A study from Imperial College London places England, Scotland and Wales among countries with the highest rates of excess pandemic-related deaths.
With global deaths from COVID-19 now reaching over a million, an international study led by researchers at Imperial College London and published in the journal Nature Medicine has placed England, Wales and Scotland among the nations with the highest rates of additional deaths from all causes – including, but not limited to, those caused by COVID-19 – during the first wave of the pandemic.
The study, titled ‘Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialised countries’, assessed weekly death data for the period spanning mid-February to late May, in industrialised countries whose 2020 populations were higher than four million and which were able to supply weekly disaggregated mortality data dating back to at least 2015.
Dr Vasilis Kontis of the School of Public Health at Imperial, the lead author of the study, explained: “The pandemic has affected people’s lives and health in so many ways. For instance, some people may have had an operation or treatment delayed or might have lost the support they need with their day-to-day medical needs. Taking these factors into account, looking at deaths from COVID-19 infection alone is too limited; looking at deaths from all causes allows us to better understand how well countries handled the pandemic, and how well they have supported their people during lockdown measures.”
Examining external factors
The study covered Australia, Austria, Belgium, Bulgaria, Czechia, Denmark, England and Wales, Finland, France, Hungary, Italy, Netherlands, New Zealand, Norway, Poland, Portugal, Scotland, Slovakia, Spain, Sweden and Switzerland. The researchers examined each country’s overall excess deaths, excess deaths as a proportion of the population, and relative percentage increase in deaths; in addition to the ‘posterior probability’ that recorded changes in mortality rates were associated specifically with the tangential effects of the pandemic.
In analysing the mortality data, the researchers took into account a number of external factors which could affect the numbers, including temperature and seasonal fluctuations, as well as both short- and long-term national and international trends. With all these factors accounted for, the data indicated that 206,000 additional deaths had occurred across all 21 countries throughout the study period than might have been expected had the pandemic not occurred. England and Wales accounted for 28% of excess deaths across all countries combined, representing a relative increase of 37%; while Italy accounted for 24% of excess deaths and Spain 22%. Meanwhile Australia, Bulgaria, Czechia, Denmark, Finland, Hungary, New Zealand, Norway, Slovakia and Poland all experienced changes of 5% or less to their excess death figures.
Co-author Dr Jonathan Pearson-Stuttard of the School of Public Health said: “Our research suggests a number of factors may influence why some countries had higher number of deaths than others. Countries with comprehensive and effective community-based testing and contact tracing programmes, or those without such systems but who implemented early and effective lockdowns, had lower death tolls during the first wave. As we enter the second wave, test and trace programmes, and supporting people who need to isolate, are our most important lever to minimise the impact of the pandemic on direct COVID-19 deaths and deaths from other conditions. Such programmes also reduce the need for further prolonged lockdowns.”
Long-term health investment is key
The nations which reported the highest excess deaths over the study period were largely the ones which had lower rates of public investment in their healthcare systems and health resilience. Austria had markedly low numbers of excess deaths from all causes, for example; and has nearly three times the number of hospital beds per head of population than the UK does.
The study’s senior author from the School of Public Health, Professor Majid Ezzati, clarified: “Long-term investment in the national health system is what allows a country to both respond to a pandemic, and to continue to provide the day to day routine care that people need. We cannot dismantle the health system through austerity and then expect it to serve people when the need is at its highest, especially in poor and marginalised communities. The conversation must now go beyond a narrow vision of pandemic preparedness and focus on creating holistic and equitable health protection and promotion. A strong and equitable health system is the only way to tackle existing inequalities, and to make the nation resilient to future pandemics.”
Commenting on the study, the UK’s National Statistician, Professor Sir Ian Diamond, said: “This sophisticated analysis throws more light on the scale of excess mortality in 21 industrialised countries and the differences between their experience of the pandemic. The authors have added to the body of robust evidence that is essential to understanding and tackling COVID-19 globally.”
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