The number of deaths in England and Wales in recent months has been significantly higher than what might be expected for the summer season. There were several weeks in July and August when the number of deaths was 10% to 13% higher than the previous five-year average. In comparison to previous years, this meant that approximately 900 more people died in England each week.
Heart and lung diseases, cancers, dementia, and Alzheimer’s disease are the leading causes of death. This corresponds to the typical range (the average over the past five years). It’s possible that Covid-19-related deaths account for half of the excess mortality, but the other half is a mystery because no single obvious cause stands out.
Covid is making us sicker and more vulnerable to other diseases (research suggests it may contribute to delayed heart attacks, strokes, and dementia); an aging population; an extremely hot summer; and an overburdened health-care system, which means people are dying due to a lack of timely medical care. A combination of factors is most likely to blame. Given the link between material deprivation and poor health outcomes, this winter’s cost of living crisis and fuel poverty concerns will add to the list of factors contributing to the problem. As a result, the unusually high number of deaths may continue.
Some people have used the “excess mortality puzzle” to argue that this is a delayed result of the lockdown. This means that, during the first and second waves of infection, mandatory restrictions on mixing and stay-at-home legal orders, as well as turning the NHS into a Covid health service, prevented people from being diagnosed or treated for other conditions such as cancer, heart disease, or even depression; and that these long-hidden conditions are now killing people. In other words, people are dying as a result of conditions that could not be diagnosed or treated.
There was undoubtedly a disruption in some aspects of medical care during the pandemic, and we know that delayed diagnosis results in poor health outcomes. It would be naive to believe that if there had been no restrictions, this issue would have been resolved. Finally, restrictions were imposed to limit the number of people who could be hospitalized at any given time as a result of Covid-19. This was done to allow the health-care system to handle the increased patient load. Because there are only so many healthcare resources available, keeping the number of Covid infections as low as possible was the best way to protect those resources for treating non-Covid conditions.
Because the UK government was slow to respond to the Covid-19 virus and implement measures to suppress it during the first and second waves, the NHS struggled to provide high-quality care to all those admitted to hospitals.
Countries that were able to avoid large numbers of Covid-19 patients in the pre-vaccine era through intelligent suppression based on testing and isolation, such as New Zealand and South Korea, were able to keep their health services running for a wider range of conditions. This was made possible by the introduction of the vaccine. The United Kingdom (UK) initially pursued late, and thus longer, lockdowns without a clear exit strategy, with England, in particular, struggling to implement test/trace/isolate and learn from the first wave’s mistakes.
Excess mortality data point to three major concerns. The first issue is that the National Health Service (NHS) is understaffed, which causes the quality of care to deteriorate. As a result, patients with acute conditions, such as heart attacks and strokes, as well as chronic conditions, for which every week and month of treatment is important, such as cancer patients and patients undergoing surgery, are waiting longer for medical care. There are far too many ambulances that cannot unload their patients.
Regrettably, some politicians have accused NHS workers of being unproductive because they only conduct virtual appointments or are absent from work due to illness. It is abundantly clear that significant investments in the NHS, in its people, facilities, and operations, are required to make it a desirable place to work while also providing the necessary quantity and quality of medical care.
Second, the Office for National Statistics discovered an increase in mortality on days with extremely high temperatures. We are aware that extreme weather events are becoming more common, and that higher temperatures can cause strokes, heart attacks, and blood clots in the elderly and other vulnerable groups. Climate experts warn that what we now perceive as unusually hot temperatures will become the norm over the next 50 years, implying that this problem will not go away.
The most important thing to remember is that the COVID-19 virus is still spreading and killing people, particularly among the elderly and those who have not been vaccinated. Even though it is no longer the leading cause of death in the population, it is still one of the top ten. Furthermore, despite the fact that vaccination and prior infection have greatly reduced the fatality rate, the disease is still a factor in the 10-13% increase in summer excess mortality. According to the ONS data, many other major causes of death are currently at a slightly lower level than the five-year average.
The good news is that the fatality rate for Covid-19, which measures the risk of death when infected, is now lower than the seasonal flu mortality rate for the vast majority of people. This is the result of scientific advances and government efforts to halt the spread of Covid-19 for as long as possible until vaccinations could be implemented. Unfortunately, it remains a leading cause of death and disability, ranking alongside coronary heart disease, cancer, dementia, and other incapacitating diseases.
Instead of engaging in illogical debates about whether or not lockdown was responsible for excess mortality – debates that are completely devoid of evidence – it is worthwhile to examine the data, which indicates that it is a combination of the newly added burden of Covid-19 and an overburdened health service, with days of extreme heat thrown in for good measure.
As is always the case, more research and analysis will help to paint a clearer picture over time. For the time being, our primary focus should be on investing in the National Health Service to ensure that patients receive timely quality care and figuring out how to better deal with extreme weather events. The Covid-19 virus’s mortality rate should also be reduced to a more manageable level. As a result of global events such as the Covid-19 pandemic and climate change, we are all becoming sicker. We could work together to find solutions if we could all agree that their impact is real, regardless of political affiliation.