Hospital admissions for Covid inflated

Method used to count cases at pandemic’s peak meant numbers were over-reported

HOSPITAL admissions for Covid-19 were over-reported at the peak of the pandemic, with patients taken in for other illnesses being included in outbreak statistics, it has emerged.

An investigation for the Government’s Science Advisory Group for Emergencies (Sage) found that people were being counted as Covid hospital admissions if they had ever had the disease and were added to those being admitted directly due to the virus.

At the peak of the pandemic in early April, government figures show that nearly 20,000 people a week were being admitted to hospital with Covid, but the true figure is unknown because of the issues with over-counting.

The oversight echoes recent problems with the data for Covid deaths, in which it emerged that thousands of people who died of other causes were being included in coronavirus statistics if they had once tested positive.

Prof Graham Medley, of the London School of Hygiene and Tropical Medicine, who was asked by Sage to look into the issue, told The Daily Telegraph:

“By June it was becoming clear that people were being admitted to hospital for non-covid reasons who had tested positive many weeks before.

“Consequently, the NHS revised its situation report to accommodate this.”

The investigation by Sage led to a readjustment of how the figures were compiled at the beginning of July.

Last night, experts warned the miscalculation was particularly concerning since the number had been used to reflect the current state of the epidemic.

Prof Carl Heneghan, director of the Centre for Evidence-based Medicine at the University of Oxford, said: “The admissions data is a crucial point. I’d say it is more important than the death data because it is the best marker of the impact of the disease.”

The issue came to light on June 18, when Sage minutes record that government scientists registered concern that non-covid patients were being included in the outbreak data.

Public Health England, the NHS Medical Director and Prof Medley were asked to convene a group to find the “ground truth”.

Prof Medley said: “With any epidemic of a new disease there is always a period during which the clinical manifestation of the disease is being developed. The initial aim is to be as complete as possible, even though there will be overestimation.

“So, we saw with the death statistics, that initially a ‘Covid death’ was defined as any death in which the person had previously tested positive.

“The same is true, but even more so, for hospital admissions. In order to capture all the potential manifestations of the disease at the start of the epidemic, all admissions of people who had tested positive were counted as ‘Covid-related admissions’.”

From July 1, the NHS began counting virus admissions as those who tested positive within a short period of entering hospital, and NHS England said there had not been a significant difference in the admissions trend line since the change. However, it is unclear how many people, before July 1, were misclassified as Covid patients.

The over-count may have included patients admitted with an unrelated ailment but who tested positive for coronavirus on arrival, or who had previously been diagnosed with the virus. They may also include patients who were tested while already in hospital for a different condition.

Experts said that knowing the correct admissions figures was crucial, not only for determining how many people are really being hospitalised with the virus, but also for working out death rates.

Prof Heneghan, added: “If admissions are going up then that should

drive the lockdown. But currently you have people with active infections, those who have tested positive but have been discharged, and those who have contracted it in hospital, so it isn’t helpful. This really does need sorting out as we go into the winter, otherwise ... we can’t understand what’s going on.

“There will be loads of people coming in with different conditions who have survived this, so it’s a huge problem. It’s clouding our judgment as to whether the disease is having a significant impact.”

There are also wide discrepancies between NHS England admissions data and that reported daily by the Government. For example, around the peak of the virus on April 8, NHS data suggest there were 480 admissions with Covid and a further 2,264 people diagnosed with the virus in hospital, a total of 2,758. However, the Government’s figures suggest there were just 2,340 overall admissions.

For March, NHS England recorded 15,810 admissions, while the Government recorded more than 20,000. Even as recently as Aug 9, the NHS recorded 33 admissions with Covid and

a further 40 diagnosed in hospital, a total of 73. Yet government figures record just 50 patients overall.

It is also still unclear how many people included in current admissions data are asymptomatic and were tested when in hospital for a different condition, or who caught the disease once they were in hospital.

Prof Heneghan said it was possible that in hotspot areas, such as Oldham, there was now nobody in hospital with an active infection. However, it is impossible to tell from the way the data was being recorded.

“The key, to me, is the admissions data,” he stressed. “You could have 1,000 people with the infection but if you have no admissions then you’re actually building up a population more able to withstand the virus.”

Prof Robert Dingwall, of Nottingham Trent University, who sits on the Government’s New and Emerging Respiratory Virus Threats Advisory Group, which feeds into Sage, said: “We should certainly be aware that it [the data] may have led to some exaggeration of the number of Covid hospital admissions and related deaths early on.”

Prof Stephen Powis, national medical girector of NHS England, denied the figures were ambiguous. “For the safety of both patients and staff it is obviously sensible and important that NHS trusts...track data on patients in their hospitals that have Covid, whether admitted as a Covid patient, or for another condition,” he said. “Throughout the pandemic we have worked with Sage and follow their advice to ensure data is collected in a manner that supports their important work.”