1. COVID was present but undiagnosed, particularly in the presence of other co-morbidities and the absence of a positive test
2. Reluctance to seek care or a delay in receiving care for people with serious health conditions
2/n
4. An increase in stress related causes due to lockdown
5. An increase in death registration efficiency introducing a process effect
3/n
- Many deaths where COVID was not mentioned were displaced from hospitals to care homes and private homes
- Age-standardised mortality rates (ASMRs) for “non-COVID” deaths were generally higher in regions with higher COVID ASMRs
4/n
- Men accounted for more at first but from mid-April this switched to women
- Analysis by leading underlying causes of death shows all leading causes above or at their 5-yr averages
5/n
Some evidence has been observed for atypical hypoxia in frail COVID patients – well preserved lungs but severely compromised pulmonary gas exchange without signs of respiratory distress
8/n
But we cannot discount the impact of changes to normal routines for vulnerable care home residents following lockdown. These could have had adverse consequences too
9/n
This fits: demography, locations, esp where testing was sparse, causes of death & timings of peaks
10/n
The % of deaths registered by coroners has reduced, but within the context of many more deaths in total
Any effect is likely to be marginal and again this may change as more inquests conclude
14/n
This may reflect improving knowledge of its complex effects, increased testing, and the fact that some earlier deaths will have been brought forward by COVID
15/15 - ENDS