Assessing the Covid death toll

The Covid-19 virus is a killer — so far some 6.9m people have lost their lives to it, either directly or indirectly. At a local level the number of Covid-related deaths varies quite widely, as the first analysis yet made public shows. Text by Nick Terdre, research and graphics by Russell Hall.

The Covid-19 pandemic is not over yet — according to the World Health Organisation in January, it “continues to constitute a public health emergency of international concern”. While acknowledging that we may be at a transition point, the Who noted the ability of the virus to “to evolve into new variants with unpredictable characteristics.” At a time when public concern has lessened, health systems are fatigued and surveillance has dropped, it warns of the need to keep up our defences.

It noted that more than 170,000 Covid-related deaths had been reported globally within the previous eight weeks. As can be seen from the chart above, there was a surge in deaths early this year in the Western Pacific region; this includes China, which made a sudden reversal in its zero Covid policy at the time.

Generally, however, in the face of vaccination and other public health measures, the death toll is now running well below its level in the early days. From its peak in early 2021, when 102,066 deaths were reported in the week ending 24 January, it has fallen to less than 10,000 a week — 8,013 in the week ending 19 February. This is consistent with the fact that the currently dominant strains of the Omicron variant, while highly transmissible, do not cause severe infection.

Overall there have been some 6.9m deaths to date. By contrast the so-called Spanish flu pandemic after the First World War is estimated to have cost at least 50m lives worldwide.

As a proportion of the 756.6m confirmed cases of Covid reported to the Who, the death toll amounts to nine in every 1,000.

National variation

Worldwide the worst losses have not necessarily been suffered by the lowest income countries with the worst resourced health systems - a glance at the interactive map of world excess deaths above shows that many African countries have suffered relatively few deaths. Topping the list are Russia and various eastern European and Balkan countries, which together account for 16 out of the top 17 countries with the most excess deaths.

There is a wide range of differences, from Bulgaria the worst hit, with 1,088 excess deaths per 100,000 to Greenland with the lowest, -172, meaning its death rate has actually fallen during the Covid period.

Among Western developed countries the death toll varies widely. Italy has clocked up 467 excess deaths per 100,000, putting it in 31st place worldwide, the US 396 (45th), Spain 340 (57th), the UK 316 (63rd), Germany 286 (73rd), France 225 (94th), Sweden, which declined to institute a lockdown, 180 (115th), Ireland 161 (124th) and New Zealand, which shut itself off from the rest of the world for a long period, one (209th).

So the UK was by no means worst hit but it is an intriguing question why it had twice as many excess deaths as Ireland. Perhaps the independent inquiry now under way into the handling of the pandemic by the UK authorities will throw some light on this.

At a local level also mortality has varied a lot. Based on data from the Office for National Statistics for cumulative excess deaths per 100,000 of population in lower tier local authorities in 2020-22, Rother has the highest number in East Sussex, 685, putting it in 13th place out of 331 in England and Wales and Eastbourne, in 247th place, the lowest number, 353.

In between come Lewes, 77th with 540, Hastings, 129th with 479 and Wealden 174th with 441.

Puzzling range of outcomes

These figures show a huge difference in outcomes across England and Wales, from 847 deaths per 100,000 in East Lindsey in Lincolnshire to 64 in Three Rivers in Hertfordshire — there is no immediate explanation for this but it is a puzzle which it would repay the health authorities to untangle.

Looking at the chart for weekly averages of excess deaths in Hastings since the pandemic struck in 2020, it is clear that there is one single period when mortality due to Covid was high — from December 2021 to March 2022, when Alpha was the dominant variant of the virus. Outside this period, the number of Covid deaths has always been in single figures and often enough there were none.

The picture for Rother shows a somewhat higher number of deaths both in the immediate period after the pandemic struck and in the peak Alpha period.

No single measure of the Covid-19 death rate is entirely satisfactory. Excess deaths measures the number of deaths over and above what would be expected according to the rate measured over a number of years prior to the pandemic — in this case the average of deaths over the five years from 2015-19.

Another way of measuring the death toll is the number of deaths which have Covid-19 mentioned on the death certificate. This does not mean that Covid has necessarily been identified as the direct cause of death, though it may have contributed. By this measure the outcomes locally are somewhat different: Rother still has the highest toll, with 504 per 100,000 putting it in third place overall. But next comes Eastbourne, in 13th place with 465, followed by Lewes (77th with 383), Hastings (87th with 376) and Wealden (104th with 364).

The data is not available at local level to tease out the factors which produced the differences in the two sets of statistics. The relative number of older people, for example, may be part of the explanation.

Influential factors

Not surprisingly, in England as a whole, the number of deaths varies drastically according to age, as can be seen in the latest ONS statistics for deaths involving Covid-19.

In the week to 10 February there were 211 such deaths in persons aged 85 or more, 134 in the 75-84 year age group, 60 in the 65-74 age group, and much smaller numbers among younger cohorts.

The latest ONS data also indicates that ethnicity is no longer having the major effect it did in 2020 and 2021. Then it was principally Bangladeshis and Pakistanis, and to a lesser extent people of Black African, Black Caribbean and Indian ethnicity, who suffered proportionally higher mortality rates compared with white British.

Now the ONS comments that “…during the Omicron period, there is no longer evidence of ethnic minority groups having a higher COVID-19 mortality rate compared to the White British group.”

And both then and now, men were and are more likely to suffer death involving Covid than women.

 

The figures and charts for excess deaths in Hastings, Rother and the other East Sussex local authorities were calculated and prepared by researcher Russell Hall based on ONS data.

This article was amended by Nick Terdre on 27 and 28 February 2023.

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