COVID-19: The latest picture as at 10th November 2020

In this week’s blog we explore the latest data on weekly deaths in the UK. Total weekly deaths continue to increase steadily, with deaths registered in the latest week around 11% higher than the seasonal average for the week. This rise has been driven by the resurgence over recent weeks of deaths which mention COVID-19 on the death certificate. Given the continued rise in both cases numbers and hospital admissions, sadly we are likely to see further rises in COVID-19 deaths in the weeks ahead. Meanwhile, non COVID-19 deaths have remained close to the seasonal average over recent weeks and are slightly below average for the latest week.

Since our recent update on weekly deaths, England has gone into a second nationwide lockdown, while Wales has just come out of its two week “firebreak”, with Northern Ireland’s four week “circuit breaker” due to end this Friday (13^th). Meanwhile, Scotland continues its own tiered alert system of regional restrictions, having so far resisted imposing nationwide restrictions.

COVID-19 cases in the UK have shown some signs of levelling off recently, although some areas have seen better figures than others. Numbers for hospitalisations of COVID-19 patients have also been rising recently. Sadly, it is inevitable that some proportion of these new cases will require hospital treatment, and a proportion of those will tragically die. Therefore concerns remain that we could see many more COVID-19 linked deaths in the weeks ahead.

Continuing increase in deaths directly attributable to COVID-19

The latest statistics from the ONS include detailed breakdowns of deaths registered in England & Wales up to 9^th October. In particular, they identify deaths where there is any mention of COVID-19 on the death certificate. Combining this information with similar data from the corresponding statistical bodies in Scotland and Northern Ireland, we can examine emerging patterns in the data.

COVID-19 deaths have been increasing steadily over recent weeks, with almost 13% of deaths in the most recent registered week mentioning COVID-19 on the death certificate. The direction of travel, with some signs of acceleration, is clearly concerning - particularly in light of the continued rise in cases across much of the country (albeit with potential signs of cases stabilising in some regions) and the imminent arrival of winter bringing further pressures on NHS services.

With nationwide restrictions in England in place for the next few weeks, along with those coming to an end in Wales and Northern Ireland, and widespread restrictions in Scotland, the hope is that we will see a slowing of case rates, and so deaths in the weeks ahead.

Weekly deaths increasingly above average seasonal levels

Total deaths remain above the 5-year average, for the eighth consecutive week. The direction of travel is concerning, as the number of excess deaths has been increasing over the past few weeks. This increase has, however, been driven by the rise in deaths directly attributable to COVID-19 over that period, as mentioned above. Weekly deaths excluding those linked to COVID-19 have been close to average for the past few weeks, and lower than average for the most recent week, as can be seen from the chart below.

The bars shaded in red indicate weeks where total deaths were above average seasonal levels. This effect was particularly evident at the same time as the COVID-19 pandemic first hit the UK over April and May and was explored as ‘missed’ COVID-19 linked deaths in our earlier blog. Since then weekly non COVID-19 deaths have been much closer to, and for a number of weeks below, seasonal levels.

Given the statistical ‘noise’ in weekly death figures, caution is required when looking at this data over relatively short periods. It will, however, be important to monitor how these figures evolve over the next few months, where deaths would be expected to increase in any given year over the winter.

Comparing cases, hospitalisations and deaths

We know that many people infected with COVID-19 have relatively mild symptoms, with some cases being entirely asymptomatic. However, there will unfortunately be a number of more severe cases which require hospital treatment and, in the most serious cases, intensive care facilities. Sadly, while medical treatments have improved markedly since the start of the pandemic, a number of those admitted to hospital will tragically die. The progression from first infection, to developing serious symptoms requiring hospitalisation, to death occurring typically takes a number of weeks.

It is therefore very useful to look at the numbers of COVID-19 cases, as an indicator of imminent hospitalisation requirements, and to look at hospitalisation figures themselves as an indicator of future rises in COVID-19 linked deaths. The chart below compares these three figures for the UK as a whole (with averaging over 7 days applied in each case to smooth out variations, such as that occurring at weekends and bank holidays). We have focussed on the figures for the past few months, given the very low levels seen over the summer.

We can see how COVID-19 cases in the UK (purple line, left hand axis) have been increasing fairly rapidly since early September, although there may be some promising signs that cases may be levelling off more recently at the national level. As expected, there has been some lag between the increase in cases and corresponding rises in hospitalisations (solid green line, right hand axis), which have also shown signs of levelling off, with a further lag in the rise in deaths.

There will not be direct correlation between these figures, for example impacts may depend on the changing rates of infection across different age groups, who are likely to have differing levels of hospitalisation. Nonetheless, there are concerns that, even if recent tightening of restrictions have the desired impact of slowing the rise in COVID-19 cases, as hinted at in some recent data, COVID-19 linked hospitalisations are likely to increase over the weeks ahead, at a time when NHS services would, in normal circumstances, expect to face increased pressures during winter.

Time will tell whether there will be further bad news on COVID-19 deaths throughout the rest of the year – we will be sure to keep our eyes on the emerging data to quickly identify any early signals.