Exactly the same 'sloppy' process for recording influenza deaths is used as when recording Covid deaths – an assessment of the symptoms of the deceased will be made and an informed opinion reached as to the cause of death. If an elderly person dies with flu symptoms during the flu season, it is likely that flu will be put onto their death certificate. If an elderly person dies with Covid symptoms at the moment, it is likely that Covid will be put on their death certificate. It is unlikely that there would be post mortem testing for the relevant pathogen in either instance.
There are several sets of figures being used.
The Public Health England figure is the headline figure that was used at the daily briefings. It does what is says on the tin – it’s the number of people who died after testing positive for Covid. The first difficulty with the figure is that it does not account for when the positive test took place in relation to the death. In other words, someone could test positive in March, recover and then die in July and the death would appear in the figure. That is part of the cause of the second issue, which is that a person who dies after testing positive for Covid does not necessarily die of Covid. Some countries address this issue by only recording a death as a Covid death if the person dies within a specified number of days of testing positive – in Sweden, for example, I understand that 28 days is used.
The ONS figures record every death certificate in which Covid is included as a cause. The difficulty with that is the assessment behind the inclusion of Covid is largely subjective, as I have touched upon above. In addition, it may only be a secondary cause of death in a person who was already very ill.
The third way of assessing the death rate is to look at ‘excess deaths’ – i.e. the number of people dying over and above that which would be expected at the time of year. The issue with this figure is that it is capturing both Covid deaths and lockdown related deaths. For example there is body of emerging evidence to show that some people are not seeking medical help when acutely ill. I would also be surprised if there hasn’t been an increase in suicide.
The problem underlying all of the above is that everybody dies at some point and that as a person becomes older, the likelihood of them dying in any specified period increases. That is a particular issue given that Covid is primarily (but not exclusively) a killer of the elderly (in the UK it is estimated that 50% of deaths have occurred in care homes – in Spain 70%). It follows that some people killed by Covid could have been expected to die very soon without the intervention of the disease. That doesn’t make it okay that they have died or excuse any failure to protect them, but it has to be borne in mind when assessing the impact of the disease.
An interesting feature of the Excess Death rate is that it is now running at a negative figure – in other words fewer people are dying than would be expected for the time of year. That may well support the contention that Covid has simply hastened the death of many people who were likely to have died in the near future without its intervention. Again, that doesn’t make their deaths ok for their loved ones, but does show context.
