Facebook post 14 April
Today my head is awash with numbers.
I have been looking at epidemiological data from Italy and Sweden. I have been looking at mutation rates of SARS-CoV2. I have been looking at the latest ONS data for deaths in the UK. I have been looking at studies on pre-existing conditions in hospital admissions data in the U.S. Fascinating, absorbing but oh so much, I really don’t know where to begin!
Let me start with some bullet points on which I will elaborate in subsequent posts. Some of these will be highly controversial, particular as I see from the headlines that the U.K. Government is today proposing to extend lockdown by three weeks.
1. Data modelling from Italy and Sweden suggests lockdown has had no effect on case load or mortality in coronavirus.
2. Data, again from Italy and Sweden, suggest that ‘flattening the curve’ has had no measurable effect on mortality from coronavirus. The area under the curve is the same!
3. Mutation rates of SARS-CoV2 suggest that waiting for a vaccine is not an option.
4. The biggest risk with COVID-19 infection is your metabolic health. If you have one or more risk factors, then your chances of having severe symptoms or dying are significantly raised. These risk factors include hypertension, obesity, chronic lung disease, diabetes, insulin resistance, cardio vascular disease. Age alone is a far lower risk factor. Many of the ‘otherwise healthy’ deaths from COVID-19 reported in the media, were in fact from individuals with one or more of these risk factors.
5. There is a big (I mean BIG) gap in the ONS data on England and Wales deaths in the week ending April 3. Let me explore this one in more detail in this post here.
So today we have the more comprehensive data on deaths in England and Wales to 3 April. For many reasons, although these data are ‘old’ they are the most important because they are more inclusive than the daily death totals from COVID-19 reported in the media. They will therefore always report higher death totals than were being reported in the media on 3 April (well actually 4 April).
The ONS report that in Week 14 (week ending 3 April) 16,387 deaths were registered in England and Wales. 3,475 of these listed COVID-19 on the registration. These data include deaths from care homes, hospices and private homes and include cases where the deceased was not tested for COVID-19 but were suspected to have the disease from symptoms presented.
The total of deaths registered in that week is 6,000 higher than the five year average for Week 14.
This is the hole.
OK, follow me on this. There was a hypothesis brewing in my head when I reported on last week’s ONS data: “Are the deaths attributed to COVID-19 additional deaths (i.e. people who would not have died if coronavirus was not present), partly people who would have died anyway or entirely people who would have died anyway?” I was hoping data for Week 14 might begin to answer this.
To make my analysis easier let me round some numbers. Let’s say over the last five years, in Week 14 on average 10,000 deaths were been registered.
Week 14 of this year 16,000 were registered.
Week 14 of this year 3,500 of those deaths were linked to COVID-19.
Can you see my 2,500 hole? Even if all of the reported COVID-19 deaths in Week 14 were ‘extra’ deaths (i.e. people who would not have died anyway), then you would expect the total registered deaths in that week to be around 13,500. But it is 16,000.
Where have the extra 2,500 deaths come from?
I have some hypotheses:
A. We are dramatically under recording COVID deaths. That is, those 2,500 died because of exposure to SARS CoV2 but were not recorded as such. If this is the explanation then it is explosive. The scale of under-reporting would be massive – actually recorded 3,500 but another 2,500 missed. The ONS reported COVID-19 deaths (i.e. the 3,500) does include deaths in all locations (not just hospitals) and includes cases where COVID-19 is suspected even if the patient has not been tested for COVID-19. To be missing 40 percent of cases with those criteria would be a game changer, and one for which there is currently no other evidence.
B. There has been some change in the registration process. The ONS numbers are based on death registrations rather than the date of death. So, is it possible that there was a bottleneck in Week 13 (deaths that would normally be registered in that week but were delayed) and there was a ‘catch-up’ in Week 14? Or conversely, an acceleration of registrations so that some deaths that would normally have been reported in Week 15 were actually reported in Week 14. As far as I am aware there is no reason to suspect either suggestion here.
C. Deaths were registered in Week 14 with conditions unrelated to COVID-19 who would otherwise have survived if they had received the appropriate medical care but because of bottlenecks in the NHS, they did not receive that care. If there were 2,500 of these in one week, would that not have made its own headlines?
D. We are beginning to see one (of the many) costs of lockdown. Social isolation and the pandemic of fear created by lockdown may have a huge impact on the vulnerable, those with mental illness, and those with metabolic chronic diseases. Less emotively, in ‘normal’ weeks, nearly 25 per cent of deaths occur in the home. Lockdown has put entire population ‘at home’ and so have these deaths increased? The scale (2,500 in one week) is staggering if this is the case.
Is there an hypothesis ‘E’ I have missed??
Addendum.
It would seem there HAS been some change in the death registration process (see comments below) so maybe hypothesis B has more weight.
Addendum 2.
Again thanks to discussion in the comments, we can put an estimate that 1,000-1,500 of the missing 2,500 is because by Week 14, not all Care Home deaths were putting COVID-19 on the registration when perhaps it was involved. Delving into the source data and comparing Care Home deaths in a ‘typical week’ with Care Home deaths in Week 14 puts an estimate on that under-reporting.