July 18, 2020

expert reaction to pause of publication on the DHSC website of PHE dashboard daily COVID-19 death figures

The Department of Health and Social Care (DHSC) have paused their publication of the daily COVID-19 death figures from Public Health England’s (PHE) website after the Health Secretary Matt Hancock called for a review following concerns having been raised about the figures by some scientists. 

Prof Paul Hunter, Professor in Medicine, UEA, said:

“That concept that there is an exact number of people who have died from COVID-19 and that this is actually measurable is, in my view, a myth.  In the UK medical causes of death certificate there is the possibility of putting down multiple conditions as follows:

• I. (a) Disease or condition leading directly to death.
• I. (b) other disease or condition, if any, leading to I (a).
• I. (c) other disease or condition, if any, leading to I (b)
• II. Other significant conditions contributing to death but not related to the disease or condition causing it.

“So if I (a) is COVID-19 or even if I (a) is pneumonia and I (b) is COVID-19 then this is clearly obviously a COVID-19 death.  But what about a death due to Myocardial infection I (a) due to ischaemic heart disease I (b) in someone who was coping very well until he got COVID-19 three weeks previously and then died?  Or even if he got COVID-19 two months previously and never really got back on his feet and dwindled since then.  Do either or both count as COVID-19?  How should a case be recorded if they were admitted to hospital with severe COVID-19, required ventilation, then got an antibiotic resistant infection in hospital from which after several weeks on ITU they died from septicaemia?  Also what about an elderly woman with several life limiting conditions who died at home without a diagnosis of COVID-19?

“There are currently three sources of information on total deaths from COVID-19 – the current daily reports now not linked to by DHSC but still available on the PHE dashboard; data from ONS of death registrations where COVID-19 is listed on the medical certificate causes of death; and estimates of excess death also reported by ONS.  None of these give the exact number of people who have died from COVID-19 and indeed this is unknowable with any degree of certainty.  NHS England also produce data on deaths in hospital but these do not give much of an indication of total deaths.

“Death certification is not an exact science and is based on clinical judgement of the medical practitioner certifying the death.  Early in the epidemic it is likely that many deaths in the community from COVID-19 were not diagnosed as such and were not included on the death certificate due to the lack of availability of testing.  However, the big problem with ONS data is the time delay as they require the death to be registered by the bereaved relatives and then these are produced once a week.  So making it difficult to understand what may be happening now.

“One issue with the current daily reporting is how do you deal with people who died some time after the initial infection.  The current system will almost certainly over-estimate deaths due to COVID-19 in the context of hospitals and care homes if people die several weeks later from totally unrelated causes.  However, if we set a time limit for example to only include deaths occurring within a month of diagnosis this will definitely underestimate relevant deaths by not including people who never recovered from the initial infection.  Also how do you know that a late death really was from a totally unrelated cause?

“Arguing about whether the existing system over or under-estimates real death numbers is missing the point.  The value of the existing system is not in total numbers but as an indicator of the progress of the pandemic by showing whether deaths are increasing or decreasing.  That these data have stopped being cited by DHSC at a time when evidence is mounting that the decline in cases of COVID may have stalled is a worrying development.  If death data does start being published again but with a different definition then it will not be possible to compare the new data with the old data and make the situation appear better than it is.

“In my view we should continue to publish the death statistics as currently made available, otherwise we may miss important signs of a re-emerging epidemic.  We can always argue about the exact number of deaths later, but what is important now is consistency in reporting to enable a clear picture of whether the epidemic is starting to get away from us again.”

Department of Health

https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

PHE

https://coronavirus.data.gov.uk/

Concerns raised by scientists

https://www.cebm.net/covid-19/why-no-one-can-ever-recover-from-covid-19-in-england-a-statistical-anomaly/

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.