The simple question “how many people have died from the coronavirus?” is becoming even more complicated week by week.
The UK government, the devolved administrations, NHS England, national statistics bodies and the Care Quality Commission are all now producing statistics on Covid-19 deaths, showing different kinds of deaths over different time periods.
How are we supposed to make sense of it? Here’s what we know, based on the latest numbers – and what we still don’t know.
Hospital deaths have been falling for three weeks in England
There is a clear trend here, with the peak of deaths occurring on April 8 and falling steadily since then (the last few days will be updated).
(Graph: Centre for Evidence-Based Medicine at Oxford University)
This is good news for the NHS and the idea that we have passed a peak chimes with other UK government data on hospital admissions in England:
Note that these are deaths of people who have tested positive for Covid-19, but the coronavirus may not be the cause of their death.
The total death toll is higher
The NHS England death toll only counts people who have died in hospital.
It is becoming increasingly clear that substantial numbers of people have been dying outside hospitals, and that care homes are a particular area of concern.
This week the Office for National Statistics said 21,284 Covid-19 deaths had been registered in hospitals and elsewhere in England by April 17, almost 40 per cent higher than the figure for English hospital deaths by that date.
This is all based on cases where the doctor mentions coronavirus on the death certificate. Again, it may not be the immediate cause of death.
We know that many Covid-19-related deaths are happening in care homes – more than 4,100 up to April 17, according to the ONS death registration data.
And the Care Quality Commission (CQC) has been notified of an additional 2,000 deaths since that date, although the figures are not compiled in the same way and may not be directly comparable.
So have we really passed the peak?
This ONS graph shows that total deaths in England and Wales still peaked on April 8 and have been falling since then, if you add together deaths in hospitals (blue), care homes (red) and everywhere else:
But if we zoom in on care homes specifically, it’s not clear that deaths there have peaked yet.
The latest available data from the CQC runs until April 24, a date on which 380 daily deaths were reported – very similar to the death toll seven days earlier:
Experts have picked up on this and are warning that care home deaths specifically may not have peaked yet and could contribute to a long “tail” of deaths.
Prof Sir David Spiegelhalter, Chair of the Winton Centre for Risk and Evidence Communication, University of Cambridge, said: “When we add in deaths at home, this suggests there are now about as many COVID deaths out of hospital as in hospital. And while hospital deaths are steadily decreasing, there is no sign yet that we are past the peak in care homes.”
So what is the real UK death toll?
It’s impossible to say for sure because of the time lag between deaths occurring and being reported in the various data sets.
But we can draw together the latest numbers of registered Covid-19 deaths reported by the national statistics bodies until the middle of April (here are the figures for Scotland and Northern Ireland).
We can estimate that there have been at least 30,000 deaths directly related to Covid-19 across the UK since the outbreak began, but this will have to be revised upward when more recent deaths are added to the official tally.
Are Covid-19 deaths being under-reported?
This has been a persistent fear, based on anecdotal evidence that doctors who fill in patients’ death certificates outside hospital may not put Covid-19 down if they have not had the diagnosis confirmed by a test.
If this happened a lot, it could lead to an underreporting of Covid-related deaths, meaning the ONS might be undercounting.
But it’s interesting to note that the Care Quality Commission numbers for fatalities in care homes tally closely with registered deaths.
The commission is notified of deaths by care homes and the assessment of whether Covid-19 was involved may be independent of a test result or medical diagnosis.
The CQC was notified of 1,968 Covid-19-related deaths in England care homes between April 10 and April 17, compared to 1,999 registered deaths in England in the same period.
We would expect the registered deaths to be much lower if doctors were under-counting coronavirus cases.
What about total deaths of all kinds?
One way of getting around the question of what doctors are writing on death certificates is to look at all-cause mortality. In other words, how many people are dying for whatever reason, and is this more than we saw in previous years?
The data for the week ending April 17 shows that there were more than 22,000 total deaths in England and Wales – around double the average for this time of year.
Nearly three quarters of the excess deaths mentioned Covid on the death certificate. That leaves a significant number of unexpected deaths that are apparently not attributable to the virus.
Is this simply undercounting? Or the effect of the lockdown rather than the virus itself?
Nobody is in a position to say for sure. A third possibility is that vulnerable people are becoming infected with Covid-19 but not showing symptoms.
But we do know that hospital admissions have fallen sharply, so it is possible that people who have other serious illnesses are not getting the same level of treatment they got before the epidemic.
David Leon, Professor of Epidemiology, London School of Hygiene & Tropical Medicine, said the Covid numbers “do not count the indirect deaths that are occurring because people with serious symptoms or diagnoses of non-COVID health conditions are not getting diagnosed in a timely way or are experiencing delays in treatment”.
He added: “Some of this will be due to people’s reluctance to go to Accident and Emergency departments, while in other cases it is because investigations or treatments are being scaled back by hospitals.”
We still won’t know for some time how many people have lost their lives to the coronavirus.
We can be fairly certain now that hospital deaths in England have been falling for three weeks, suggesting we have passed the peak of deaths in the wider population – though possibly not yet in care homes.
The death toll is likely to be above 30,000 so far, when we include deaths from across the UK and outside hospital.
Fears that doctors might be under-reporting coronavirus deaths are not supported by new data from the Care Quality Commission.
A significant number of excess deaths we are seeing have not been attributed directly to Covid-19 infection.