Covid-19: “Huge rise” in deaths at home is not fully explained by virus, say experts

Deaths resulting from covid-19 infection account for only half of the number of excess deaths taking place in private homes, expert analysis of latest data suggests.

Figures from the Office for National Statistics from the seven weeks to 15 May show that more than 40 000 covid-19 deaths have now taken place in hospitals, care homes, and private homes in England and Wales. The figures also show 14 418 excess non-covid deaths.1

The week ending 15 May saw the lowest number of deaths involving covid-19 in several weeks, down by 120 from the previous week (3810, down from 3930). The rate of covid-19 deaths is declining more quickly in hospitals than in care homes and at home.

Although covid-19 was mentioned on death certificates 13 500 times in care homes and private homes over the past seven weeks, some 23 500 more non-covid deaths have taken place in the community than would be expected. The data showed that around 9000 of these were “exported” from hospitals to private homes, with most of the remainder taking place in care homes.

Deaths at home
Discussing the data at the Science Media Centre on 26 May,12 David Spiegelhalter, chair of the Winton Centre for Risk and Evidence Communication at the University of Cambridge, said that “as soon as the pandemic started we saw a huge immediate spike in non-covid deaths in [private] homes that occurred close to the time hospitals were minimising the service they were providing.

“Over the seven weeks up to 15 May, as the NHS focused on covid, around 8800 fewer non-covid deaths than normal occurred in hospitals.”

He added that these had not been “exported” to care homes, since fairly few care home residents normally died in hospitals. Instead, he said, it seemed that these deaths had contributed to the huge rise in extra deaths in private homes during this period.

Spiegelhalter’s own calculations showed that “only 1800 of these 12 300 extra deaths were labelled as covid-19, leaving 10 500 excess non-covid deaths.” He further explained that, “if up to 8800 of these deaths would normally have occurred in hospitals, this would leave at least 1700 unexplained non-covid deaths at home.”

Deaths in care homes
Spiegelhalter also concluded from his calculations that 12 800 extra non-covid deaths in care homes could not be not explained by deaths “moving” from hospitals. He said that more work was needed to find out their cause, adding, “This is a vital issue if we are to understand the consequences of the actions taken.”

He called for further study of deaths that were not registered as covid-19, both in care homes that had had covid outbreaks and in those that had not, warning that “this won’t be the last epidemic.”

Carl Heneghan, director of the Centre for Evidence Based Medicine and professor of evidence based medicine at the University of Oxford, said that, by now, because of visiting restrictions it was hard to see how these excess non-covid deaths in care homes might actually be unrecognised covid-19.

The excess deaths were probably influenced by some other factors, he said, including people presenting with “usual problems that are highly amenable to treatment, such as non-ST-elevation myocardial infarction.” Heneghan called for a new approach to looking at deaths over the next six months and for the “triangulation of the Office for National Statistics data with individual data from some care homes.”

Some attendees also called for a more strategic approach to gathering evidence to help inform decisions, such as release from lockdown and the reopening of schools, which could also be informed by data from countries that have released restrictions ahead of the UK.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
↵Office for National Statistics. Deaths registered weekly in England and Wales, provisional: week ending 15 May 2020. 26 May 2020.
↵Office for National Statistics. Deaths involving COVID-19 in the care sector, England and Wales: deaths occurring up to 1 May 2020 and registered up to 9 May 2020 (provisional). 15 May 2020.
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