Source: United Kingdom – Executive Government & Departments
Public Health England (PHE) have announced* that the reported daily death data will now include all positive COVID-19 deaths, including out of hospital deaths.
Prof Sir David Spiegelhalter, Chair, Winton Centre for Risk and Evidence Communication, University of Cambridge, said:
“PHE are to be congratulated for linking multiple systems and getting more accurate and timely data into the daily announcements. But we should still remember that this does not include deaths without a positive test for COVID, nor the deaths due the collateral damage of disrupted health-care – we can only get a full picture by looking at overall death registrations.”
Prof Carl Heneghan, Director of the Centre for Evidence-Based Medicine, University of Oxford, said:
“The PHE data (as of the 28th April) now includes 23,550 deaths – 3,811 more than the hospital-only death data.
“This new data doesn’t change the peak of deaths, which is the 8th of April for hospitals
“Because these reported deaths have occurred over the length of the pandemic, they do not represent a new surge. See Figure 1 of the PHE report, which shows the peak is still the 8th of April including this new data.
“ONS data (see figure 3) is higher than PHE’s data as it includes those who died without laboratory-confirmed diagnosis but had COVID mentioned on their death certificate.
“I am reassured that the death data is now reported in a more robust format. The trend in the data continues to be reassuring as the added data, which includes out of hospital deaths shows we are still on the downward trend.
“Comparing the absolute deaths across different countries, and drawing conclusions at this stage is premature. There is still a lot of work to understand how different countries report the data and the impact this has on the figures.”
Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:
“The scale of deaths in care homes is not surprising given the ages and co-morbidities of the residents. Given the numbers of people with COVID-19 in the community it was only a matter time before infections were introduced given what we know about asymptomatic infections. The testing of staff and residents, even if asymptomatic, would not have stopped the inevitable introduction and spread of infection.
“We now have a third number for the deaths: hospitals, the new PHE figures and also the ONS weekly returns. They are all worthy of merit but not interchangeable for monitoring the trend in deaths. Each cannot compared be with the others. The most useful of these figures remains those admitted to hospital as it best reflects transmission within the general community. The deaths in care homes only reflects selective parts of the epidemic.
“Hospital deaths appear to be declining but deaths are reflecting what was happening with transmission of infections 3-4 weeks ago. The number of new cases in hospitals, pillar 1 of the government data, remains the best measure of what is going on with the infection rate across the country.”
Prof David Leon, Professor of Epidemiology, London School of Hygiene & Tropical Medicine, said:
“The data released today at the Downing Street Press Conference (April 29) on numbers of deaths from COVID-19 confirms that there are appreciable numbers of deaths from the virus occurring outside of hospital. For the UK as a whole they report a total of 26,097 COVID-19 deaths in any place compared to 22,286 COVID-19 deaths occurring in hospital as reported up until 5pm yesterday. This gives a total of 4,621 COVID-19 deaths occurring in the UK outside of hospital: making up 18% of the total. These outside hospital deaths will have occurred in care homes, private homes and a small number elsewhere. Unfortunately no breakdown was available to show how these out of hospital deaths were split between these different locations. However, from the ONS data published yesterday for the period up to April 17, we can see that just under three quarters of the out of hospital deaths in England were in care homes. This suggests that around 3,400 COVID-19 deaths as presented in the new data may have occurred in care homes.
“The precise source of these headline figures for out of hospital deaths for the UK as a whole is not entirely clear. However, more detail is available in a new report just published by Public Health England (Technical Summary : Public Health England Data Series on Deaths in People with COVID-19). This shows that for England alone there were a total of 23,550 COVID-19 deaths reported up to 5pm on April 28. Of these 3811 (16%) occurred outside of hospital.
“While Public Health England does not separate these according to where they occurred, they do make it clear how they define an out of hospital COVID-19 death. This is a death occurring outside of hospital where the person has tested positive for COVID-19. This is the same criterion as used to define a COVID-19 hospital death. This consistency is a good thing. However it has the same weakness – which is that not everyone who dies because of COVID-19 has been tested for it, and not everyone who has tested positive before death, dies because of COVID-19. This total of COVID-19 deaths will on balance underestimate the total numbers of deaths from the virus. Indeed the Public Health England report shows that up to April 17, their total COVID-19 death count is below that produced by the ONS – which counts COVID-19 according to what is on the death certificate. The ONS COVID-19 deaths include those where the doctor certifying the death believes that COVID-19 was involved even if they were never tested.
“These new data are welcome but only go a little further in helping us understand the numbers of COVID-19 deaths occurring outside of hospital. They throw no direct light on numbers dying in care homes. However, the information provided by ONS yesterday that covers the period up until April 17 suggests that the numbers of people dying with COVID-19 on the death certificate in care homes reached a peak on April 12 and then were stable at around 300 per day between April 14 and April 17. We will need to wait until next Tuesday (May 5) for the next ONS report for us to see whether these numbers subsequently increased. But the information provided today on out of hospital deaths in the UK and separately for England would do NOT indicate that these daily numbers outside hospital (the majority of which will be in care homes) have been going up substantially.”
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