Measures to deal with covid-19 “may be having a negative effect on other causes of death,” says expert

But it’s too early to predict their wider effect on population health 

The measures being taken to deal with covid-19 may be having a negative effect on other causes of death, particularly other respiratory causes, says an expert in The BMJ today.

But John Appleby, Chief Economist at the Nuffield Trust, says for the moment, the data are incomplete, too uncertain, and too fast moving to support any reliable conclusions.

One problem may be that people might not seek care from the NHS, perhaps because they fear contracting covid-19 or they don’t want to burden the NHS at a time when the service is under pressure, he explains.

Indeed, March figures show a 29% drop in the number of attendances at emergency departments and a 23% drop in total emergency admissions in England, compared with 2019.

“What we don’t know of course—at least not yet—is who has stayed away and what happened to them,” he writes. “But these are large falls, and the fear would be that some who didn’t attend emergency departments will have died, or may die in the coming months, when timely treatment may have prevented their death.”

On actual deaths, weekly figures from the Office for National Statistics (ONS) on the number of registered deaths shows that, in the week ending 10 April 2020, 7996 more people died than the equivalent five year average for this week.

It’s clear that the number of death registrations mentioning covid-19 accounted for a large part of this excess (6213)—but not all, notes Appleby.

But it may be that deaths from covid-19 have been undercounted and that increases in other causes have been artificially boosted, he adds, and ONS figures on registered deaths by place of occurrence could support this. However, he says, given the relatively low level of covid-19 testing outside hospitals, “some—or many—of the other deaths in homes and care homes may also have been related to covid-19.”

“For the moment, it seems impossible to properly answer concerns about the wider effect current measures might be having on the health of the population,” he writes. “The data are incomplete, too uncertain, and too fast moving to support any reliable conclusions.”

He points to the difficulties of constructing a comprehensive and consistent picture of the situation as it unfurls from week to week, even in statistically sophisticated countries such as the UK.

And the position in many other countries is even worse, he says. The World Health Organisation, for example, estimates that although 84 countries collect usable data on deaths and cause of death, 81 collect only very low quality data or fail to register deaths at all, with just 6% of African countries collecting cause of death data.

[Ends]

24/04/2020

Notes for editors

Data Briefing: What’s happening to non-covid deaths?
Journal: The BMJ
Link to Academy of Medical Sciences press release labelling system: https://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Descriptive analysis of data
Subject: Deaths from causes other than covid-19

Link to full article: https://beta-www.bmj.com/content/369/bmj.m1607