England and Wales mortality during the COVID-19 outbreak – a lay summary

In an outbreak, people focus on deaths resulting from the infection. But understanding the impact the infection is having on overall death rates can provide vital information about its effect in the population at large. This summary has been updated with figures published by the Office for National Statistics on the 30th June 2020.

This study is tracking data published each week by the Office for National Statistics (ONS) on the total numbers of deaths in England and Wales. This includes deaths in the community, and in care homes, as well as hospitals. Data is published with a time lag of 11 days, and the latest data currently available is for the week ending 19th June, that is, week 25 of 2020. As the outbreak progresses and new data becomes available the study will update its answers to the following questions:

Has the number of deaths this year been higher than for previous years?

The total number of deaths from all causes in the 25th week of 2020 was 9,339. This is now in line with the average for week 25 of the previous five years (that average was 9,404). In the first 25 weeks of 2020 there were 326,627 deaths in England and Wales from all causes. This a death rate 20% higher than the average for the first 25 weeks of the previous 5 years (272,262). See graph:

Is the number of deaths overall rising?

In the middle of April this year, which is when the COVID-19 pandemic peaked in the UK, the death rate for England and Wales surged to 22,351 (week 16). Since then, the death rate has been falling, and is now close to the level we would expect for this time of year. It can be helpful to compare with the typical rate when winter influenza strikes. A winter peak in deaths is seen most years, when respiratory illnesses such as influenza disproportionately claim the oldest members of the population. This year the winter peak hit in the 2nd week of January with 14,058 deaths, of which 2,477 were claimed by respiratory disease. In a normal year we would expect to see the weekly overall death rates, and deaths from respiratory diseases, gradually fall from the January influenza peak towards summer. This year was different.

In this current outbreak, are deaths from respiratory conditions on the rise?

Week 25 of 2020 saw 846 deaths listed as being from underlying respiratory disease. This is similar to the level for the previous week (837), and much lower than 2020's week 2 winter peak of 2477 respiratory deaths.

Are deaths in older people rising?

The proportion of deaths among older people is stabilising - 67% per cent of all deaths in week 25 were of people aged over 75. The excess deaths during the COVID-19 surge were highest among the older age groups, which is in line with evidence that the risk from the infection increases with age.

In week 25, COVID-19 was mentioned on the death certificate for 783 deaths, compared to 1,114 recorded for the previous week - this number has been gradually falling since the April surge. Remember that mention on the death certificate may not mean that the infection was the cause of death. And, there will be deaths from respiratory causes whose death certificates also mention COVID-19.

Mandy Payne, 30th June 2020

This is a lay summary, updated with latest figures, of a report prepared for the Oxford COVID-19 Evidence Service by the Oxford Centre for Evidence Based Medicine by Nick DeVito, Carl Heneghan, Jason Oke, and Jeff Aronson and posted on 24th March 2020, updated 21st April 2020. The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for healthcare. It has committed its skills and expertise in evidence synthesis and dissemination to the effort against the current COVID-19 pandemic. HealthWatch is supporting by providing lay summaries.

Disclaimer: the article has not been peer-reviewed; it should not replace individual clinical judgement and the sources cited in the original report should be checked. The views expressed in this commentary represent an interpretation by HealthWatch and do not necessarily represent those of Oxford CEBM, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice.