Thread: Throughout the pandemic there's been plenty of attention focused on #COVID19 deaths and on what’s happened in hospitals and in care homes - for obvious and understandable reasons. But for months there’s been another phenomenon which I find deeply unsettling.
Even after lockdown ended the number of people dying at home has stayed far, far above historic levels. There have been 28k excess deaths in people’s homes - more than in hospitals, care homes or other settings. Only a fraction of these deaths are officially put down to #COVID19. Image
I’ve been banging on about this since early on in the pandemic. It's not a new phenomenon. But it remains stubbornly unchanged even months on, even as excess deaths in other settings - care homes and hospitals - have dropped into normal or negative levels.
Is this something to worry about? Or is it (kind of) good news - in that lots of people would rather die at home than in a medical setting. Frustratingly there’s been v little research on this, so over the past few weeks we’ve been working on a short film looking beneath the data
It starts with Charlotte. Her mum, Caroline, died of ovarian cancer this summer. She had been in hospital but because of lockdown her family hadn’t been allowed to visit her, so they brought her home to try to care for her there. It was an ordeal, but they had little choice. Image
The family couldn’t get as much palliative care as they needed. Their home became a hospital. If she had gone into a hospice (as she might in normal times) they might not have been able to be with her, so she died with them at home. Her death is one of the thousands in this chart Image
Indeed, the most compelling theory about why excess deaths are up at home and down elsewhere is that these deaths are simply being displaced from other settings.
But these data can’t tell you anything about the QUALITY of death - something which matters enormously.
For many families the answer is remote hospice care (80% of hospice work is done in people’s homes).
Problem is those services have been overwhelmed during the pandemic. And like many, in the early days they struggled to get the PPE that would allow them to do their jobs
Selina says: “We can lose four patients just in one day. We can go off shift and have our two days off, come back to work and all our patients have changed because they’ve died. We’re getting our referrals in later and people are dying a lot sooner.” Image
And even as deaths at home remain so high, the hospice sector are struggling to keep up with the demand.
We’ve been shown numbers from an internal Hospice UK survey: 44% of hospices think they'll have to REDUCE their services. 93% fear people may miss out on the support they need Image
But there’s another likely explanation for high excess deaths at home:
some people are dying earlier than they would have because they've been unable or unwilling to go into hospital for the medical treatment they need. We know these cases are happening anecdotally.
Meet Amanda & Adrian. Adrian has stage 4 bowel cancer. He responded well to chemo - so well that his docs scheduled a life-saving operation to remove a large part of his liver. It was due in April. Then came lockdown, then the op was cancelled. Adrian’s cancer is now terminal Image
Adrian is one of potentially thousands of cancer patients whose care has been affected by lockdown. Doctors expect a surge in cancer deaths in the coming months and years. It is another dimension of what is happening beneath the surface of the data
We're still in the early stages of understanding this. Next week @ONS will produce further data breaking down home deaths by cause to see if there are any early patterns. But @d_spiegel told me it’s not impossible this is a permanent - or at least a long-lasting - change.
If you have time, do check out my long read on a disquieting phenomenon. For months I've been worried about the data showing thousands of excess deaths at home. This is my attempt to get beneath these numbers and understand what's going on news.sky.com/story/coronavi…
Here's our @SkyNews report about excess deaths at home, produced by the brilliant @maddylratcliffe.
As #COVID19 surges again and parts of the country go into another lockdown, this troubling phenomenon is likely to be with us for a while longer
Interesting @ONS deep dive into deaths at home.
Underlines point in my @SkyNews piece on this 👆, some of these deaths would have happened anyway.
Some may be happening sooner because of inability to access healthcare.
Eg see increases in causes of death:
ons.gov.uk/peoplepopulati… Image
As of the latest data there have been more excess deaths happening in people’s homes this yr than any other place. Vast majority of the deaths were not from #COVID19.
This is one of the most important but least discussed phenomena of the pandemic.
More on it in the thread 👆 Image

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More from @EdConwaySky

6 Nov
Transparency, worst case scenarios, & why govt is treading a dangerous path over #COVID19.
This is the longest thread I've ever posted.
But I think it may be among the most important.
Please do read and share if it strikes a chord.
This stuff affects all of us.
Deep breath... 🧵
Before we go any further let's get something out of the way: I'm not making a point here abt whether govt is right or wrong to impose lockdown. Like most of you, I can see strong arguments for & against but respect that others are better informed than I am to make these calls
This is really about something else: trust. Lockdowns, like em or not, won't work if no-one trusts the process and doesn't comply. It would be the worst of both worlds - economic damage but limited epidemiological effect. But that trust is earned. And easily lost.
Read 33 tweets
5 Nov
Big news.
Another u-turn - but one which will be welcomed by many employees and businesses. Though they will ask why it had to come so late. After all, many companies already laid off employees whose jobs could have been saved.
More on this on @skynews with my colleague @pkelso
Key info on the extension of the furlough scheme until March:
-Employers only cover NI & pensions. Biz may have to contribute more from Jan (but, perhaps to avoid future u-turns, no concrete plans to ratchet it down)
- Employees laid off since 23 Sep can be rehired & furloughed
- Job retention bonus shelved
- More support for self-employed
And the Treasury wants us all (esp the self-employed) to know THIS WILL ALL COST A LOT OF MONEY
Read 5 tweets
5 Nov
The count is going down to the line in Georgia. Here’s something we did live on @skynews last night, digging into county level data to show why that race is very much on (and since then it’s got even tighter!)
Yes that’s right election geeks, at @skynews we ARE showing you detailed county level data on the US election, to give the most granular, detailed analysis of any UK network. @SophyRidgeSky is currently there at the big screen. I’ll be back later. TUNE IN.
Here’s @SophyRidgeSky with one of my favourite graphics of the election: showing how the race for AZ has narrowed in Trump’s favour and how the race for PA has narrowed in Biden’s favour.
You’ve heard the phrase “going down to the wire”. Well: there’s the wire - in those charts…
Read 6 tweets
30 Oct
How does one reconcile this with the fact that case growth was actually SLOWER than in that "worst case scenario" (on basis of pretty much every measure inc @ONS survey)?
As @JeremyFarrar admits, communication of this stuff hasn't been great.
Lots of questions still unanswered.
Here's that famous illustration from Sep.
The black & grey lines show you what actually transpired.
I’ve included @ONS cases growth for comparison, mapped onto the baseline @uksciencechief used.
How, on the basis of actual case data, can one claim that trajectory was surpassed?
The point is not to dispute the substance of @JeremyFarrar’s thread. And yes I’m being somewhat pedantic. But these details matter.
What is the point of publishing a “worst-case scenario” and then claiming it’s been surpassed when the numbers show it hasn’t?
Genuine question…
Read 9 tweets
29 Oct
NEW: I have seen internal NHS data which reveals that the number of #COVID19 cases in care homes in Leeds has now exceeded the peak it hit in the spring.
It’s the first solid evidence that the disease is again spreading rapidly into the care sector.
news.sky.com/story/coronavi…
I’ve tweeted many depressing charts in this pandemic but this is among the worst.
I’ve obtained unpublished NHS data showing that the number of care home #COVID19 cases in Leeds has leapt so dramatically in the past week that they have exceeded the levels during the first wave.
My TV live on this story.
Hopeful interpretation is this rise is partly explained by more testing and that many of the cases are among younger care workers or asymptomatic residents.
Scary interpretation is that efforts to shield the elderly from this second wave are now failing
Read 5 tweets
28 Oct
The green line on this chart might help explain why Germany is imposing a #COVID19 lockdown.
Unlike in the first wave of the disease, its case trajectory is steeper than in countries like France, Spain, UK etc.
However, it’s locking down comparatively earlier than some others
If you want a sense of what many European leaders hope for from these short term #COVID lockdowns, look at the light blue line here - Israel.
Cases were rising fast there. A month-long lockdown was imposed and new case growth dropped. The lockdown is now being eased.
For those who like to keep tabs on Sweden and its #COVID19 situation (I’ve heard that’s a “thing”), here it is. In the same pack as most other countries. Denmark there too.
BUT NB: Norway’s caseload is so low it currently doesn’t even make it above the line in this chart
Read 4 tweets

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