On Tuesday, the government announced that 100,000 Covid-19 deaths had occurred in the UK. Yet some people are still disputing the numbers. I have been an NHS acute hospital doctor for 32 years and have been working on Covid wards for many months. I have sadly seen hundreds of people with the condition and certified many deaths.
So let me clear up some of the most common myths and misunderstandings I have heard since the pandemic has grown.
1. People are dying with Covid, not from Covid
This is a wilful misunderstanding of how doctors certify cause of death (and were doing so well before anyone had even heard of Covid-19).
The certificate must be completed by a doctor who was responsible for the care of the person during their final illness to “the best of your knowledge and belief”. It is based on the course of the person’s clinical picture, investigations, treatment, and their previous medical history. For deaths in hospital, certificates are also discussed with a doctor who is an independent medical examiner of deaths. Cremation papers are also scrutinised for accuracy.
Death certification is a solemn and serious professional duty and there would be serious professional or criminal consequences for falsifying certificates. We are also very aware that bereaved families read them and may be affected by what they see.
There is no financial incentive or push from any regulator to inflate the number of Covid-19 deaths, nor play them down, no credible motive and no evidence that this is happening. The idea that 300,000 registered medical practitioners in the UK are all colluding to cover up such a plot, along with coroners and medical examiners, is risible.
In 90 per cent of cases for which Covid-19 is recorded on a certificate, it features as an “underlying cause of death”. The straw man that we routinely write it on certificates for people who died of something different is demonstrably false and made clear in both Office for National Statistics figures and in independent explainer and fact checker articles from Sarah Scobie of the Nuffield Trust and Venagh Raleigh of the King’s Fund.
2. Reporting deaths within 28 days of a positive Covid test could be death from anything
This is the government’s preferred method of reporting the numbers since the summer of 2020. However, the politically independent ONS data is based on what doctors write on death certificates (whenever or whether a Covid-19 test has been performed) and this methodology has not changed. Doctors don’t take any account of the 28-day rule when certifying.
Plenty of people who develop Covid-19 are sick enough to stay in hospital for weeks before death. A recent analysis of more than 40,000 UK Covid discharges by Leicester University showed that over a five month follow up period, around 30 per cent of people are readmitted and nine per cent die, often with complications of long Covid. They were 3.5 times more likely to be readmitted during that period and seven times more likely to die than patients discharged with non-Covid diagnoses.
If anything, the government’s preferred method of counting under-estimates the real death toll. A recent Guardian analysis suggested that this underestimate was about 20 per cent.
3. The death numbers are no worse than a normal flu season
Well, the ONS reported in January that the previous 12 months had seen the largest increase in excess mortality (against the five-year average for those months) since the Second World War and before December deaths had yet been counted. With the additional deaths in January, February and March, a March-to-March reference period will put this increase even higher.
Sweden has now reported its largest increase in excess mortality since 1918.
Now of course some of those excess deaths are from non-Covid causes and there is no denying that the pandemic has impacted other patients with other healthcare needs, but about half the excess mortality has been in people dying from Covid-19.
4. PCR tests are useless with most cases being false-positives
This assertion is based on misinformation. The PCR test, when performed in people with symptoms suggestive of Covid and where we are quite likely to find it, has a low false positive rate (that is to say, the percentage of people testing positive who do not have Covid-19). It’s often reported at less than one per cent. In these people, false negatives are a bigger issue with 10 to 20 per cent testing negative initially who then go on to develop clear evidence of Covid-19 and often then test positive.
It is true that a positive test cannot tell us how infectious you still are to other people. It is also true that if you do mass population screening of people with no symptoms and if the population prevalence of real Covid-19 is low, you will identify a high number of people who don’t have Covid – just because of the number of tests.
But the people who die do have symptoms and are generally sick enough to come to the attention of health professionals or be admitted to hospital and the death certificates are based on their clinical picture, not just on the results of a PCR test. If the doctors don’t think Covid-19 had anything to do with the death, we won’t write it on the certificate.
5. Covid-19 is no worse than normal seasonal flu
Well, a recent study reported in the British Medical Journal, comparing 3,641 patients hospitalised with Covid-19 versus 12,677 admitted with seasonal influenza showed a far higher incidence of many complications including acute renal failure, septic shock, stroke, pulmonary embolism and ventilation and death including acute cardiac death.
Any doctor working in acute care will tell you they have never seen so many patients requiring oxygen for so long, nor so many requiring non-invasive ventilation. And twice in the past year we have had to double (or more) intensive care unit capacity and seen oxygen supplies under threat in a way that none of us remember from seasonal flu.
6. Covid only kills older people or those with pre-existing conditions who were going to die anyway
Well, it is true that the median age of victims is 81 and that is roughly what life expectancy at birth is – though patients in intensive care units and many of those hospitalised or living with long Covid are much younger on average. But an academic analysis from Glasgow University showed that on average those who died from Covid-19 lost nine years of life expectancy at that age (which is a very different matter from averages at birth).
And of course it always was the case that older people, including care home residents or those in hospital and those with long-term medical conditions and those more socioeconomically deprived, were more likely to die from any seasonal infection.
However, many people in their 50s, 60s and 70s live with conditions like diabetes, asthma, obesity, heart disease and yet still have active lives and years ahead of them. Older people also often remain active and engaged members of society and even the most frail have human worth and dignity and are members of our own families.
The idea of condemning them all to some kind of Covid knackers yard is unappealing and would say something disturbing about our society.
7. There is no second surge and the pandemic is over
This assertion has by now been completely discredited. Look at the record numbers of daily Covid deaths; the number of Covid related admissions and hospital beds; the number of intensive care patients; the much higher positivity rate in those tested for Covid as part of population home testing studies like Imperial College’s React. It is clear that the pandemic did take off again in the autumn and accelerate with a vengeance in winter
No amount of misleading accusations and distortions can change that. So let’s take it seriously, shall we?
David Oliver is an experienced NHS consultant who has looked after Covid wards throughout the pandemic. He has played several national leadership roles in medicine and writes a weekly column, Acute Perspective, for the British Medical Journal
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