The wave of excess non-Covid deaths continues. The latest Government figures from the ONS, published this morning, take the tally of excess deaths from causes other than COVID-19 to 17,839 since April 23rd, when the recent surge began. This is 9.5% more deaths than expected, based on an average of the previous five years. Overall excess deaths, including Covid deaths, have been 13% higher than expected during the period.

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In the week ending September 9th, the most recent week for which data are available, 10,753 deaths were registered in England and Wales, which is 938 (9.6%) above the five-year average for the week. Of these, 365 mentioned COVID-19 on the death certificate as a contributory cause and 223 mentioned COVID-19 as underlying cause, leaving 715 deaths from a different underlying cause.

Here are the excess non-Covid deaths by date of occurrence since February, plotted with the spring vaccine booster rollout figures owing to an apparent correlation, at least at the initial stages.

The disturbing trend of surging excess non-Covid deaths is not restricted to the U.K., but is also being seen in Australia and across Europe.

Investigations into what lies behind the worrying pattern are now belatedly appearing, though notably none as yet include vaccination status.

Stuart McDonald, Co-Chair of the COVID-19 Actuaries Response Group, has written an analysis, in which he notes that many of the deaths are due to cardiovascular disease (CVD). He suggests that the causes are likely to lie in the impact of the virus on the heart or in problems with accessing healthcare both currently and during the pandemic.

The ‘Swiss Doctor’ (i.e., Swiss Policy Research) has similarly argued that Covid itself it likely to blame (alongside heatwaves and wrong baselines), noting the strong temporal association between when the non-Covid excess occurs and Covid waves.

This week the Office for National Statistics has also published its latest report on excess deaths. Sarah Caul, ONS Head of Mortality Analysis, implied the virus is likely to blame, saying the excess non-Covid deaths in 2022 have been “driven by higher than expected numbers of deaths since March, which could be caused by a combination of factors. Across March, April and May we saw increases in deaths due to cardiac arrhythmias [irregular heartbeat], predominantly among those aged 80 and above. Further work needs to be done to understand any link between the long-term effects of Covid and increasing cardiac deaths.”

The ONS report shows that excess mortality in May and June was 15.4% and 8.6% above average respectively, with 76% of the excess deaths in May and 82% in June not being due to COVID-19.

Ms. Caul suggested that the mild winter may have resulted in some “mortality displacement”, with below average deaths during the winter leading to above average deaths now – though this seems to ignore somewhat the 150,000 excess deaths in the past two and a half years, which will have caused substantial mortality displacement of its own, in the opposite direction.

Could it be the lack of access to healthcare that’s causing the deaths, as suggested by Stuart McDonald? It can’t be helping, of course. But since heart problems (and more generally cardiovascular disease) are among the main causes, the central question is why more people are dying of CVD. Is this purely or mainly due to lack of access to treatment? This seems unlikely. It’s true that NHS elective and emergency admissions dipped considerably during 2020 and 2021, as shown below.

NHS

The long length of the current hospital delays are also well-known. These are mainly caused by ‘bed-blocking’ preventing the movement of patients efficiently through the hospital system, which has a number of causes, but increased demand (patients are sicker) is an important factor. Some of this is self-reinforcing – the delays are making people sicker, causing more delays. But there must also be an independent driver of demand, something that is a cause of serious cardiovascular disease. No doubt some of this is a result of missed operations and procedures during 2020 and 2021. However, the preponderance of CVD-related deaths and the lack of excess cancer deaths suggests that something besides lack of access to healthcare is going on (though admittedly the cancer deaths may be on their way).

It’s also relevant here that the excess CVD non-Covid deaths didn’t begin until mid-2021 and were not a feature of the first 16 months of the pandemic.

They began around the same time as the Delta variant emerged, and have largely continued since, albeit with a gap during the winter when the mildness of Omicron (in the U.K. at least) resulted in a low-mortality winter. The temporal association with the Delta and Omicron waves is what leads many to suggest that the virus is triggering the deaths in some way. It’s also well known that cardiovascular deaths are often associated with acute respiratory infection, and Covid is no exception (though whether this risk continues longer term is disputed, and limited autopsy evidence suggests that Covid, when fatal as a respiratory infection, does not routinely attack the heart).

The question, though, is why have cardiovascular deaths associated with Covid waves become much more pronounced since mid-2021?

The Japanese Government has noted this association, reporting that 89% of those who died of Covid in the latest Omicron wave had only moderate respiratory symptoms, up from 57% in 2021’s Delta wave. It added that a smaller percentage of COVID-19 patients have developed serious pneumonia as the vaccination rate has increased, while more have died because the coronavirus “causes their pre-existing conditions to worsen”. This seems to indicate that the vaccine is playing a role in the shift from textbook respiratory Covid deaths to deaths from other causes triggered by the virus.

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