Should Scotland should have had a significantly higher Covid death rate than England?

boris johnson
Glenn Campbell in September 2020 ‘Coronavirus outcomes are not profoundly different between the UK nations.’
https://www.bbc.co.uk/news/uk-scotland-scotland-politics-54250302

By Alex Lee-MacDonald


Polling
 consistently shows the public believes the Scottish Government has handled the coronavirus pandemic significantly better than the UK Government but it has become a common refrain among media commentators that the public’s interpretation is (to quote John Curtice) “generous”. The BBC’s Glenn Campbell even went as far as to say the UK and Scottish Governments have had “similar outcomes”. Official Statistics though tell a different story and back public opinion – England has a death rate per capita of around 1990 per million, which is about 40% higher than Scotland at around 1400 per million*. This suggests a significantly better outcome in Scotland.

Is that the end of the story though? The media often ignore these widely available statistics so they can present the public as mistaken but on social media when this issue is debated, people sometimes point to Scotland’s lower population density and even the lack of a major international hub airport like Heathrow as the reason Scotland’s death rate is lower. However, no one (including supporters of the Scottish Government approach) ever seems to consider that there could be other historical factors that mean Scotland should actually have had a significantly higher death rate than England.

First though, other than the Scottish Government’s Covid-19 response, are there any other reasons that could explain why Scotland has a lower death rate than England?

It is true that Scotland has a lower average population density than England but in Scotland’s case this is not particularly relevant as most of the population is located in the Central Belt. What is more important to consider is the percent of the population living in urban areas which is largely the same in both Scotland and England (around 80%).  National Records Scotland has noted that the death rate in large urban areas in Scotland is 3.7 times higher than in remote rural areas (compared to 1.3 times for all deaths) so this is an important factor to consider**. In terms of the ‘Heathrow’ argument, this is easily disproved as there is no correlation in England between proximity to Heathrow and Covid-19 death rate. The higher death rates are in regions of England that are no more closely connected to Heathrow than Scotland’s Central Belt.

In reality, looking at the factors that are known to lead to higher Covid-19 mortality, Scotland has some significant disadvantages in the Covid-19 pandemic compared to England. Age is one of the most important factors determining Covid-19 mortality so an older population will likely see more deaths. Scotland has an older population than England with a median age of 42 in Scotland compared to 40 in England so, all things being equal in terms of Covid-19 response, you would expect Scotland to have a higher death rate. Socioeconomic status is also an important factor in Covid-19 mortality and England has a different socioeconomic profile (on average) to Scotland, largely due to the affluence of London and the South East.

Given all the factors that can affect Covid-19 mortality, the best way to assess the Scottish Government’s Covid-19 response compared to England (or other UK nations)*** is to find a comparator region within the UK that has similar characteristics to Scotland. As noted by the Nuffield Trust, a number of studies (including a recent Institute for Government report) have previously argued that, when comparing health outcomes/NHS performance across the UK, Scotland (and other devolved nations) should be compared to North East England. The Nuffield Trust argue that the “North East region looks to be a good choice of comparator as it is similar in scale, morbidity and socioeconomic characteristics” to Scotland (and the other devolved nations). The North East also has a slightly older population than England with a median age of 41 years, though still one year younger than Scotland. In addition, the North East has a similar percentage of the population living in urban areas as Scotland.

North East England is therefore probably the best comparator region**** we have to assess the Scottish Government’s Covid 19 response (so far) compared to the UK Government’s response in England. The North East currently has a death rate of around 2230 per million while Scotland has a death rate of around 1400 per million. It therefore has a Covid-19 death rate around 60% higher than Scotland’s current death rate, illustrating that basic Covid-19 death rate comparisons between Scotland and England actually flatter the UK Government.

Given the North East’s slightly younger population, we can be fairly sure that if Scotland’s Covid-19 response had been run entirely by Westminster, the death rate in Scotland would have been about 60% higher than it is currently.  This is definitely not a “similar outcome”.

*This is using the comparable deaths within 28 day of a positive test measurement. England’s death rate is 30% higher than Scotland using the Covid-19 on death certificate measure but the disparity between Scotland and England’s care home death figures suggests there was a significant issue with death certificates in England correctly identifying Covid-19 at the start of the pandemic. The authors of a University of Stirling study noted that, although Scotland had “the highest proportion of care home deaths attributed to the virus, it had a lower proportion of excess deaths in these facilities compared to England and Wales…This may reflect differences in testing practices and death registrations across the nations”. The positive test within 28 days measurement is therefore a better measure for the purposes of comparing England and Scotland’s Covid-19 response as it uses the exact same criteria across the UK.

**It should also be noted that Northern Ireland which is the only area of the UK with a lower death rate than Scotland has a significantly lower percent of the population living in urban areas (as does Republic of Ireland)

*** Given that Scotland has limited powers over key policies like borders; financial support for business and self-isolation; and sick pay, it is only fair to make comparisons between the UK nations when assessing the Covid-19 response of the Scottish Government. In fact, even this comparison is unfair to the Scottish Government as Scotland, unlike England and Wales, did not have full legal powers to lockdown until the Coronavirus Act 2020 was passed in late March 2020, when the epidemic was already out of control. At this point, most of the cases/deaths in the first wave were already baked in, given how long it takes to get a Covid-19 epidemic under control even with an effective lockdown.

****There is never going to be a perfect comparator region. It should be noted that Scotland has a higher average income than North East England and this could potentially affect North East England’s usefulness as a comparator region. However, if we look at East of England, which has a very similar average income to Scotland (both are the highest in the UK outside London and the South East) then we can see that this issue does not affect our conclusion as East of England has a very similar death rate to North East England. In fact, East of England is potentially also a good comparator region for Scotland as it has a median age of 41; a similar average income; and similar level of benefit claimants though it is slightly more rural than Scotland. East of England has a death rate 54% higher than Scotland, probably slightly lower than North East England mostly due to its more rural population (though higher average incomes will probably also play a part).

24 thoughts on “Should Scotland should have had a significantly higher Covid death rate than England?

    1. Obesity seems to be a risk factor that impacts on the severity of the disease and the need for hospitalisation and intervention but not necessarily on death rates.

      Obesity also seems to have a greater impact on those under 40 who contract the disease.

      https://globalnews.ca/news/7820307/obesity-covid-19-risk-lancet-study/

      Not sure what you mean by: “thus the far lower death rate in India”. It is highly likely that the deaths in India from Covid-19 are massively underreported in part because the whole system is buckling under the sheer weight of numbers of people dying. The younger age groups also seem to be more affected in this second wave in India and that may be because of factors such as obesity, diabetes and hypertension.

      Liked by 2 people

      1. John,
        In reply to your post at 8.53am. That was then – Jan 2021 – I was talking about the current situation in India which I thought you were too.

        Liked by 2 people

    2. Unfortunately the death rates in India are likely to match or maybe even exceed the UK rates in a few weeks given the acceleration i them recently..

      Like

  1. A fascinating and informative analysis….
    Although the article by @stewartb wonderfully demonstrated how excess deaths glaringly diverged between the 4 nations particularly in the second wave of Covid, such pooling of national information masks regional effects.
    This is a perspective the Tories have mercilessly exploited throughout the Covid pandemic, but their problem in Scotland was shutting down the information flow from SG’s Covid Updates.

    Having previously compared figures (when you could find them) between the worst in Scotland and worst in London, it was the London borough which had double the rate, yet the media bemoaned the appalling Scottish tragedy time and again, general levels, care-homes, vaccinations, a political misdirection with which the media appeared happy to comply.

    In Scotland the “too wee, too poor and too stupid” schtick of HMS Sarah Smith’s propaganda was now joined by “too sick and too dead” – and yet – Scots trusted not a word they said, and what was once given credence as broadcast from London, joined Scottish media in a daily “what’s the angle?” competition.
    Poor old Glenn Campbell, finally made it to the top of the greasy pole of his propaganda outfit and Scots are about to set fire to the grease.

    Liked by 2 people

  2. An interesting ‘take’ on the topic. Making valid comparisons and drawing significant conclusions is a complex task, but one which can be done and this is a good example. It is in marked contrast to the media method of deciding on the conclusion in advance and then selecting the data to suit fit the ‘conclusion’

    Liked by 1 person

  3. Watch this space
    England’s infection rates beginning to climb in 3 days
    A bit early yet but enough to set off alarm bells
    I am tired of saying that give this virus one sniff of a chance and with terrifying speed it shall take full advantage
    It is only a matter of time given Brazil And India that a 4 fold mutant arises that renders current vaccines utterly useless
    You heard it hear 1st
    After all Boris does not mind piling the bodies high on the streets

    Liked by 1 person

    1. You may well be correct but I hope you are wrong. This just now from the Guardian online
      “”R number in England rising slightly
      The Government Office for Science has also published its latest weekly update for the R number and the growth rate for coronavirus in England.

      R is now estimated to be between 0.8 and 1.1. A week ago it was estimated to be between 0.8 and 1, so this represents a slight increase.

      This also means the scientists are no longer confident that R for England is at or below 1.

      R is the measure that shows whether a disease is increasing or decreasing. As the government explains, “an R value between 0.8 and 1.1 means that, on average, every 10 people infected will infect between 8 and 11 other people.”

      And the growth rate is now put at between -4% and -1%. A week ago it was estimated to be between -5% and -1%. So that also represents a slight increase – or a slowing of the rate at which the virus is decreasing. A growth rate of between -4% and -1% means infections are shrinking at between 1% and 4% every day.

      As the prevalence of coronavirus falls, the R number is seen as a less useful measure. The government used to publish an R number for the UK as a whole, but it no longer does because of the differences in the situation facing the four nations of the UK.””

      Like

      1. Legerwood
        It is far too early to predict but the slight
        Movements are in the wrong direction
        Albeit warmer and sunnier now which helps reduce spread
        But Heathrow still wide open to dodgers
        Avoiding Red List Nations like Brazil/India where a very high risk of a 3 or 4 fold mutant sneaking in
        Any person from these high risk Nations only have to hop skip and jump between nations to avoid restrictions at Heathrow or Gatwick
        If by chance a asymptomatic infected carrier does so then quickly travels to various locations in UK and amongst dense crowds then the cat is out the bag
        The chances of a fold 3 or 4 variant entering are high
        But the important bit is that if so and vaccine efficacy greatly compromised
        Then it will take at least 5-6 months to develop a new vaccine
        A case of up the ladder and down the snake
        That is why any leaky control system is a very dangerous strategy
        And allows a 3rd wave to take off early Autumn

        Like

    2. The India variant is already in UK so yes it’s just a matter of time. the Tories closed the border far too late again, and, the US is still accepting flights from India, are they mad?

      There is no proof yet far as I know that the new variants can totally outwit the vaccines, but it may be just a matter of time. So important to get vaccinated. Waiting for letters for my sons, people with all l;evels of learning disabilities are meant to be vaccinated by now, I think.
      Canada is not in a good way and younger, some very young people, one 13 year old and one 17 yr old have died from Covid past few days it’s horrendous, they can’t cope with the numbers in some towns and cities.
      this is definitely not going away.

      I do hope UKEngGov officially are not saying we are over the pandemic in UK, really not a good idea.

      Liked by 2 people

      1. ArtyHetty
        You obviously have a basic understanding of this virus
        But with respect not knowing how you have
        Fortunately I do as I have 1st class Honours in genetics along with a fundamental comprehension of evolutionary processes
        So in as a simple way as possible i explain how nature and evolution has
        Led to covid 19
        1.Corona viruses are termed as Template RNA (They have no DNA of their own ) which means they can’t proof read their genetic code, which in turns leads to many mutations
        2.Once a Corona virus invades a hosts body it must enter the hosts cells then high jack some of its DNA
        This enables it to replicate with terrifying speed
        3.Once vast replication undertaken
        In order to find other hosts it must leave the original host in order to survive
        4.Covid is a respiratory virus so leaves the host via droplets mixed in with the hosts expelling air
        5.Once out 2 factors are critical in finding new hosts A) Ability to survive outside former host for considerable time in most environmental conditions
        B ) Infection dose rate of new host
        E.G. HIV requires a very high dose for success usually at least 50,000 no
        To stand a chance ( Hiv dies as soon as Tenprature drops by 0.5 C )
        Corona survives in a great range of temps.
        So Covid may only require a few hundred for a successful infection
        Or Many thousands
        6.So this where mutations make it so deadly because any one can turn it to one that requirers a very low dose transmission rate ( fold 1)
        Then that one mutates again that is more aggressive (fold 2 )
        Then that mutates again to impact all age groups ( fold 3 )
        Then that one mutates in very numerous genetic ways that then defeats the bodies immune system such as white blood cells ( T cells )
        Once that achieved it is so aggressive that any anti bodies produced by the host are quite simply swamped
        Bingo evolutionary success and a most efficient survival strategy
        Finally couple all this by the simple fact that a modern passenger Jet Aircraft can transport to any place on the Planet within 24 hrs
        Whilst in bygone days great natural barriers such as mountains,oceans,deserts etc.contained its spread
        And if you factor in modern intensive farming and food production whereby Corona can easily jump from one species to other species
        When this achieved the new host Species is extremely vulnerable as it has no pre disposed evolved protection
        And all this is exactly happening to
        Homo Sapiens currently
        Luckily with modern genetic technology we have the ability to engineer vaccines using sections of Covid 19 RNA
        But the downside is from requiring one to jabbing 95% of global population takes 2- 4 yrs but only so
        With the greatest of efforts and a completely disciplined controlled manner by ALL nations
        To conclude to let this virus rip anywhere is cataclysmic
        Why do you think China was 100 % ruthless in its control measure once they knew exactly what they were dealing with
        Those in power who think that for even 1 second that they have defeated this virus and relax is naive beyond all comprehension and we shall all pay a massive price for such

        Like

    1. Re; premieroneuk or maybe premieronescot??
      I get my minimal info from Dr.John Campnell mainly, see link below, also read about research etc at phys.org. I leave science to the experts!

      Ta for the longish lecture though. I didn’t know you were an expert on such things…maybe I just didn’t notice from your many comments before now.

      Anyhoo, Covid’s nasty, and my worry is that Scotland is still at the mercy of the EngGov on this, with no border control powers, and no say over who comes and goes. Some people think the spike in Moray could be due to MOD coming and going. I wouldn’t be surprised. The population there must be quite small though.

      I can’t quite understand how China, with such a massive population, knocked this thing on the head in their own country, even with strict measures at the start. Closing their borders? A miracle it didn’t get much worse there, or do we just not know the extent?

      Like

      1. ArtyHetty
        Re.China although i do not advocate for some of their methods
        It is by operating a command and control
        Socio-economic system, that enables fast
        Effective responses to major threats and problems

        And that is exactly how they were and still successful in 99.9% control of the virus
        Big clue once the genome of covid was established and the science told the leaders in the Communist party exactly what would happen if immediate measures were not enacted ( believe me all governments world wide were given similar advice )
        Whuan was 100 % sealed off
        All were told they would be paid
        98 million test trace and isolate personnel were recruited trained and deployed country wide in a efficient coordinated manner
        Testing was massively ramped up,results in 1 hr,when positive test result immediate isolation,where outbreaks total localised lock down no one out no one in,lock down not phased down just 100 % ended only after 14 days of no new cases
        China every year produces 99million university graduates
        So few in the West understand China
        Basically Chairman Mao knew at all costs
        Western Capitalism had to kept out of China as quite simply they would have been plundered rotten by large mainly American corporations
        Once China had achieved educating,housing,health for its citezens
        Then it adopted Capitalism but with the strictest of controls to tame but harness the beast
        Mao clearly stated from the very beginning that once social wellbeing established that this what would happen
        As such would be required to ensure no Foreign power would even consider attempt to dictate to China
        Such position has now been reached
        Western financial and military hegemony
        Is now in its death throes
        Very soon the $ will NOT be the Worlds
        Trading reserve currency
        I am not arguing for Command/Control
        But very firmly against Neo Liberal Capitalism
        But China points the way forward as does the Nordic and other small Northern Hemisphere nations also do

        Like

  4. The thing about the whole UK situation was the fact that the Scottish government could not diverge from the terrible neglect in acting quickly by the disaster capitalists in Westminster, at least not until they allowed (!) Scotland to make their own decisions, by which time the virus was rampamt anyway. The blame for huge numbers of deaths in the UK lies squarely with the Tory red Tory government in London.

    If a bit cynical anyone might think the disaster capitalists had £ signs in their greedy eyes at the beginning of the pandemic. They and their pals have certainly cashed in on the pandemic it seems and, the way the media (100% anti SNP) have revelled in deaths in Scotland is truly sickening. The jobsworths in the daily lying rags should hang their heads in shame.

    The situation in India is horrific, mainly because there is no medical care for those who might have otherwise stood a chance. There is a real evidence that Vitamin D deficiency definitely impacts the severity of the virus, and believe it or not, most people in India are deficient.

    Again a link to Dr. Campbell, always worth a watch, he is a bit less well informed perhaps about Scotland, in comparison to rUK, I have yet to try contacting him about that!
    The UK is now at ‘endemic’ stage apparently, (this was mentioned in his 29th of April talk) which is a tad irresponsible imo, because people will let down their guard hearing that. Not sure but is that now official according to the UK/Eng.Gov?
    This from the 26th of April. Dr. Campbell does have on the ground knowledge of the situation in India via Dr’s he knows there.

    Like

  5. And some say I’m not even a pretty face. 🙂

    I’m rusty but not completely uninformed, so I went looking for relevant stuff and thought “What Makes Health Public?: A Critical Evaluation of Moral, Legal, and Political Claims in Public Health”, would be a good place to start. I couldn’t find an open source, not even to a book review. Then I found a helpful open source to “Public Health Ethics and Law”, but I might save that for another day. So getting back to John’s original comment, here’s what I thought might be of interest.

    What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift
    https://journals.sagepub.com/doi/full/10.1177/2158244018772888

    Like

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