By stewartb:

I’d like to highlight the work of two academics from Nuffield College, University of Oxford published (18 May) on coronavirus in Europe.

Source: Aron and Muellbauer (2020) Measuring excess mortality: England is the European outlier in the Covid-19 pandemic., Centre for Economic Policy Research.

They join a growing group of independent researchers and analysts identifying the importance of the ‘excess mortality’ metric when assessing the impact of the pandemic. They join a growing group pointing out that on this crucial metric England – not the UK  – is the clear OUTLIER.

The authors do warn of the unreliability of some official statistics on the impact of the pandemic:

“In a pandemic, deaths rise sharply, but causes are often inaccurately recorded. The death count attributed to Covid-19 may thus be significantly undercounted. Excess mortality data overcome two problems in reporting Covid-19-related deaths: miscounting from misdiagnosis or under-reporting of Covid-19-related deaths is avoided. Excess mortality data include ‘collateral damage’ from other health conditions, left untreated if the health system is overwhelmed by Covid-19 cases.”

They explain that ‘normal’ death rates i.e. the level above which the ‘excess’ is calculated, reflect persistent factors within a population: age composition of the population; incidence of smoking and air pollution; prevalence of obesity, poverty and inequality; the prevailing quality of health service delivery.

England – the European outlier across all ages

The paper refers to the Z-scores produced for countries and regions by EuroMOMO to provide insights into levels of excess deaths. This has already been covered in several previous articles by the TuSC but this summary table from Aron and Muellbauer’s paper is worth reproducing.

Note that on Z-scores England is the clear outlier in terms of excess deaths. Note especially that it has had the highest number of excess deaths across ALL the different age groups.

England – the outlier within the UK

The authors also refer to ‘P-scores’, as favoured by the National Centre for Health Statistics in the USA and used in reporting by the Financial Times. The P-score is the percentage of deaths that are above the normal level of deaths in a country or region.

England’s far higher excess mortality scores than the rest of the UK are shown in the chart below again from the Oxford researchers’ paper. The differences are very marked. The relative position of Scotland compared to other European countries can be seen: whilst of course any excess in mortality is bad, Scotland is by no means the ‘exceptionally bad’ that some are working hard to imply.

England’s excess mortality for the 15-64 age group

For these Oxford researchers the most disturbing finding is from the country comparisons for the 15-64 age group, which includes the mass of the working age population. Again England’s relative record in excess mortality in this age group during the Covid-19 period is strikingly higher than in other European countries.

At its peak to date, in Week 15, England’s record is 2.8 times worse than the weekly peak in next worst country, Spain, around 4 times worse than France and Belgium, and more than 5 times worse than in Italy.

The authors also note: “Within the UK, excess deaths for this age group are also strikingly worse for England than for the other nations … Puzzling too, is that Z-scores in the 65-74 age group for England, .. are similar to the 15-64 age group. By contrast, in the five other European countries examined, excess deaths in the 65-74 age group are around twice as high as for the 15-64 age group, though still below the 65+ age group.”

Moreover, the authors find that England was the only country in Europe, for which Z-scores for the 15-64 group had NOT decreased below about 2 by Week 18, ending 3 May. 

Why the difference across the UK?

The researchers argue that to interpret what are large differences in excess mortality between the four UK nations requires consideration of three main factors, and the within-nation deviations in these factors:

  • the average infection rates in preceding weeks
  • the average mortality risk from Covid-19
  • constraints on Covid-19-specific health capacity. 

The authors then provide an in-depth assessment of factors – intrinsic and policy implementation – that may cause differences in excess mortality. These, in summary, include:

  • the London factor – its connectedness; the timing of its infection outbreak; its scale and population density; the nature of its public transport system
  • social distancing and lockdown – late and initially unclear application of social distancing and delayed lock-down measures in response to initial London outbreak/s
  • public health system preparedness – collective failure in preparedness for testing capability; and on supplies and distribution logistics of PPE for health workers
  • care homes – late recognition of the need to provide care-homes with PPE and tests
  • occupational groups – differing Covid-19 death rates in different occupational groups – relatively high amongst security guards, transport workers, care workers
  • areas of deprivation – places with the greatest economic deprivation have much higher Covid-19-related death rates
    • underlying health is likely worse here and low-paid key workers, more exposed to potential infection, may live here in disproportionate numbers
  • ethnic differences – in the incidence of Covid-19-related deaths.

Ed, see: Covid-19 death rate among black and ethnic minorities in Scotland is ‘lower’ than wider population:

The authors suggest that in combination England was more adversely affected by the influence of this range of factors than the other nations of the UK.  They note that the West Midlands and the North West, the next largest conurbations in England after the London area, eventually had the next highest excess death rates, underlining for the authors the roles of timing and urban density.

They offer no assessment of the relative impact of each factor. And notably they offer no comparable causal assessment of England’s record relative to other, European locations which will undoubtedly be affected by similar factors. 

Is it the news ‘where they are’ yet?

A quick search on the BBC News website for the terms ‘excess’ and ‘excess deaths’ reveals little.

On 4 May I did find this: ’Coronavirus: Can ‘excess deaths’ figures show pandemic’s true extent?’ This reference to excess deaths was in an article aimed at Wales!

On 20 May there was this: “Coronavirus: Which regions have been worst hit?” The opening paragraph does mention ‘excess deaths’ but note the framing: “The rate of excess deaths in London continues to fall at a faster pace than in the rest of England and Wales as all parts of the country move past the peak of the coronavirus pandemic.” No international comparison; no comparison with NI and Scotland; and only a one week’s comparison between figures for England and Wales.

Finally, on 15 May there was this: “Coronavirus: Death toll in NI about 70% higher than daily figure.” Deep within this article there is a substantial account of ‘excess deaths’. There are even individual graphs for each of the four nations: as these are not based on standardised EuroMOMO Z-scores it is not straightforward to make useful comparisons. And no international comparisons were made. The article was in the BBC News website’s Northern Ireland section!

So it seems fair to say that up until now at least comparative analysis of excess mortality in England relative to other parts of the UK and Europe – something that is gaining increasing profile in many other publications – is not making much impact on the news output of the BBC ‘where they are’, in England!!