Why so many deaths outside hospitals?

[AndyY]

In https://www.bbc.co.uk/news/live/world-53426297:

Posted at 15:25

England records further 19 deaths, none in NI and Wales
A further 19 people who tested positive for the coronavirus have died in England, bringing the total number of confirmed reported deaths in hospitals to 29,144.

Patients were aged between 52 and 91 years old and all had known underlying health conditions.

Northern Ireland and Wales both reported no new deaths, while Scotland reported one.

Separate UK-wide figures will be released by the UK government later.

And then less than half an hour later:

15:59

UK death toll rises by 66
A further 66 people in the UK have died after testing positive for coronavirus, the Department of Health and Social Care has said.

It takes the UK's official death toll to 45,119 across all settings.

If only 19 people died in hospitals, what are the "other settings" for the other 47 people to make a total of 66?
I thought that confirmed cases in care homes are sent to hospitals (e.g. infection risk to the other residents)?

 

[Domh245]

They're predominantly care homes, but you've also got deaths at home, hospices, and 'other' locations as well. The last week of ONS released data (week ended 3rd July) shows that 58% of COVID positive deaths were in hospitals, 32% in Care homes, 6% at home, and the rest were in other locations including hospices. That sort of distribution has been fairly typical for the last few weeks



Sadly it seems that COVID is still very much a concern in care homes, although given the low numbers of deaths (169 in w.e. 3rd July, down from peak of 2794 w.e. 24th April) now being reported there these would seem to be largely under control. I wouldn't be surprised if in some cases they've not gone to hospital at their own request (or Dr's suggestion) and have simply 'awaited the inevitable' at the care home with strict isolation, which is more manageable now that the PPE issue seems to be sorted

 

[furlong]

This one seems rather easy. to answer: In the English data, anyone who has tested positive in the past, irrespective of how long ago it was and whether they recovered or not, gets included in the figures - even if they recovered long ago and the virus had nothing to do with their demise e.g. they were run over by a bus.

 

[furlong]

Reread the words - "have died after testing positive for coronavirus" - it says "after" not "because of the virus" - they don't make a judgement about whether or not there's a correlation or apply a time cut-off, rather they just count them all. Over time, an increasing proportion of those deaths are likely to be unrelated to the virus. Lies, damned lies and statistics.

 

[MikeWM]

This one seems rather easy. to answer: In the English data, anyone who has tested positive in the past, irrespective of how long ago it was and whether they recovered or not, gets included in the figures - even if they recovered long ago and the virus had nothing to do with their demise e.g. they were run over by a bus.

Yes, amazingly this appears to be the case; there was a paper on it today by the Oxford CEBM (who seem to come out of this whole mess as one of the few medical establishments worth paying attention to).

See eg.
https://twitter.com/carlheneghan/status/1283827126962204672

Why no-one can ever recover from COVID-19 in England – a statistical anomaly.

 

[yorksrob]

It is notable that other countries tend to report recoveries from Covid19, whereas we never have. I suppose there is the inevitable question at what stage do you judge someone to have 'recovered'

 

[yorkie]

Yes, amazingly this appears to be the case; there was a paper on it today by the Oxford CEBM (who seem to come out of this whole mess as one of the few medical establishments worth paying attention to).

See eg.
https://twitter.com/carlheneghan/status/1283827126962204672

As it happens I just stumbled across that and decided to post it here but I see you already linked to a Tweet referencing it.

Here it is:

Why no-one can ever recover from COVID-19 in England – a statistical anomaly - The Centre for Evidence-Based Medicine

Yoon K Loke, Carl Heneghan People living in England have become increasingly concerned in the face of Public Health England’s

www.cebm.net

Some key extracts:

....roughly 80 000 recovered patients in the community will continue being monitored by PHE for the daily death statistics. More and more people (who are mainly in the older age group) are being discharged to the community, but they clearly may die of other illnesses.

This is why ‘out of hospital setting’ deaths remain constantly high (Figure 1), even though the Office of National Statistics data shows there have been fewer deaths than the five year average in the last three weeks, and NHS England data shows a moving average of 19 deaths per day in hospital.

It’s time to fix this statistical flaw that leads to an over-exaggeration of COVID-associated deaths. One reasonable approach would be to define community COVID-related deaths as those that occurred within 21 days of a COVID positive test result....

I think they felt they had to do this because those with a certain agenda would crucify them if they didn't; I do recall early on in the pandemic there were demands by certain individuals for deaths to be recorded as Covid even if there was doubt, as they didn't want the Government 'underestimating' the figures.

Either way, they can't win!

Edit: and here is the reaction from Prof. Karol Sikora

https://twitter.com/ProfKarolSikora/status/1283851195396902912

I read this and was appalled. It's from Oxford's CEBM & two very talented Professors @carlheneghan
& Prof Loke. I just can't believe PHE could be so incompetent - it's scandalous. Read for yourselves. Judgement reserved until PHE comment- @PHE_uk?

 

[45107]

They're predominantly care homes, but you've also got deaths at home, hospices, and 'other' locations as well. The last week of ONS released data (week ended 3rd July) shows that 58% of COVID positive deaths were in hospitals, 32% in Care homes, 6% at home, and the rest were in other locations including hospices. That sort of distribution has been fairly typical for the last few weeks

View attachment 80797

Sadly it seems that COVID is still very much a concern in care homes, although given the low numbers of deaths (169 in w.e. 3rd July, down from peak of 2794 w.e. 24th April) now being reported there these would seem to be largely under control. I wouldn't be surprised if in some cases they've not gone to hospital at their own request (or Dr's suggestion) and have simply 'awaited the inevitable' at the care home with strict isolation, which is more manageable now that the PPE issue seems to be sorted

Can you provide a link to the data, instead of a cut n paste graph ?

 

[Peter Mugridge]

Yes, amazingly this appears to be the case; there was a paper on it today by the Oxford CEBM (who seem to come out of this whole mess as one of the few medical establishments worth paying attention to).

Does this mean that technically even if the whole world somehow manages to get to a state where there are zero new infections in any country anywhere after, say, December this year that we in the UK would still be saying "there have been x deaths related to covid" for potentially the next 60 or 70 years or so until all the very young patients who have recovered have eventually all died from other reasons?!?

 

[Domh245]

Can you provide a link to the data, instead of a cut n paste graph ?

The data I used to produce the graph is taken from these data sets (the last page in the file - deaths by place of occurrence)

 

[30907]

Reread the words - "have died after testing positive for coronavirus" - it says "after" not "because of the virus" - they don't make a judgement about whether or not there's a correlation or apply a time cut-off, rather they just count them all.

Your comment applies to the "quick and dirty" statistics issued on a day to day basis on gov.uk. They are were generally thought thus far to underestimate the deaths, but that seems to have changed. may change if they don't apply a cut off.
The ONS figures, which are slower to release, are based on registered deaths where Covid19 is mentioned as one of the factors on the certificate. This will depend on the (first) GP's/clinician's professional judgement based on patient records and (virtual or actual) visits. They will therefore be more reliable.

To answer the queries about care homes, from the latest ONS (ie registered) figures for England and Wales around 20% of all Covid deaths happen in care homes and around 10% of all deaths in care homes are Covid related.
All care homes (I speak with recent experience) will have discussed end of life arrangments with relatives, and that may well include a presumption against hospital admission, resuscitation etc. - though with Covid in particular that depends on the home being able to control transmission.

On all this see (the summary in):
https://www.ons.gov.uk/peoplepopula...nglandandwalesprovisional/weekending3july2020

 

[Mag_seven]

As it happens I just stumbled across that and decided to post it here but I see you already linked to a Tweet referencing it.

Here it is:

Why no-one can ever recover from COVID-19 in England – a statistical anomaly - The Centre for Evidence-Based Medicine

Yoon K Loke, Carl Heneghan People living in England have become increasingly concerned in the face of Public Health England’s

www.cebm.net

Some key extracts:

I think they felt they had to do this because those with a certain agenda would crucify them if they didn't; I do recall early on in the pandemic there were demands by certain individuals for deaths to be recorded as Covid even if there was doubt, as they didn't want the Government 'underestimating' the figures.

Either way, they can't win!

Health secretary Matt Hancock has ordered a review:

Hancock calls for urgent review into coronavirus death data in England

Deaths recorded in England may have included people who tested positive months before they died.

www.bbc.co.uk

Health Secretary Matt Hancock has called for an urgent review into the compilation of coronavirus deaths data in England.

It follows confirmation that reported deaths may have included people who tested positive months before they died.

 

[AndyY]

In https://www.theguardian.com/world/l...-plan-nhs-battle-ready-for-winter-second-wave:

The Office for National Statistics has just published its latest coronavirus death figures. They say that between 1 March and 30 June, there were 50,335 deaths involving Covid-19 in England and Wales. 46,736 of those deaths had COVID-19 assigned as the underlying cause of death.

Some 26% of those who died had dementia and Alzheimers, the ONS said.

It’s worth noting that these figures are not based on the same apparent anomaly as the Public Health England figures mentioned earlier, and simply count deaths recorded as being caused by coronavirus on death certificates - which means that the example of those who ‘had a heart attack or were run over by a bus’ being counted as coronavirus cases does not apply.

If my reading comprehension is correct, the Public Health England figures includes the anomalies mentioned by furlong (e.g. includes those who recovered but subsequently run over by a bus), but not the Office for National Statistics figures.

The figure of 66 yesterday is from the Department of Health and Social Care. It is not clear where the figure of 19 comes from.
So we have numbers from at least 3 different sources. Why does it have to be so complicated?

 

[richw]

Just watching bbc. Unbelievable how covid stats are recorded. If you’ve ever tested positive it’s recorded on covid figures even if you die from something unrelated months later!
She used an example of someone in April fully recovering, got an all clear and then got killed in a car accident in late June, it went on the covid death stats.
In Scotland and Wales it’s recorded as a covid death for 28 days after the positive test. In England is a covid death if you’ve ever tested positive

 

[Nicholas Lewis]

Just watching bbc. Unbelievable how covid stats are recorded. If you’ve ever tested positive it’s recorded on covid figures even if you die from something unrelated months later!
She used an example of someone in April fully recovering, got an all clear and then got killed in a car accident in late June, it went on the covid death stats.
In Scotland and Wales it’s recorded as a covid death for 28 days after the positive test. In England is a covid death if you’ve ever tested positive

Heres the technical background to the above. Its unbelievable that we've made ourselves looks worse than other countries including devolved areas by the way we count deaths.

Why no-one can ever recover from COVID-19 in England – a statistical anomaly - The Centre for Evidence-Based Medicine

Yoon K Loke, Carl Heneghan People living in England have become increasingly concerned in the face of Public Health England’s

www.cebm.net

 

[Belperpete]

In https://www.theguardian.com/world/l...-plan-nhs-battle-ready-for-winter-second-wave:



If my reading comprehension is correct, the Public Health England figures includes the anomalies mentioned by furlong (e.g. includes those who recovered but subsequently run over by a bus), but not the Office for National Statistics figures.

The figure of 66 yesterday is from the Department of Health and Social Care. It is not clear where the figure of 19 comes from.
So we have numbers from at least 3 different sources. Why does it have to be so complicated?

Agreed, it has always been accepted that in order to get a quick daily figure, the PHE figure has always been very rough and ready. In many cases of death, an accurate cause won't be known until a post mortem has been carried out, for example, and you are allowed several days at least to record a death. So in order to give yesterday's figure, there has always been a large element of guesstimate. This is hardly news. Yes, this factor may be inflating the number, but there are other factors that mean the number is less than it should be.

Unfortunately, the press and politicians (and I suspect a large proportion of the population) want to know what is happening NOW, and aren't prepared to wait for the far more accurate ONS figures. As several posters have commented, the ONS figures do not suffer from this issue.

 

[Djgr]

It does look like the daily figures reported are, to be blunt, wrong and getting "wronger" as time goes on

 

[Domh245]

They may be 'wronger' but it's a fairly small discrepancy by the look of it (around 30/day), certainly compared to the sort of numbers seen in April

https://twitter.com/RP131/status/1283117139684139010/photo/1

PHE vs. ONS comparison based on today's ONS week 27 report and latest PHE/DHSC all-settings date-of-death data. Numbers by positive test still seem to be tracking above death cert mentions.

 

[MikeWM]

They may be 'wronger' but it's a fairly small discrepancy by the look of it (around 30/day), certainly compared to the sort of numbers seen in April

https://twitter.com/RP131/status/1283117139684139010/photo/1

Yes, this wouldn't make much of a dent in the overall figures. It would however potentially have a fairly major impact on the current figures (one calculation I saw suggested by about 150 a week, which given we're currently reporting about 500 a week, would make quite a difference).

 

[jtuk]

Sadly it seems that COVID is still very much a concern in care homes, although given the low numbers of deaths (169 in w.e. 3rd July, down from peak of 2794 w.e. 24th April) now being reported there these would seem to be largely under control. I wouldn't be surprised if in some cases they've not gone to hospital at their own request (or Dr's suggestion) and have simply 'awaited the inevitable' at the care home with strict isolation, which is more manageable now that the PPE issue seems to be sorted

There's obviously what's been posted already in terms of the ridiculous way things are attributed to covid, but here's the big clue:

Flu and coronavirus - News & insight - Cambridge Judge Business School

The COVID-19 death rate is higher in European countries with a low flu intensity since 2018, says a working paper by Chris …

insight.jbs.cam.ac.uk

The key quote - “This implies that there were over 30,000 people alive in the UK at the start of the COVID-19 pandemic who would have been expected to die in the previous two flu seasons. These people are likely to have been predominantly elderly and in poor health,” says the working paper, entitled “COVID-19 death rate is higher in European countries with a low flu intensity since 2018”.

In other words, there's so many in care homes who have died "from" Covid because, ordinarily, we'd have expected them to have died in the previous couple of years, but didn't

 

[MikeWM]

The key quote - “This implies that there were over 30,000 people alive in the UK at the start of the COVID-19 pandemic who would have been expected to die in the previous two flu seasons. These people are likely to have been predominantly elderly and in poor health,” says the working paper, entitled “COVID-19 death rate is higher in European countries with a low flu intensity since 2018”.

In other words, there's so many in care homes who have died "from" Covid because, ordinarily, we'd have expected them to have died in the previous couple of years, but didn't

Indeed so. Somewhat ironically, those countries that have looked after the elderly the 'best' [1] - keeping them alive but frail - would have 'worse' death rates from Covid, for exactly that reason. It's another reason why death rates are far from being the whole story.


[1] Though I'm not at all claiming the UK does look after the elderly particularly *well*, though we seem quite good at keeping them alive, albeit with little or no quality of life.

 

[jumble]

You could not make this nonsense up https://www.dailymail.co.uk/news/ar...review-way-PHE-counts-coronavirus-deaths.html Health Secretary Matt Hancock today ordered Public Health England to review the way it counts deaths because of a 'statistical flaw' that means officials are 'over-exaggerating' the daily toll. PHE counts people as victims if they die of any cause any time after testing positive for Covid-19 – even if they were hit by a bus months after beating the life-threatening infection, top academics revealed last night. The method is likely why the daily fatality tolls are not dropping quickly in England because survivors never truly recover from the disease as their deaths are blamed on the coronavirus – regardless of their real cause. One of the leading experts who uncovered the flaw told MailOnline his 'best guess' was that more than 1,000 people have had their deaths wrongly recorded as caused by Covid-19. Dr Yoon Loke, a pharmacologist at the University of East Anglia, warned that it is 'not a good way of collecting data', has had a significant impact in the past two months and is happening because PHE 'chose a quick and easy technique'. And the daily death tolls may not hit zero 'for months to come' because of a long tail of elderly people who beat Covid-19 but will die of other causes, Dr Loke added. He uncovered the flaw alongside Oxford University's Professor Carl Heneghan. Dr Loke said: 'By this PHE definition, no-one with Covid in England is allowed to ever recover from their illness

 

[yorkie]

[1] Though I'm not at all claiming the UK does look after the elderly particularly *well*, though we seem quite good at keeping them alive, albeit with little or no quality of life.

I have some very strong views on that subject, but it's a whole new topic in its own right, and there are no easy answers.

 

[Djgr]

Yes, this wouldn't make much of a dent in the overall figures. It would however potentially have a fairly major impact on the current figures (one calculation I saw suggested by about 150 a week, which given we're currently reporting about 500 a week, would make quite a difference).

So it appears to be adding 50% onto the current daily figures?

 

[MikeWM]

So it appears to be adding 50% onto the current daily figures?

If the calculation I saw (can't remember where) turned out to be accurate, yes. It seemed to be based on reasonable evidence but I didn't spend too much time considering it.

 

[30907]

All this shows why relying on one set of stats can be misleading - as ONS point out. However, since both sets are showing the same trends, it is somewhat academic whether covid-related deaths are 4% or 3% of the weekly total.
(My suspicious mind wonders if someone is pushing an agenda here?)

Rather more important IMO is the trend in cases detected (again, complicated by the increased numbers of asymptomatic people being tested).

PS I am interested to discover (somewhere or other) that the ONS figures are now the lower of the two - I have amended my earlier post.

 

[MikeWM]

PHE have now released this on twitter, which basically confirms the CEBM article:

https://twitter.com/PHE_uk/status/1284125486025768960

Counting only those who died within 28 days of a positive #COVID19 test would include 35,664 deaths, and exclude 4,149 deaths in people with laboratory confirmed infection.

Ok, so some of those 4,149 will probably still have died from covid, but pretty obvious to deduce that many won't have done too.

The point is not that it makes a massive change to the overall numbers, or to the figures reported back in April, but it could be having a large effect on the numbers being reported now, which are being used to formulate policy going forward [1].

[1] (though I guess there isn't a lot of evidence of that actually being the case. either way

 

[Jamesrob637]

Look at today. 114 but only 17 in hospitals. The weekday hospital total is almost equivalent to the weekend final figure now. In fact last Sunday and Monday averaged 16, equal to hospital deaths recorded today in England (the 17th being in Wales)
.

 

[Tom B]

Sadly it seems that COVID is still very much a concern in care homes, although given the low numbers of deaths (169 in w.e. 3rd July, down from peak of 2794 w.e. 24th April) now being reported there these would seem to be largely under control. I wouldn't be surprised if in some cases they've not gone to hospital at their own request (or Dr's suggestion) and have simply 'awaited the inevitable' at the care home with strict isolation, which is more manageable now that the PPE issue seems to be sorted

There was an incredibly deep interview on the Today programme with an eloquent old lady who was in a care home back in April; she said that, at 89, if she contracted the virus she would not want to be taken to hospital, she would sooner die in familiar and comfortable surroundings. She praised the efforts of the care staff in seeing that she, and the other residents, were all kept safe as best as they could.

I read a few weeks later that she had, sadly, died.

 

[45107]

It does look like the daily figures reported are, to be blunt, wrong and getting "wronger" as time goes on

In what respect ?
I accept that the daily figures presented are not an accurate record of infections/deaths from the previous day - they reflect what has been registered that day.

if there is dubiety about the figure for C-19, I maintain that a better figure is to use excess deaths over the period. This is a truer reflection of how it has been dealt with.

And for those who say ‘they would have died anyway’ - we all die eventually - so using that logic, any figure is meaningless as we all die anyway.
These are people who’s lives have been cut short either due to a virus or the lack of capability to multi task and deal with other illnesses. I do not blame the NHS, but rather those who hold the purse.

What is the level of under/over reporting (in absolute figures & percentage) ?