Dr Raghib Ali OBE MD MPH FRCP Profile picture
Mar 11, 2022 10 tweets 3 min read Read on X
V. important paper published in the Lancet - the first peer-reviewed global estimates of excess deaths (the most reliable way to compare Covid deaths) over first 2 years of pandemic with findings that will surprise many & correct five widespread misconceptions / assumptions:
1/9
1. Far from the UK having the worst death rate in Europe (or even Western Europe) as many still think, it is actually 29th in Europe & 9th in Western Europe - below the Western European average & at the same level as France & Germany (no statistically significant difference) Image
W. Europe: 140.0 (133.5-146.3)
Italy: 227.4 (212.0-242.5)
Portugal: 202.2 (190.7-212.2)
Spain: 186.7 (181.3-191.5)
Belgium: 146.6 (135.8-156.3)
Netherlands: 140.0 (131.3-147.6)
UK: 126.8(122.3-130.9) Eng. 125.8(122.1-128.7)
France: 124.2 (120.5-127.7)
Germany: 120.5 (115.1-125.1)
2. Even the misleading claim that many still make that the UK had the highest death toll based on absolute numbers (which is obviously mainly determined by the population size) is now wrong:

Italy: 259000
Germany : 203000
UK: 169000 (England: 142000)
Spain: 162000
France: 155000
3. England hasn't had a higher death rate than other home nations: all are basically the same level with no statistically significant difference:

England: 125.8 (122.1 - 128.7)
Northern Ireland: 131.8 (101.6 - 165.0)
Scotland: 130.6 (115.7 - 145.1)
Wales: 135.5 (121.9 - 147.5)
4. Sweden has not had a higher excess death rates than its Scandinavian neighbours (no difference except to Norway) and is well below the W. European average (as shown above):

Denmark: 94.1 (80.5-106.3)
Sweden: 91.2 (85.2-98.1)
Finland: 80.8 (66.2-94.0)
Norway: 7.2 (0.0-15.9)
5. There is no clear relationship between levels of excess mortality and different levels of restrictions/ NPIs across Western Europe or indeed the whole of Europe. (The much higher Covid death rates in Central and Eastern Europe are mainly due to lower levels of vaccination.) Image
Of course as we look back, we must see what lessons we can learn from countries that have had much lower excess death rates (like Norway) but all the commentary to date as to to how and why the UK (or Sweden) has done so much worse than its neighbours is clearly no longer valid.
And of course we owe it to the tens of thousands who have died, including many of my NHS colleagues, to have a proper public inquiry that looks at all the decisions made over the last two years to ensure we learn from our mistakes and see how we can do better in the future.
There are lots of other important findings in the full paper too showing that deaths from Covid have been much higher in many countries than official figures suggest and that excess death rates have varied very widely between countries and within regions.
thelancet.com/journals/lance…

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More from @drraghibali

May 11, 2022
With restrictions having ended across all home nations, it’s time to have a look at the results of the 'natural experiment' that we've had in the UK since July 19 when policies diverged with England having fewer restrictions than Wales, Scotland & Northern Ireland since then.
1/6
While some described England’s approach as a "dangerous & unethical experiment", @CMO_England, I & others thought that ongoing restrictions in a highly immune population would simply postpone infections - not prevent them.
So what has happened with infection & death rates?
2/6
The graphs below show cumulative infections & deaths across the home nations from July 19 to April 9 (last date data available) & also from December 17 to April 9 when Omicron became dominant and show no significant differences in infection or death rates over that time.
3/6
Read 6 tweets
Apr 16, 2022
Studies like these (based on models) ignore what is now well-established i.e. key role of voluntary behaviour change in controlling Covid - with behaviour changing more in response to the level/fear of Covid ('voluntary lockdown') than govt. mandates
1/7
telegraph.co.uk/news/2022/04/1…
e.g. household visiting & mobility fell more in the week before lockdown than after lockdown came in. There is limited evidence that the govt. mandate produced a bigger fall than that which occurred anyway & we know that compliance with mandates is associated with level of risk
And we also saw what happened with the Omicron wave in December when, contrary to what was widely predicted based on models, voluntary behaviour changes led to an outcome similar to what was projected to happen with lockdown equivalent to step 2 of roadmap (only schools open.)
Read 7 tweets
Mar 30, 2022
With hospital admissions in England approaching the 1st Omicron peak (& hospitals being busier overall due to more non-Covid patients) & ONS likely to show a record no. infections this week, some are again calling for a return of mandatory measures assuming this will help but
1/6
evidence for this is lacking.
In the absence of better evidence, we look at the real world data from the natural experiment we've had since July 19 when the home nations diverged & we don't see any indications from the case, death or ONS survey data that England has fared worse
from have less mandates & relying more on public health guidance & people taking personal responsibility.
This is also true for the most recent Omicron wave where Scotland has had the highest infection rates & higher hospitalisations than first peak despite having more mandates.
Read 6 tweets
Feb 1, 2022
A note on excess deaths last wk:
1. They are 8.6% lower when comparing to the 5 yr avg which includes 2021 - unsurprising as it was peak of 2nd wave & no-one fully vaccinated - but
2. More significantly, they are also 3.3% lower than the 5 yr avg. for 2015-19 (pre-pandemic)
1/4
This is a huge contrast to the same week last year when there were 18,676 deaths (about 1.5 times higher than now) and deaths were 41.3% above the five-year average again illustrating the massive impact of vaccines and Omicron's decreased severity (& very low deaths from flu)
2/4
It is also consistent with point I raised in December re. '28 day positive test' measure over-estimating deaths due to Covid with Omicron (as shown below from @AlistairHaimes).
The proportion of 'due to' (72.9%) vs. 'involving' Covid is also lower than previous week (77.4%).
3/4
Read 4 tweets
Dec 29, 2021
There is understandable concern about increasing numbers of children being admitted into hospital with a positive Covid test recently. This needs urgent investigation but from what we know so far the data suggests the headline figures may be hiding a more complicated reality:
Firstly, the situation with children is in many ways similar to that with adults in that we need to distinguish between those who are admitted for a Covid-like syndrome versus those who are admitted with another condition (eg. abdominal pain) but have an incidental positive test
(There are also those who are admitted with a condition which Covid may have contributed to - and for the in-hospital figures those who were admitted before and now have a hospital-acquired infection.)
Read 10 tweets
Dec 29, 2021
I really don't understand why some people - despite having zero clinical experience of looking after Covid patients - insist that Omicron is not causing more mild disease in the vaccinated than previous variants.
You can't judge severity just by looking at numbers/graphs -
1/5
you have to look at the clinical presentation of patients as well. And based on my own and others frontline experience of all 4 waves, it is clear that so far Covid patients are less likely to have pneumonia and more likely to have an incidental +ve test or milder symptoms.
2/5
& given that most people are going to catch Covid at some point, we should be reassuring the vast majority who are vaccinated that they are much better protected than last yr & much less likely to have severe disease - not scaring them.
(& encouraging unvaccinated to get jabbed)
Read 5 tweets

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