The Long Tail

Deaths with COVID-19 show large differences by source.

Public Health England are reviewing their definition of COVID-19 deaths. This article compares their measure to figures from the Office for National Statistics.

Counting certificates

The Office for National Statistics publishes a weekly report on death registrations. These reports are for England and Wales. It takes time to register a death, and process that registration. As a result, the published figures covers registrations 11 days or more in the past.

What do Medical Certificates of Cause of Death show?

Clinicians must certify causes of death “to the best of their knowledge and belief”. Doctors are not infallible, nor expected to be.

The Medical Certificate has two parts, following World Health Organisation recommendations:

• Part I: The sequence of diseases or conditions that led to the death.
• Part II: Other significant factors, which contributed to the death.

The guidance gives an example:

Diabetes contributed to, but did not cause, this death. (Image: GOV.UK)

Colon cancer — listed in I(c) — caused liver metastases. Those deposits ruptured — in I(b) — and caused a fatal haemorrhage, I(a).