Counting UK COVID-19 deaths

As the UK exceeds 100,000 deaths, how do we count these deaths?

On Tuesday 26th January, the UK daily COVID-19 death toll reached 100,000.

This article looks at the different ways of counting COVID-19 deaths.

Public Health England and the daily count

Broadcasts and article will often report how many more COVID-19 there are.

This is not the number of people who died with COVID-19 on that day. There are delays between a person dying and their death entering record systems. The figure for the United Kingdom comprises:

  • England, Scotland, and Northern Ireland: deaths from any cause within 28 days of a positive SARS-CoV-2 test result.
  • Wales: deaths of Welsh hospital patients and care home residents, with a positive test. Clinicians must also suspect that COVID-19 was a causative factor in the death.

Public Health England call this count the ‘death within 28 days of positive test’ measure. PHE have responsibility for collating and reporting the UK-wide daily counts.

This measure is not meant to be comprehensive. There is not an intentional consensus on daily reported deaths. As an Office for National Statistics spokesperson said, the daily count is:

[a] short-term measure designed to give an up-to-date account of how the pandemic is developing[.]

There are circumstances where a person can die of COVID-19, but not appear in the daily count:

  • No positive test: a lab-confirmed death only counts people with a positive test result. Untested people and those with all false negative results are not part of this figure.
  • Time-outs: if a death occurred 29 days or more after a positive test, public health agencies do not count this death. In Wales, it depends on whether clinicians suspect COVID-19 was a causative factor.
  • Other settings in Wales: suppose a person dies outside hospital or institutional settings in Wales. That COVID-19 death is not part of the Public Health Wales figure.

By Tuesday 26th January, this measure reported 100,162 COVID-19 deaths in the UK.

Office for National Statistics and death registrations

As an alternative, we can count death registrations. Each week, the Office for National Statistics publishes weekly death registration reports.

To register a death, there must be a Medical Certificate of Cause of Death. That certificate has two parts:

  • Part I: the causal chain of conditions that led to a person’s death.
  • Part II: other contributory factors to the death.
The certificate lists the causal chain, and other contributory factors. (Image: Geeky Medics)

If a disease is on the certificate, clinicians believe it caused or contributed to the person’s death. Doctors do not need a positive test to suspect involvement of COVID-19 in the death.

Another strength is we can estimate the number of deaths caused by COVID-19. Around 9 in 10 death registrations involving the disease had COVID-19 as its cause.

Due to limited testing, daily lab-confirmed death count understated total COVID-19 deaths. Later in the pandemic, the two measures were similar.

The ONS publishes a UK-wide count of COVID-19 deaths by date of death. (Image: R Pubs)

The main limitation of death registrations is timeliness. It takes days from death occurrence to registration. There is then more time for processing and publication. The ONS publishes weekly reports for registrations 11 days behind the publication date.

Each small graph shares the same axis counting deaths. (Image: R Pubs)

Clinical suspicions can also be mistaken. ONS analysis suggested it was likely there was some under-recording of COVID-19 deaths earlier in the pandemic:

This suggests that undiagnosed COVID-19 is a likely explanation for some of non-COVID-19 excess deaths observed in this setting, because of the increased vulnerability of this population and increased likelihood that symptoms would be hard to identify in addition to existing comorbidities.

For deaths registered up to 15th January, there were 103,602 UK deaths involving COVID-19. By date of death, cumulative deaths involving COVID-19 reached 100,018 on 7th January.

The intermediate measure

Public Health England also publishes a ‘60-day measure’ for England. This measure counts deaths with a positive test result, where:

  • They died within 60 days of a positive test result
  • Or, had COVID-19 mentioned on the death certificate.

This is not a new measure. Public Health England began reporting this count in August. The public health agency also use the 60-day measure in their mortality analyses.

By 26th January 2020, there were 88,042 reported deaths within 28 days of a positive test in England. The 60-day measure for England was 97,135.

In the United Kingdom, the COVID-19 death toll exceeds 100,000 whichever of the measures we use.

The R code for the graph is available on R Pubs and GitHub.

This blog looks at the use of statistics in Britain and beyond. It is written by RSS Statistical Ambassador and Chartered Statistician @anthonybmasters.

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