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September 2020

Excess deaths in UK ‘highest in Europe’

Despite changes to the way that Government reports COVID-19 deaths, excess deaths in the UK remain the highest in Europe, according to a report from the King’s Fund.

How mortality trends develop over the coming months depend on whether or not there is a second wave of the virus, the severity of the 2020-21 flu season, and the impact of delays to health care for non-COVID conditions, the King’s Fund says.

The controversy – and confusion – over how deaths from COVID-19 are counted has prompted The King’s Fund to publish an updated ‘explainer’.

The report shows that after a significant surge in total deaths earlier this year, weekly deaths have been below the five-year average since mid-June. This is thought possibly to be because the virus precipitated many deaths prematurely.

COVID-19 deaths (51,879) in England and Wales have already exceed the annual number of deaths from stroke (29,816) or lung cancer (29,463), and are approaching the total number of deaths from heart disease (55,064) recorded in 2019.

Almost half (46%) of all excess deaths in England and Wales up to 7 August were in care homes. Between early March and 7 August, there were 23,500 excess deaths at home, compared with the 2015-19 average. These data suggest that some non-COVID-related deaths that would normally have occurred in hospitals occurred elsewhere.

Nurses are among the public-facing occupations that experienced higher mortality rates from COVID-19.

Since 12 August, the headline measure now reported is deaths that occurred within 28 days of a positive laboratory-confirmed test for COVID-19, with a supplementary measure to account for deaths that occur within 60 days of a positive test. Both measures reduce the cumulative number of deaths attributed to the virus. For example:

  • Old definition with no time limit: 42, 031 deaths
  • New 28-day definition: 36,683 deaths
  • New 60-day definition: 40,403 deaths.

The King’s Fund report states: ‘The virus precipitated many deaths prematurely among vulnerable groups, and cut short many other lives. Mortality trends henceforth depend on the future trajectory of the pandemic, the severity of the 2020-21 flu season, and deaths among people who are not receiving health care for non-COVID conditions because of the wider effects of the pandemic.

‘Excess deaths in the UK thus far from the pandemic are the highest in Europe. While future trends are unpredictable, it will require a sea change to alter the UK’s unfavourable ranking significantly. And as the UK already trails many European countries in terms of life expectancy, it could slide further down life expectancy league tables.’

  • On average, almost 50% more people with diabetes died each week in care home, private homes and in hospital during lockdown, excluding those categorised as COVID deaths, according to figures from the Office of National Statistics. Diabetes UK says the figures back up their concerns that people with diabetes are not receiving the support they need to keep them safe as lockdown restrictions continue to ease.

The King’s Fund. Deaths from Covid-19: how are they counted and what do they show?

Practice Nurse 2020;50(7):6