Why deaths rise despite NHS holding firm

Coronavirus deaths in Britain continue to mount. The sun is shining, the NHS has dramatically expanded its critical care capacity but hundreds of deaths are still being reported each day.

The latest official figures show 4,934 Covid-related deaths in Britain, up 621 in a day. The total number of deaths reported over the past week has climbed sharply, reflecting the early exponential spread of the virus across the country.

It’s a reminder that the terrible toll of the disease, while not as visible on our television screens as it has been in Italy, Spain and now

America, is still very much with us and claiming many lives, old and young.

Warnings that we would follow the same trajectory as Italy have unfortunately come to pass with reported UK deaths tracking Italy’s at a 14 to 15-day time lag. Thankfully, Italy is now reporting fewer deaths each day, suggesting the lockdown has stifled the rate of new infections and, for the moment at least, brought the epidemic there under control.

Figures on the reduction in social interactions since the lockdown supplied last week by Google from anonymised mobile phone data are broadly similar for both countries. This suggests the number of deaths here should also start to slow in around a week to 10 days’ time.

But why, given we have expanded our critical care capacity and not yet seen our hospitals overwhelmed, are we seeing so many deaths in the UK? Surely, with those new ventilators we should be doing better?

Looking at raw death rates (confirmed deaths compared with confirmed cases) the situation looks bleak. The crude case fatality rate in the UK stands at about 10 per cent, compared

Germany’s death rate appears lower because it is doing much more testing

with 12 per cent in Italy and just 1.5 per cent in Germany.

But these data sets are hugely misleading. Deaths are likely to be underestimated because, although updated daily, the deaths themselves can date back days or even weeks which means there is a substantial lag in reporting.

Confirmed cases are even less reliable and really only reflect a country’s testing capacity rather than the incidence of the virus. The reason Germany’s death rate appears so much lower is likely to be explained by the fact it is doing so much more testing.

Most experts, including Prof Chris Whitty, the Chief Medical Officer, still expect the final mortality rate to settle at under 1 per cent.

But for Britain’s intensive care doctors this will be of little solace for the moment. Intensive care wards are already beyond normal capacity, and medical teams are working round the clock in a bid to save thousands of lives.

Graham Cooke, NIHR research professor at Imperial College London, said it was wrong to think ventilation alone could provide a “cure” for Covid-19. “Ventilation buys time, it’s supportive care – it buys time for the body to recover,” he said.

“For some of those who are very frail and who will not survive despite intensive care, it may be thought preferable not to put people through it.”

Even for those who are healthy, critical care beds are not necessarily a life saver. Paul Hunter, professor of medicine at the University of East Anglia, pointed to early data which suggests critical care for Covid-19 patients is less effective than for other types of viral pneumonia.

“Sadly, about half of cases that go into critical care [with Covid-19] still die. This is much higher than for other viral pneumonias.”

Prof Cooke is one of many senior doctors organising rapid trials across the UK to test new therapies. “It is the immune response rather than the virus itself that is the problem in many cases. If we can understand how to control that we will see much better outcomes.”