Thread by @NickStripe_ONS

THREAD – my first take on the COVID mortality reports we released today

1.Deaths occurring in April
2.Deaths in the care sector

Our data sources are:
-death registrations
-death notifications to CQC & CIW

1/n

The number of COVID-related deaths increased from 7% of all deaths in March to 37% of all deaths in April

Of these deaths (approx. 34k), COVID was the underlying cause of death in 95% of cases (approx. 32k)

i.e. 95% died from COVID not just with COVID

2/n

In just 2 months we have seen as many deaths due to COVID as the 3rd most common cause of death in the whole of 2018 - our last full annual analysis

Annualised age standardised mortality rates (ASMR) are c.70% higher than normal in Eng this Apr and c.40% higher in Wales

3/n

In 90% of COVID deaths, the deceased had at least 1 pre-existing condition. On av they had 2.3 conditions, down from 2.7 in Mar

Main conditions incl – Dementia & Alzheimer; Ischaemic heart disease; flu & pneumonia; chronic lower respiratory; diabetes; hypertensive diseases

4/n

COVID was by far the leading cause of death in April – ASMR 587 per 100k (Eng); 481 (Wal)

2nd was Dementia & Alzheimer Disease – ASMR 209 per 100k (Eng); 168 (Wal)

3rd was Ischaemic heart disease – ASMR 85 per 100k (Eng); 86 (Wal)

5/n

We already know that approx. 25% of excess deaths above 5 yr averages are not explained by COVID according to what has been recorded on death certificates

Today’s analysis starts to bring some insight into what might be going on. Further work is underway

6/n

I have stated before that there are two likely reasons for this:

-Disruption to normal care pathways

-COVID being present and exacerbating other conditions, but not obvious to the certifying medical practitioner in the absence of a test

7/n

ASMRs for Dementia & Alzheimer have increased very significantly in April which may provide some evidence for the second reason. Up 83% Eng & 54% Wal

Although less prevalent, ASMRs for “ill-defined conditions”, more frequently noted for the very old, are also up c.100%

8/n

There have been c.23k more deaths of care home residents than we would expect so far this year, most in April

c.12.5k are COVID-related, with c.9k occurring in care home settings and c.3.5k in hospital settings

Care home residents now account for c.35% of all COVID deaths

9/n

The daily number of care home residents that died with COVID in hospital settings levelled off during April – to approx. 75-130 per day

But they increased in care home settings to reach a peak of 425 deaths on 17 April

10/n

A lower proportion of death certificates of care homes’ oldest residents in Mar & Apr mention COVID:

27% of all care home residents’ death certificates mention COVID

Whilst 33% of those aged 65-69 mention COVID

This falls to 24% of those aged 90+

11/n

From death notifications to CQC in Eng we can also assess at a headline level the number of deaths of recipients of domiciliary care

From 10 Apr (when CQC indication of COVID was first captured) to 8 May:

- 3,161 recipient deaths were notified, 593 (18%) indicated COVID

12/n

Looking at CQC notifications for the same time period from the previous 3 years, this is:

- c.1,600 more deaths of recipients of domiciliary care than were notified in 2019

- c.2,000 more than the 3 yr average

13/n

When using aggregate statistics, please remember that behind every number is someone who has died, leaving family, friends and communities grieving in very difficult circumstances

We process & code every death registration/cert - it remains very real for us

Take care🙏

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