May 15, 2020

expert reaction to ONS data on deaths within the care sector involving COVID-19, England and Wales

The Office for National Statistics (ONS) have issued new data on deaths within the care sector involving COVID-19 for England and Wales.

Prof Sheila Bird, formerly Programme Leader, MRC Biostatistics Unit, University of Cambridge, said:

“Crucially, for England and Wales, the Office for National Statistics (ONS) has set deaths of care home residents during the COVID-era against deaths which occurred in the corresponding week of 2019 (past-expectation).  Data are summarised starkly in the Table below.

“During 7 March to 1 May 2020, an additional 22,900 deaths (to nearest 100) have occurred in residential care homes (above past-expectation).  However, only 12,500 (to nearest hundred) – just over half – had COVID mentioned on their death certificate.  Substantial under-diagnosis seems to have occurred because, in the Table below, the COVID-mention percentage has increased from 23% initially (weeks 11 to 13) through 49% (weeks 14 to 16) to 69% in the most recent weeks (weeks 17+18).

“ONS has set a new and welcome standard for the monitoring of fatalities among care home residents in England and Wales: not only in 2020, but henceforth.

“Monitoring against past-expectation is essential as we emerge from lock-down so that any resurgence of coronavirus-2 infections among residents and care-workers will be recognised.  Still earlier detection (and prevention) will depend on regular swab-test surveillance (‘have I got it’).  Surveillance could be instituted in a weekly random sample of residential care homes.

Table: COVID-era deaths of care home residents in England & Wales by death-week vs 2019-expected

“During weeks 11 to 13 (7 to 27 March 2020), an additional 1,400 deaths (nearest 100) occurred of care home residents above 7,900 expected on 2019-basis.  Could the Care Quality Commission have noticed this 18% increase without taking past-year experience into account as its benchmark?

“Only 23% of the additional 1,400 deaths had COVID on the death certificate.  Yet, week-on-week increases in COVID-mention were clearly alerting.  And Public Health England was already investigating COVID outbreaks in residential care homes during weeks 11 to 13.

“During weeks 14 to 16 (28 March to 17 April 2020), additional deaths of care home residents beyond 2019-expectation had risen to 13,200.  Even then, barely half of these deaths (6,500) had COVID mentioned on the care home residents’ death-certificates.

“Not all deaths which occurred during Weeks 17+18 (18 April to 1 May 2020) have yet been registered.  Currently there are 8,300 excess deaths of care home residents.  Of these, 69% were COVID-mention deaths which suggests substantial under-estimation hitherto.

“ONS has set a new and welcome standard for the monitoring of fatalities among care home residents in England and Wales: not only in 2020 but henceforth.”

Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said:

“The data behind this report have been assembled carefully, and despite the inevitable (and generally small) discrepancies between the numbers from different sources, this provides very valuable new information.  It’s no surprise, given other data that have emerged, that there has been an appalling wave of deaths of residents in care homes that are recorded as involving COVID-19.  What wasn’t quite so clear until now was the huge number of excess deaths of care home residents, compared to last year, that were not recorded as involving COVID-19.

“Leaving deaths involving COVID-19 out of the picture, there were about 10,000 excess deaths of care home residents that did not officially involve COVID-19 during March and April, the great majority of them happening in the short space from about 20 March to the end of April.  At the peak, there were over 400 such deaths per day.  It’s far from clear, up to now, exactly what caused these excess deaths.  Perhaps some should have been recorded as also involving COVID-19.  But also there has been general concern, for the population as a whole, about whether changes to the availability of other NHS services, because of the need to provide services to people with COVID-19, have increased mortality from other conditions.  One might expect that this would particularly affect care home residents, given their average age and frailty.  It’s good to see that this huge wave of unexplained deaths seems to have eased off now, but we really need to know more about how they arose, and to take any appropriate actions.  It’s very good to see in the ONS report that “We are looking into excess of non-COVID-19 deaths and will be publishing more on this soon”.”

https://www.ons.gov.uk/releases/deathswithinthecaresectorinvolvingcovid19englandandwales

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

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Kevin McConway: “Prof McConway is a member of the SMC Advisory Committee, but his quote above is in his capacity as a professional statistician.”

None others received