The Risk to Granny

15 December 2020. Updated 16 December 2020.

by Guy de la Bédoyère

One of the current tropes peddled by the government and its rag, tag and bobtail of scientific advisers is ‘don’t kill Granny’. This has led to some beliefs circulating which are that:

1. If Granny is exposed to COVID-19 she will catch it

2. If Granny catches COVID-19 she will automatically die as a matter of course

3. If Granny isolates herself and keeps away from her family and everyone else, she will not only escape COVID-19 but also apparently death itself since the consolation for missing Granny at Xmas is that she is guaranteed to be available for a hug in a year’s time.

I thought I’d look into this. By looking at the ONS figures for deaths by week and sex in 2019 (available here) I was able to work out that 194,945 women aged over 75 in England and Wales died that year from all causes, of whom we can assume a fair number could be classified as grannies. That’s an average of 534 women aged 75 and over dying per day, every day throughout the year. As it happens, 530,841 deaths were registered in England and Wales in 2019 or 1,454 per day (36.7% of the total). Or, in other words more than 1:3 people who died in England and Wales in 2019 were women aged 75 or over.

The population of England and Wales in 2019 was 59,439,840. The estimated number of all females in 2019 in England and Wales was 30,057,331 (available on this page).

By using the ONS’s Analysis of Population Estimates Tool I saw that in 2019 the estimated number of women aged 75 and over in England and Wales was 2,895,057. The deaths from all causes that year of women aged 75 and over means that about 1 in 14.8 died in 2019 (2,895,057 divided by 194,945) which is 6.7% of that whole cohort of women. That’s an average and it’s drawn from the whole cohort. Obviously, within that range the majority of the 194,945 deaths occurred to those women aged 85 or over. The ratio varies but 65:35 is representative.

Now let’s look at Covid deaths of women aged over 75 in England and Wales (and remember these are deaths with Covid on the death certificate) which I found here. Up till 27 November 2020 these were 24,280 which obviously does not (yet) represent a whole year since the disease arrived. The population of England and Wales in 2020 based on the steady increase in recent years can be estimated at 59,700,000. So, we can increase the theoretical number of women aged over 75 to 2,907,728 in England and Wales in 2020.

Divide that by the number of women over 75 who have died from ‘or with’ COVID-19 (assuming all the death certificates are correct, which we know they are not) and we get 1 in 119.8 (0.83% of all the women in England and Wales in that age block). In other words, ‘Granny’ is till 8.09 times as likely to die from something other than Covid for the simple reason that at the age of 75 or over the remorseless march to 100% mortality is well advanced. For those aged 85 and over the chance of dying from something else is even higher.

Now we could consider all sort of other factors. For a start, we cannot say for certain whether the risk from Covid is 100% additional to the existing risks of death for a woman of that age. But we can assume safely that it is not and that some of those deaths from ‘or with’ Covid would have occurred anyway and within the same time span. But once someone has died of anything it is impossible to say how likely they were to have died from something else.

At the beginning I pointed out that one of the assumptions that seems to be peddled is that if ‘Granny’ catches COVID-19 then death will inevitably follow. This certainly seems to be a prevailing fear. If that was true, then we would be seeing a far more terrifying number of deaths in elderly people who had been infected. It’s odd because the IFR (Infection Fatality Rate) for COVID-19 is largely absent from coverage in the news and it’s not something you hear when people talk about their fears but is in fact now well understood.

This recent Imperial College article (October 2020) explains that that an IFR for COVID-19 of about 0.1% for under-40s rises to over 5% for the over-80s (it doubles for about every 8 years of life over 40). In other words, of 100 people aged over 80 who catch COVID-19 up to about 6 will die. That’s another way of saying that 94 will survive Covid. That’s both sexes and we know women do slightly better.

Now, surviving Covid is one thing but of course you remain susceptible to any one or more of the various other conditions or misadventures that contribute to the 6.7% of those women aged 75 and over who die annually. So much of the debate has been focused on COVID-19 that is implicitly overlooked by creating the impression that there is only one risk.

Covid is not something everyone gets at once. Like other diseases the impact is spread out over time – and the lockdowns and tiers have been intended to slow that spread. The effect means then that the ongoing risk from Covid is distributed across time just like other diseases and conditions. Covid has therefore become an additional risk to an existing range of risks. Its relative impact has to be assessed in that context – which is what I have tried to show here.

But there is only so far you can go.

Shielding and isolation have helped older people to evade the disease and other infectious conditions. We also haven’t finished the year yet and the number will inevitably increase. On the other hand, the physical and psychological effects of isolation and inactivity, as well as untreated conditions, have had a negative effect and increased the chances of dying from something other than Covid. Of course, these factors and their impact cannot be unravelled for now. It will be years, decades even, before the answers will emerge.

The upshot is that Granny certainly has a measurable and significant chance of dying if she catches Covid from a relative or anyone else. I’m not for one moment trying to pretend otherwise. But it remains the case she is still much more likely to die of something else, as she always was, and it would seem by a factor of at least 8. Moreover, these other risks accumulate and rise over time as ageing continues: the older she is the more at risk Granny is from other causes of death as well as Covid. That lies at the heart of the dilemma. Do you risk seeing Granny at Xmas? Or do you keep away and risk her dying from something else before you get to see her again? And what does she feel about it?

When this is all over, if it ever is, there will be families breathing a sigh of relief in six to nine months’ time, once more able to resume normal family relations. There will be other families tormented by the discovery that death caught up with their elderly female relative – especially if she had a serious underlying health condition already – before they were able to see her again. That, sadly, is the way it is. No-one in any individual instance can know what will happen. One thing is always certain: life is a series of difficult and sometimes tragic choices, but a properly informed choice is always going to be a better one.

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