Almost 90% Of English and Welsh Neighbourhoods Saw Zero Covid Deaths in April

Covid accounted for just 2.4% of the deaths registered in England in April – a month in which nearly 90% of the more than 7,000 neighbourhoods in England and Wales reported zero Covid deaths. The MailOnline has the story.

Office for National Statistics (ONS) data reveal April was the first month since August 2020 where the number of deaths was below the five-year average, with fewer than 1,000 virus-linked fatalities.

The overall death rate in England – 851.2 per 100,000 people – was the lowest rate for April since the ONS started recording mortality rates in 2001. 

MailOnline analysis shows the proportion of English and Welsh neighbourhoods with zero deaths increased from 57.9% in March to 87.6% last month – some 6,301 areas.

Just ten areas saw three deaths each, which was the highest amount for any postcode.

The ONS data also revealed that Covid was just the ninth leading cause of death in England last month – its lowest ranking since September 2020. Heart disease and dementia were the leading killers.

A total of 941 deaths were due to coronavirus in April, the equivalent of 2.4% of all deaths registered in England. Another 35 were recorded in Wales…

Professor Tim Spector, the epidemiologist who leads [King’s College London’s symptom-tracking app], said [the Indian Covid variant] “hasn’t altered numbers significantly” and outbreaks remain focused in hotspots, such as Bolton. “While the outbreaks remain localised and U.K. numbers are steady and most cases appear mild, it’s highly unlikely to cause the NHS to be overrun or stop us coming out of lockdown,” he said.

Meanwhile, Public Health England bosses hailed “hugely encouraging” data that showed cases remained “stable” nationally at around 12,000 last week, and dropped in all age groups except 5 to 9 year-olds. Hospitalisations with the virus also fell across the country, while infection rates dipped in every region except the North West, which is struggling against an outbreak of the Indian strain.

Britain today also recorded just seven Covid deaths as the fatality toll continues to drop. Meanwhile, infections are flat with another 2,874 positive tests recorded. For comparison, 11 deaths and 2,657 cases were posted this time last week. 

Despite the fear being spread regarding the Indian Covid variant, the case for a full unlock grows stronger by the day.

The MailOnline report is worth reading in full.

What Second Wave? Total Deaths in UK and Sweden Now Average for 2021

New figures from the ONS released yesterday show that deaths in England and Wales are running 7.3% below the five-year average for the week ending April 30th. This is the eighth consecutive week that registered deaths have been below the five-year average.

While the UK’s winter epidemic has been over for some months now, Sweden, like much of the continent, has seen a spring wave.

ICUs have been busier in spring than they were in winter.

Cases Halve in a Month; R Rate Falls; Fewer Than 1,000 Covid Patients

More good news today – if only Boris was paying attention to data, not dates. MailOnline has the rundown.

England’s coronavirus cases have halved in a month, the R rate is still below one, and the number of people in hospital has dropped below 1,000 for the first time since September, promising data revealed today.

Just 46,000 people had coronavirus in England on any given day last week, or one in 1,180 people, according to the Office for National Statistics (ONS). The figure was around 112,000 towards the start of April – and is down 15% last Friday’s estimate.

No 10’s top scientists said the reproduction rate – which tracks the spread of the virus – was between 0.8 and 1.0, meaning the outbreak is still shrinking. This was down from 0.8 to 1.1 in the previous seven-day period.

Meanwhile, NHS figures show the number of infected patients in hospitals across England has dropped into three figures for the first time since the second wave spiralled out of control nine months ago. Daily admissions are now below 100.

The data follows on from promising statistics from Public Health England and a symptom-tracking app yesterday, which showed the easing of restrictions on April 12th has not triggered any spike in the disease.

Boris Johnson is under mounting pressure to speed up his roadmap out of lockdown, with businesses and MPs warning that they risk suffering another lost summer if there are further delays. But the Prime Minister has refused to budge from plans to re-allow holidays and indoor hospitality from May 17th, despite promising he would be led by “data not dates”.

Come on BoJo. What are you waiting for? Reward the electorate for delivering yet another hammer blow to the Labour Party and set them free.

Worth reading in full.

Covid Deaths Lower Than Typical Fatalities from Influenza and Pneumonia for Past Month

Covid deaths continue to fall in England and Wales – to such an extent that the number of daily deaths from Covid for the past month has been lower than the five-year average of deaths from influenza and pneumonia. The Telegraph has the story.

For the past month daily Covid deaths in England and Wales have been lower than the typical number of people dying from the flu, data shows. 

Since late March there have been fewer Covid deaths each day than the five-year average of deaths from influenza and pneumonia, which normally stood at 86 during the months of March and April, according to preliminary figures published by the ONS. 

As of the week ending April 16th, there have been on average 29 daily deaths where Covid was mentioned on the victim’s death certificate, as opposed to an average of 80 involving influenza and pneumonia at the same point in the years between 2015 and 2019.

While Covid deaths are now lower, the data also shows how they massively surpassed typical flu deaths during the worst days of the second wave, and continued to remain significantly higher over a month into England’s third national lockdown. 

On January 19th there were 1,372 deaths mentioning Covid on the death certificate, a tenfold increase on the average number of flu deaths at that time of year of 133.

Even a month later by February 19th Covid daily deaths stood at 407, four times higher than the five-year average of influenza and pneumonia deaths of 107 at the same time of year.

The ONS data also reveals the extent to which the spread of Covid has now been brought to heel, with the country’s top epidemiologists claiming the coronavirus has moved to manageable “endemic” levels. 

Not only that – even SAGE modellers have admitted that a “third Covid wave” probably won’t happen, as Toby reported here.

The Telegraph’s report is worth reading in full.

Lancet Paper Claims Zero Covid Is a Sensible Strategy, but It’s Not Very Convincing

Yesterday, a short paper titled “SARS-CoV-2 elimination, not mitigation, creates best outcomes for health, the economy, and civil liberties” was published in The Lancet. The authors claim, “Countries that consistently aim for elimination – i.e., maximum action to control SARS-CoV-2 and stop community transmission as quickly as possible – have generally fared better than countries that opt for mitigation – i.e., action increased in a stepwise, targeted way to reduce cases so as not to overwhelm health-care systems.”

This claim is supported by three charts, each comparing “OECD countries opting for elimination” with “OECD countries opting for mitigation” (see below). The first chart shows that “OECD countries opting for elimination” had fewer deaths per million; the second shows that they had smaller declines in GDP; and the third shows that they had less restrictive lockdowns.

The authors note, “With the proliferation of new SARS-CoV-2 variants of concern, many scientists are calling for a coordinated international strategy to eliminate SARS-CoV-2.” They also note, “Countries that opt to live with the virus will likely pose a threat to other countries” whereas those “opting for elimination are likely to return to near normal”.

One might be tempted to conclude that “elimination” (or “Zero Covid” as it’s sometimes termed) is a sensible strategy going forward. However, I don’t find the authors’ analysis very convincing.

First, they don’t explain how they classified countries as either “opting for elimination” or “opting for mitigation”. For example, did they simply look at outcomes (which would be circular), or did they examine statements by politicians from the spring of last year? (E.g., “This Government will pursue an elimination strategy.”) It’s not clear.

Only five countries were classified as “opting for elimination”: Australia, Iceland, Japan, New Zealand, and South Korea. All other OECD countries were classified as “opting for mitigation”. It may have occurred to you that the five “eliminationist” countries are not exactly representative. Four are islands and one is a peninsula (with a fairly impenetrable border to the north). Two are East Asian. And in fact, these two – Japan and South Korea – are the only East Asian countries in the OECD.

As I argued in a piece for Quillette, all the Western countries that have kept their death rates low are geographically peripheral countries that imposed strict border controls at the start (Norway and Finland, plus a few islands). Their geographic circumstances not only made border controls practical, but also gave them a head start in responding to the pandemic.

It’s very unlikely that large, highly connected countries like France, Italy or the US would have been able to contain the virus during the deadly first wave. And although Britain is an island, we probably wouldn’t have been able to either. The epidemic was already more advanced in London and other international hubs by the time most Western countries introduced lockdowns and social distancing.

In other words, “elimination” was probably never a realistic option for Britain and other large Western countries – even if it could have a passed a cost-benefit test. But what about Japan and South Korea?

Although South Korea did use a combination of early lockdowns and strict border controls to contain the virus, the same cannot be said for Japan. According to the Oxford Blavatnik School’s COVID-19 Government Response Tracker, Japan has had only two days of mandatory business closures and zero days of mandatory stay-at-home orders since the pandemic began. (And the two days of mandatory business closures were the 25th and 26th of April this year.)

Japan did introduce border controls quite early, which may have protected it during the first wave. However, these were not sufficient to prevent an epidemic from burgeoning in the winter of 2020–21. (By early February, the number of daily deaths was in the 90s.) Yet this epidemic retreated without any real lockdown measures being imposed, which suggests that some other cultural or biological factor accounts for Japan’s success.

Second, even if you believe an “elimination” strategy was feasible for Britain and other large Western countries in the early weeks of the pandemic, that ship has arguably sailed. This is particularly true for Britain, where almost 70% of adults now have COVID antibodies. In other words: while it might have been sensible to “eliminate” the virus last spring (assuming that was possible), the costs of doing so now would almost certainly outweigh the benefits.

Overall, the Lancet study does not provide a strong case for “elimination” of COVID-19. And in fact, a survey by Nature of 119 experts found that 89% believe it is “likely” or “very likely” that SARS-CoV-2 will become an endemic virus. As Michael Osterholm – an American epidemiologist – noted, “Eradicating this virus right now from the world is a lot like trying to plan the construction of a stepping-stone pathway to the Moon. It’s unrealistic.”

Number of Weekly Covid Deaths in England and Wales at Lowest Level in Six Months

The latest figures from the Office for National Statistics (ONS) show that the number of weekly Covid-related deaths has fallen to the lowest level since last October. There has been a particular fall in Covid deaths in the 70-and-over age group, a large proportion of whom have been fully vaccinated. Sky News has the story.

A total of 362 deaths registered in England and Wales in the week ending April 16th mentioned Covid on the death certificate, according to the ONS.

This is the lowest number since the week ending October 2nd, 2020.

The figure is also down by 4% on the previous week’s total, although the ONS said the number of deaths registered is likely to have been affected by the recent Easter bank holidays.

Around one in 29 (3.5%) of all deaths registered in England and Wales in the week to April 16th mentioned coronavirus on the death certificate.

The latest data also showed a massive 97% fall in Covid deaths in the 70-and-over age group, with 196 virus-related fatalities registered in the week ending April 9th compared with 7,049 in the week ending January 22nd.

Deaths for those aged 65 to 69 decreased by 96% during the same period, with drops of 95% for those aged 60 to 64, 94% for those aged 55 to 59, and 96% for those aged 50 to 54.

Overall, Covid deaths were down by at least 95% since the second-wave peak among people in all 50-and-over age groups, the ONS said.

Worth reading in full.

The ONS also found that almost as many people are now dying from flu and pneumonia as they are from Covid. The Mail has the story.

Flu and pneumonia are now killing almost as many people as coronavirus, official figures revealed today as the outbreak continues to fade away.

ONS analysis showed the illnesses were listed as the underlying cause of death for 265 victims in England and Wales in the week ending April 16th.

For comparison, Covid was blamed for 275 deaths.

Also worth reading in full.

Age-Standardised Mortality Rate Drops 26% From February to March

The ONS announced today that there were 45,567 deaths registered in England in March, which is 18% less than in February, though still 1.5% more than the five-year average. (Note that deaths decreased throughout the month, so that by the week ending March 26th, the number of deaths was in fact below the five-year average.)

However, the best overall measure of mortality isn’t the number of deaths, or even the death rate (i.e., deaths divided by total population), but rather the age-standardised mortality rate. This takes into account the ages of those who died, as well as the age-structure of the overall population.

In March, the age-standardised mortality rate was 26% lower than in February, and 5.5% lower than the five-year average. This chart from the ONS shows the age-standardised mortality rate for the first three months of the year, each year, going back to 2001:

It indicates that 2021 has seen the highest level of mortality in the first three months of the year in England since 2006. However, it’s worth noting that the figure for 2021 is only 5% higher than the figure for 2018. And in Wales, the level of mortality in the first three months of the year was actually lower than in 2018.

January saw a much lower peak than April of last year, and today’s figures confirm that the mortality rate has fallen substantially further since then.

Britain Records Lowest Daily Covid Death Toll Since the Start of September

The Department of Health recorded just four Covid deaths in the past 24 hours – the lowest number since September 7th, when three deaths were announced. The Mail has the story.

Department of Health figures showed there were also 2,963 new infections in the past 24 hours, down 17% on last week’s figure of 3,568. 

Today’s Covid deaths are the lowest they’ve been in more than seven months, after falling by almost 70% compared to last Monday’s 13. 

There is no indication that opening outdoor pubs, gyms and hairdressers last week, or reintroducing the rule of six late last month, has caused any uptick in cases. Coronavirus metrics are usually low on Mondays due to the way test results and fatalities are logged, but ministers will take confidence in the fact both cases and deaths are down significantly from last Monday. 

The statistics will inevitably pile more pressure on Boris Johnson to speed up his roadmap out of lockdown, with the next relaxation not due for almost another month.  

Mr Johnson has promised to stick to “data, not dates” when it comes to easing curbs but has so far refused to move quicker despite vanishingly low death numbers and just 2,000 Covid patients being treated by the NHS.

Cause for optimism, you’d think. But apparently not, according to the Government. The narrative continues to focus not on falling Covid cases or the success of Britain’s vaccine rollout but on the threat of Covid variants – particularly the Indian variant, which has landed the country on the Government’s “red list” for international travel. In light of this, Environment Minister George Eustice has said it is still “too early to say” whether the reopening of indoor hospitality can take place on May 17th.

Worth reading in full.

Stop Press: Daily deaths from Covid have fallen below the average numbers from road accidents, latest official figures show. The Telegraph has more.

“We Have to Compare Sweden to Its Neighbours” Isn’t a Convincing Argument

In a recent post on Lockdown Sceptics, I argued that the case for lockdown basically collapsed in May of 2020, when Sweden’s epidemic began to retreat. Sweden was the only major Western country that didn’t lockdown in 2020, yet it saw age-adjusted excess mortality up to week 51 of just 1.7% – below the European average.

A common reply is that, although Sweden did better than the European average, it did worse than its neighbours. Here its neighbours are taken to be the other Nordic countries: Denmark, Norway, Finland and Iceland. Looking at age-adjusted excess mortality, it’s true that the other Nordics did better than Sweden. All four saw negative excess mortality up to week 51.

Does this mean lockdown sceptics are wrong to cite Sweden as evidence that the benefits of lockdowns are vastly overstated? No, I don’t believe it does.

First, the economist Daniel Klein and his colleagues have identified 15 different factors that may account for the higher death toll in Sweden as compared to the other Nordics. These include the greater number of frail elderly people alive at the start of 2020 (the ‘dry tinder’ effect); the larger immigrant population; and the lack of adequate protection for care home residents in the early weeks of the pandemic. 

Second, as the researcher Philippe Lemoine has pointed out, the epidemic was already more advanced in Sweden by the time most European countries introduced lockdowns and social distancing. The other Nordic countries therefore had a head start in responding to the deadly first wave. This is particularly important because, when the first wave struck, the best ways of treating COVID-19 were not yet well understood.

I would add that, with the exception of Denmark (which saw a moderate second wave), the other Nordics are small, geographically peripheral countries for which a containment strategy was actually workable. As I’ve noted in Quillette, all the Western countries that have managed to keep their COVID-19 death rates low (Norway, Cyprus, Australia, etc.) benefited from pre-existing geographical advantages. And all imposed strict border controls at the start (something the UK Government’s scientific advisers cautioned against).

Third, as the legal scholar Paul Yowell has argued, the Baltics (Estonia, Latvia and Lithuania) are similar to the Nordics in terms of climate and population density, and once you include them in the comparison, Sweden no longer stands out. Lithuania actually had higher age-adjusted excess mortality than Sweden last year, despite imposing a strict winter lockdown.

Finally, as Yowell also points out, the ratio of Sweden’s COVID-19 death rate to Denmark’s isn’t that much higher than the ratio of Denmark’s to Finland’s. And this is despite the fact that Denmark has taken a more restrictive approach than Finland. One could therefore take the comparison between those two countries as evidence against the efficacy of lockdowns.

What’s more, this exercise could be repeated with other pairs or trios. For example, despite taking a slightly less restrictive approach than Spain and Italy, France has reported fewer deaths from COVID-19 (as well as lower excess mortality). Of course, these kinds of comparisons don’t tell us very much. But that’s the point. We shouldn’t only compare a country to its immediate neighbours.

And when researchers have analysed European countries and US states in a systematic way, they haven’t found evidence that lockdowns substantially reduce deaths from COVID-19.

BMJ: 2020 Was Less Deadly Than Every Year Before 2009

Leading medical journal the BMJ published a peer-reviewed article last week by John Appleby, Director of Research at the Nuffield Trust, that draws on ONS data to look at the 2020 England and Wales death toll in a historical context.

In terms of absolute number of deaths, 2020 was the worst year since 1838 except for the Spanish Flu year of 1918 (note that overseas deaths including war casualties are not included).

Total deaths in England and Wales, 1838-2020

However, as a proportion of population, it was only the worst year since 2003.

Deaths per 100,000 population in England and Wales, 1838-2020

Furthermore, once you take into account the fact that the population is getting older and standardise the figures by age, 2020 was less deadly than 2008 and every year prior to it.

Age standardised mortality rates per 100,000 in England and Wales, 1942-2020

Appleby for his part makes no attempt to downplay the pandemic death toll, pointing out that only in four previous years had there been a sharper increase in percentage terms on the previous year and they were all prior to 1941. It was definitely counter to the decreasing trend.

A point he doesn’t make, however, is that the historically low levels of the previous 11 years would have left an unusually large amount of ‘dry tinder’ for any novel virus to burn through. Plus, 2019 had the lowest age-standardised mortality ever, to the extent that if you took an average of 2019 and 2020 then that average was lower than 2015, 2013, 2012 and every year prior to 2011. While it’s fair to note (as Appleby does) that the coronavirus epidemic continued into 2021, with high excess deaths in January and February, it is hard to regard this as an earth-shattering death toll. It also includes lockdown deaths from lack of access to medical care and other support and the psychological impact of isolation and loss of livelihood, estimated by the ONS to be up two fifths of the overall death toll.

The graphs also make clear that previous similar pandemics, such as in 1957 and 1968, made only a modest impact on mortality and only for a year or two, notwithstanding the lack of vaccines or social interventions. There is nothing about this disease to think the long-term pattern should be any different that would justify some kind of radical, permanent change to the way we interact or organise our lives. It’s important to remember that our immune systems develop and maintain resistance to a host of pathogens through being frequently exposed to them and that social isolation, where it is not merely ineffective, can deprive us of the opportunity to keep our immunity topped up.

The BMJ article is worth reading in full.