Experts need to work together to solve puzzle of rising excess deaths

When Britain first locked down on March 23 2020, the average daily death rate from Covid was about 213, triggering understandable alarm and the ushering in of strict restrictions.

Now a similar number of unexpected deaths are occurring each day, the majority of which are not primarily caused by coronavirus.

Yet there is largely silence from the Government and the NHS.

Figures from the Office for National Statistics (ONS) show there were 18,394 deaths due to Covid recorded this year in England and Wales.

But since May there have been 23,195 excess deaths where the primary cause was another condition.

Some of those people did die with a coronavirus infection but it was not the main reason for their death.

Experts continue to argue over the reasons behind this recent uptick in unexpected deaths, which shows no sign of slowing.

But it is likely that collateral damage from the pandemic, coupled with long term NHS problems, have collided into a perfect, and deadly, storm.

Amitava Banerjee, professor of clinical data science and honorary consultant cardiologist at the Institute of Health Informatics, University College London, recently completed work showing how admissions for heart problems declined steeply during the pandemic.

In 2020, there were 31,064 fewer hospital admissions for heart patients, 14,506 fewer emergency admissions and 16,560 fewer elective procedures compared to 2016-2019 in England, Scotland and Wales.

Elective admissions were still down in 2021, with 10,996 fewer operations but, alarmingly, emergency admissions for heart problems had increased by 25,878.

Prof Banerjee fears that the indirect effects of the pandemic will turn out to be greater than the harm from Covid itself, and that it is vital for future planning to take into account longterm outcomes. “Treating and preventing underlying diseases is not a can that should be kicked down the road,” he said.

“We should never ever have had a pandemic preparedness team that did not consider the indirect and longterm effects. Traditionally, it has been virologists and infection specialists, but with a pandemic of this scale across so many countries, that is not fit.

“We focused on the direct effects of excess deaths from Covid but from the beginning it’s likely the indirect effects will lead to more deaths, and more morbidity and more economic impacts than Covid deaths itself.”

Some experts have argued that the figures may not be quite as worrying because the ONS does not take into account population changes, simply comparing weekly figures to the expected five year average (excluding 2020). As the population ages, more people would be expected to die each year. However other measures which do take the ageing population into account are also showing worrying rises in excess deaths.

A recent report from the Institute of Actuaries Continuous Mortality Investigation (CMI) showed that in the third quarter – July, August and September – Britain saw the highest mortality rate since 2010.

Cobus Daneel, chairman of the CMI mortality projections committee, said:

‘Nobody in charge of the NHS or any of the new health secretaries are making any noises about this’

“The third quarter of 2022 saw unusually high mortality for the time of year – higher than any third quarter since 2010.

“There were more deaths than expected from non-Covid causes. This contrasts with most of the pandemic period, when non-Covid deaths were lower than expected.”

The situation is all the more unusual as mortality rates should have fallen after the pandemic because so many people died early, an effect known as “harvesting”.’ Instead we are seeing the reverse trend.

The Government has made a half-hearted attempt to find out what is going on with excess deaths, asking for a report from the Office for Health Improvement and Disparities (OEHD).

The report showed a worrying increase in deaths in people who had heart complaints and diabetes, many of which were preventable.

Recent reports have found that people admitted to hospital with Covid-19 are more likely to suffer heart problems, particularly in the first month after their release, which could be leading to some of the excess.

Epidemiologist Veena Raleigh, a senior fellow at The King’s Fund, believes this could be a real factor, along with NHS waiting lists.

She told The Sunday Telegraph: “The continuing trend of higher numbers of deaths in England and Wales than expected, apparent since the spring, is worrying.

“From April to mid-October there have been almost 30,000 excess deaths, of which one-third have been due to Covid-19 – a reminder that the virus remains a life-threatening risk.

“While some 3,000 excess deaths occurred during the excessively warm summer periods, that still leaves the bulk of excess deaths unexplained.

“Deaths from cardiovascular disease and diabetes, in particular, show a significant excess; Covid-19 increases the risk of subsequent cardiovascular problems and could in part be driving excess deaths. An overstretched NHS coping with a large backlog of care and unprecedented pressures on emergency services could be another factor.”

Health experts are continuing to call for a full government investigation, with Dr Charles Levinson of the private GP service DoctorCall complaining that he had been “ringing the alarm on this for months and months”.

But some experts believe it will be tricky to tease out which deaths should be included.

Prof Kevin McConway, emeritus professor of applied statistics at the The Open University, said: “There’s no way of going through the list of people who died and saying ‘this death is an excess death, this death isn’t’ because there’s nothing resembling a sensible way of deciding on an individual basis who would have lived and who would have died. That all makes any investigation of the reasons for the excess deaths rather difficult.”

However, experts believe there is still too much attention being paid to the direct effects of Covid at the expense of the wider implications.

Prof Banerjee said specialists should come together to pool their data on excess deaths in their field.

“What I see is still a focus on the direct effects of Covid,” he said.

“Nobody who is in charge of the NHS, or any of the new health secretaries, are making any noises about it.”