Coronavirus: Why are there so many different death tolls?

With so much data available, and in so many different forms, it is hard to grasp true scale of the pandemic and how many lives have actually been lost, finds Samuel Lovett

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Every day brings confirmation of more people who have died from coronavirus in the UK, but regional and national discrepancies in the figures have compounded attempts to provide a clear and full picture of the pandemic.

There are a number of government bodies reporting on these numbers, from the Office for National Statistics to the Department for Health and Social Care, along with regional bodies such as the Northern Ireland Statistics & Research Agency and National Records of Scotland.

Different ways of recording deaths – from those that tested positive to suspected fatalities – have also added to the sense of confusion that surrounds the country’s handling of these numbers.

Here, we take a look at the various organisations, how figures are compiled and why there are so many inconsistencies in the data:

The main sources for reporting daily and weekly Covid-19 deaths:

• The Department for Health and Social Care (daily)
• Office for National Statistics, which covers England and Wales (weekly)
• Northern Ireland Statistics & Research Agency (weekly)
• National Records of Scotland (weekly)

Daily death figures:

The daily Covid-19 deaths statistics are published for the UK at around 2pm every day by the DHSC.

These figures are based on data produced by Public Health England, Public Health Wales, Health Protection Scotland and Public Health Agency (Northern Ireland).

The four organisations provide a count of all deaths where a positive test for Covid-19 has been confirmed, wherever the death took place (e.g a hospital or care home).

As of 8 June, 40,883 people in the UK had died of coronavirus, according to the DHSC.

Weekly death figures:

The ONS, Northern Ireland Statistics & Research Agency and National Records of Scotland all play the same role in providing weekly death figures that offer more detail and analysis than the daily data released by the DHSC.

Up to 30 May, 51,089 people in the UK had died of coronavirus, according to figures released by the three organisations.

The Office for National Statistics

The ONS’ weekly data for England and Wales are released every Tuesday at 9.30am and relate to the week that ended 11 days prior (for example, data for the week ending 20 March are released on 31 March).

These are based on registrations of deaths where confirmed or suspected Covid-19 was mentioned on the death certificate, wherever the death took place. Death certification involving Covid-19 does not depend on a positive test.

“There are two parts on the death certificate,” an ONS spokesperson said. “Part 1 is the sequence of events or health conditions leading directly to death. There are three lines. For example, (line) 1a: Pneumonia, 1b: Pneumonia due to (i.e. caused by) Covid-19.

“Part 2 is optional, and contains any other conditions which the certifier considered had contributed to the death, but were not part of the direct sequence. For example, there might be a pre-existing condition, such as diabetes, which made the individual more vulnerable to the main sequence.

“That’s what we mean when we say any mention of Covid-19.”

What is the reason behind the 11-day lag?

This reflects the time between a death taking place, it being officially certified by a doctor and then processed by the ONS.

“Deaths are usually certified by a doctor one or two days after death (the process is different for cases needing referral to a coroner). The next of kin or other relevant person then registers the death with the local registration office. The law allows five days to register a death.

“From the point of entry into the local registrar’s computer it takes two days for different pieces of processing and validation to be done, and the record can potentially be used for statistics, assuming there is no delay in validation e.g. because of a mistake in the certificate.”

Why do the ONS and DHSC provide different tallies?

The ONS total is 29 per cent higher than the Department of Health total.

This is because the ONS figures include all mentions of Covid-19 on a death certificate, including suspected cases, and are based on the date that deaths occurred.

The Department of Health figures are based on when deaths were reported, and are for deaths where a person has tested positive for Covid-19.

How are excess deaths calculated?

This looks at how many people are dying in total in England and Wales over a specified week compared to the five-year average for that corresponding period.

Since the outbreak of coronavirus, the number of people dying on a weekly basis has sharply increased above the usual average.

As an example, for the week ending 29 May, the total number of all deaths in England and Wales stood at 9,824. This was 1,653 more deaths than the five-year average for this particular week.

Looking at the bigger picture, in the first six weeks of the outbreak, 108,345 deaths were registered by the ONS for England and Wales – which is 46,494 more than the five-year average over the same period.

Covid-19 was responsible for 33,257 of these deaths, or 71.5 per cent, the ONS said.

How are authorities explaining non-Covid-19 excess deaths?

The ONS has begun exploring the factors behind non-Covid-19 excess fatalities. It has outlined five hypotheses:

• Covid-19 may have been present but undiagnosed or not recorded on the death certificate
• A reluctance to seek care or delay in receiving care could cause deaths where someone already had a serious health condition
• Reduced hospital capacity could mean some people with other underlying conditions had not received sufficient care
• An increase in stress because of lockdown could be causing more deaths
• An increase in registration efficiency could lead to more deaths being registered

“There’s not enough evidence to support the theories for an increase in death registrations, reduced hospital capacity and increases in death caused by stress,” an ONS spokesperson said. “The ones we’re able to look into are Covid-19 was present but not diagnosed and the delay in seeking care.

“A full analysis of non-Covd-19 excess deaths will only be possible in several months’ time when longer-term effects and additional data, both death registrations and other sources, can be considered.”

The largest increases in non-Covid-19 deaths compared to the five-year average are seen in deaths due to “dementia and Alzheimer disease” and “symptoms, signs and ill-defined conditions” (the latter mostly indicating old age and frailty). The ONS has said that undiagnosed Covid-19 and delays in health care could help explain this rise.

Deaths due to causes such as asthma and diabetes also increased up to the week ending 24 April and occurred increasingly outside hospital.

According to the ONS, Northern Ireland Statistics & Research Agency and National Records of Scotland, 63,596 excess deaths have been recorded in the UK since the beginning of the coronavirus outbreak.

Can we expect all of this data to be centralised?

With so much data available, and in so many different forms, it is hard to grasp the true scale of the pandemic and how many lives have actually been lost.

But the ONS has said that, for now, it’s unlikely these statistics will be centralised under one specific body. “It might take some time before a full review into it would be able to happen,” an ONS spokesperson said.