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Attributing death to COVID-19

As we move to the 'surge stage' in the coming weeks of COVID-19 deaths in the UK, we do need to get more detailed information on deaths outside hospitals.

This week the Office for National Statistics reported the highest total number of deaths since ONS weekly death reporting began in 2005. 



That gives us some idea of what the underreporting of COVID-19 deaths might be. It is extremely difficult to be sure.  One question is to what extent the virus is the cause of deaths that would not have happened without an infection, and to what extent it is hastening deaths that would have occurred in any event.  

The provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average.  

COVID-19 was mentioned in 21.2% of all deaths registered in that week - a significant increase on the previous week (4.8%). 

In London, nearly half (46.6%) of deaths registered in Week 14 involved COVID-19; the West Midlands also had a high proportion of COVID-19 deaths, accounting for 22.1% of deaths registered in this region.

Of deaths involving COVID-19 registered up to Week 14, 90.2% (3,716 deaths) occurred in hospital, with the remainder occurring in hospices, care homes and private homes.

Prof Martin Hibberd, professor of emerging infectious disease, London School of Hygiene and Tropical Medicine has said that "We know that for some situations, we may be overplaying the role of COVID-19, for example where COVID-19 was mentioned in a death but where it may have actually played only a minor role. Whereas in other situations, a death may not mention coronavirus, even though it may have contributed, possibly as a result of the indirect consequences of the lockdown and stretched healthcare services."

What we should not do is fill the void with speculation. Without systematic testing in the population, we simply cannot know for certain.

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