Why has the UK done so badly on Covid-19? There are still no easy answers | Coronavirus epidemic

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AAt the end of April, which seems like an age ago, I wrote an article for the Guardian on the problems of comparing the death rates of Covid-19 in the UK with those in other countries, and I said, “It’s tempting to try to build a ranking, but we’ll have to wait months, if not years, to get the real picture. Three months later, the Office for National Statistics (ONS) duly conformed to a classification of European countries, using Eurostat data until the end of May. The UK leads the way. But, unlike football or Eurovision, this isn’t a league table you want to lead.

The ONS analysis completely ignores the statistics on coronavirus deaths that we hear about all the time, and simply counts the total number of deaths from whatever cause. It then calculates the excess over the average of the last five years, adjusting for the age profiles of each country. Any excess could be due to Covid-19, the effects of the lockdown, or some other reason.

Ranking countries according to the excess mortality accumulated since the start of the year, England leads the way, with almost 8% more deaths over the five-year average. Spain is second (7% more), then Scotland (5%) and Belgium (4%). Wales and Northern Ireland are fifth and eighth respectively. The UK has done wrong.

The UK, however, did not experience the highest temporary spike in excess mortality: in mid-March, Bergamo in Italy had more than nine times the normal number of deaths, which produced the kind of desperate stories that led the NHS protection campaign. . The largest city in Europe was Madrid, for a week in mid-March. A month later, Birmingham had more than three times its normal death rate, and some local areas were even higher: In one week in April, Brent in north London had more than four times its normal number of death. These statistics hide what must have been a devastating time for the communities.

For those of us obsessed with these things, a little surprise was that Belgium only had half of England’s relative excess mortality, since websites that do international comparisons all show it to be the country (ignoring San Marino) with the highest number of coronaviruses. deaths per million inhabitants. But Belgium has been very generous in calling the deaths Covid-19, which may have given it an even poorer record than it deserves.

It should be noted that the issues of counting deaths linked to Covid-19 are clearly illustrated each day, when the Public Health England dashboard publishes a tally for the UK; for example, 119 and 83 additional coronavirus deaths were reported last Tuesday and Wednesday. NHS England currently suffers less than 15 Covid-19 deaths per day in hospitals, but the implausibly high PHE figures for England apparently also include one of the more than 250,000 people who have already tested positive and have died for whatever cause, even if it has nothing to do with the coronavirus.

The Department of Health and Welfare has suspended these daily figures, but they are still current at all international sites and are presumably used by others to judge how things are going in the UK. They may be misrepresenting the negative, as the ONS recently reported that the UK’s total death toll has shown no overall excess over the past five weeks.

But when we look at where the deaths are occurring, it is clear that we are not back to normal: people stay away from hospitals and die at home. In England and Wales, 766 excess deaths occurred at home in the week ending July 17, of which only 29 were with coronavirus, while in hospitals, 862 fewer deaths than normal have been registered. Thus, more than 100 deaths a day were occurring at home, which would normally occur in hospital – although this is at least a reduction from the peak of the epidemic, where there were 2,000. additional deaths at home per week.

Most people would rather die at home, but we seem to have no idea how good these deaths are and whether any of them might have been delayed had they been to the hospital.

Why has the UK done so badly? A clue is given by the interactive map provided by the ONS report, which shows the evolution of excess mortality at local level across Europe. We see strong hotspots in northern Italy and central Spain, which remain fairly localized – for example, Rome has not experienced excess mortality. But it is truly frightening to see these additional deaths erupting fairly evenly across the UK, as the thousands returning from winter holidays in Spain and Italy have left hundreds of separate outbreaks across the country. country. The outbreak in the UK was more widespread and lasted longer than in other countries, which saw their mortality return to normal levels in May, while the UK surplus continued to ‘in June.

But like I said before, it doesn’t make sense to try to attribute good or bad performance to individual causes. Sweden did badly and rank sixth in the table, just behind Wales. How much of this is due to his liberal measures, avoiding a strict lockdown? And how much is it due to the fact that a large number of Swedes take winter holidays in Spain and Italy, and have come back and started epidemics, or that (like in the UK) its nursing homes are not were not properly protected? There are no easy answers.

My first comments are still valid: it will take us years to properly assess the effect of the epidemic and the measures taken against it. We now have a league table, but as to why the UK has done so badly, the arguments will continue.

• David Spiegelhalter is President of the Winton Center for Risk and Evidence Communication at the University of Cambridge. He is the author of The Art of Statistics

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