 17,371 Covid-19 deaths come from?
Covid-19: The Freedom of Information Request
this figure is created from a Freedom of Information request to the Office for National Statistics asking for the number of deaths where Covid-19 was the only recorded cause of death. To make matters worse, Covid-19 can often itself cause complications such as severe breathing difficulties or organ failure, which are then listed alongside Covid-19 on the death certificate.
To rule out these deaths, the ONS responded by stating the number of deaths where no “pre-existing medical conditions” were listed on the death certificate. For the period up to the end of September 2021, that is 17,371. But what is a “pre-existing condition”?
Pre-existing conditions and their International Classification of Diseases (ICD) codes.
This list is extensive and includes high blood pressure, asthma, COPD, diabetes and a host of other common conditions. Some argue that 17,371 is the true number of Covid-19 deaths because people with these pre-existing conditions, which make up the vast majority of deaths that list Covid-19 on the death certificate, were already ill. But even a cursory glance at the list makes it clear that for a great many people this will be wrong.
More than a quarter of adults have high blood pressurefour million people in England have diabetes and a similar number have asthma. Having one of these diseases is neither a death sentence nor a sign of ill health. You almost certainly know several people with one or more of them or live with one yourself.
The idea that people with a pre-existing condition are on the brink of death is simply wrong. More than half of those over 50 have at least one long-term health status. But if someone with one of these conditions is unfortunate enough to get Covid-19 and subsequently die, the condition only needs to have some impact for it to end up being listed as a contributing cause on the death certificate.
Let’s take asthma as an example. Covid-19 often attacks victims’ lungs, resulting in the need for ventilators. As a respiratory disease, asthma can certainly exacerbate these difficulties and is therefore listed on the death certificate if the person dies. It would be bizarre to claim that the person died of asthma on that basis. Maybe they wouldn’t have died if they didn’t have asthma, but they certainly wouldn’t have died if they didn’t get Covid-19.
The vast majority of people who become seriously ill with Covid-19 lived a full, independent life before they were admitted to the hospital. And reasonable estimates suggest the average number of years of life lost per Covid-19 death around 10. The notion that people who have died from Covid-19 are all seriously ill and would have died soon anyway is not supported by the facts.
To argue that the deaths of people with pre-existing conditions from Covid-19 do not count as true Covid-19 deaths is to say that people with pre-existing conditions do not matter; that their lives are expendable and should not be taken into account when assessing the impact of the pandemic.
Over 140,000 people with pre-existing conditions have died from Covid-19 in the past two years. We should mourn this tragic loss of life and not belittle it.