- Covid-19 deaths are reported weekly by the Office for National Statistics (ONS) and daily on GOV.UK for the UK as a whole and the constituent countries individually. The two data sources use different definitions and serve different purposes. The ONS reports that 51,935 Covid-19 deaths occurred in England and Wales to 7 August 2020, compared with 38,226 reported on GOV.UK.1
- Covid-19 deaths first occurred in England and Wales in early March 2020 and increased sharply thereafter, causing a surge in total deaths. There were about 58,000 excess total deaths between early March and 7 August 2020 compared with the 2015–19 average for the same period.
- From about mid-April total deaths started declining, reflecting falling numbers of Covid-19 deaths. From about mid-June total deaths have been below the five-year average, possibly because, in preceding weeks, Covid-19 precipitated many deaths prematurely.
- In about five months, Covid-19 deaths in England and Wales in 2020 have already exceeded the annual number of deaths from stroke or lung cancer in 2019. In addition to its direct impact on overall mortality, Covid-19 may have caused an increase in deaths from other serious conditions such as heart disease and stroke because of fewer people receiving health care for non-Covid conditions.
- Total deaths in hospital increased sharply during the first weeks of the pandemic, reaching almost double the average number of hospital deaths during the same period in the past five years by mid-April. Total deaths at home also increased steeply, to more than double the five-year average by mid-April.
- Total deaths in care homes increased even more sharply, to more than three times the five-year average for mid-April. Almost half (46 per cent) of all excess deaths in England and Wales to 7 August were in care homes.
- Between early March and 7 August, there were about 26,500 excess deaths in care homes and 23,500 excess deaths at home compared with the 2015–19 average. The data suggest that some non-Covid-related deaths that would normally have occurred in hospitals have occurred elsewhere.
- Some population groups have a higher risk of dying from Covid-19 than others. Mortality rates are affected by:
- age: mortality rates rise sharply with age
- gender: mortality rates are higher among men than women
- co-morbidities: mortality rates are significantly higher among people with pre-existing conditions such as dementia and Alzheimer’s disease, heart disease, high blood pressure and diabetes
- deprivation: between 1 March and 30 June 2020 the mortality rate from Covid-19 was 120 per cent higher in the most deprived compared with the least deprived decile of areas. Rates were highest in London and the northern regions, and lowest in the South West. Nine of the ten local authorities with the highest mortality rates were in London (Brent, Newham, and Haringey being the highest)
- ethnicity: people from some ethnic minority groups2 have a significantly higher risk of being diagnosed with Covid-19, developing serious complications and dying from it. Mortality among Black groups is almost double that of the white group; in males from Bangladeshi, Pakistani and Indian groups it is about 1.5 times higher
- occupation: mortality rates from Covid-19 are higher among people working in some public-facing occupations, such as nurses, social care workers, security guards, transport workers and sales and retail assistants
- obesity: excess weight is associated with an increased risk of a positive test for Covid-19, hospitalisation, severe disease and death.
- ONS analysis of excess all-cause mortality in European countries from week ending 3 January to week ending 29 May 2020 compared with the average for the same period in 2015–19 shows that, out of 23 countries, England had the highest excess mortality rate, followed by Spain and Scotland. The rate was lower in Wales and Northern Ireland. England also had the second highest weekly peak of excess mortality (after Spain), and the longest continuous period of excess mortality of any country compared.
- Overall, excess mortality was geographically spread throughout the UK, whereas it was more localised in most Western European countries. The pandemic had little or no impact on all-cause mortality in Norway, Finland, Denmark, Austria and Eastern European countries.
- The overall age-standardised mortality rate for England from 1 January to 31 July 2020 was the highest since 2009.3
- 1. The ONS numbers are higher because they include deaths where Covid-19 was recorded as a cause of death on the death certificate, whether or not there was a laboratory-confirmed test and irrespective of the interval from date of testing positive for those who were tested. The GOV.UK numbers include only deaths within 28 days of a positive test (see ‘How are Covid-19 deaths counted?’ section for further details).
- 2. The terms ‘ethnic minority’ or ‘ethnic minority groups’ refer to people belonging to ethnic groups that are in the minority in the context of the population of England.
- 3. Age-standardised rates adjust for changes in the size and age structure of the population.
Why does the UK count deaths?
Mortality data has many uses. It can be used to assess population health and health care needs, plan health and other public services, evaluate the effectiveness of such services, identify inequalities, inform medical research and more. Information from death certificates compiled by the ONS provides the main source of national data on deaths. Details of the deceased person, such as name, date of birth, gender, cause and place of death, are recorded on the death certificate. The aggregated ‘vital statistics’ produced from this information are used to calculate mortality rates for different causes of death. The data can also be analysed in different ways, for example, to show how mortality rates vary between different population groups and areas and how they are changing over time.
As with deaths from other causes, deaths from Covid-19 are registered and recorded in official statistics. However, these processes take time and some delay in reporting the numbers is unavoidable. Being a new, potentially dangerous and highly infectious virus, monitoring its spread and impact on a daily basis is vital for containing and managing it. This means new ways of counting Covid-19 deaths had to be developed.
How are deaths usually counted?
Registration of deaths is mandatory in most countries. Deaths in England and Wales are required by law to be registered within five days, unless there is to be a coroner’s post-mortem or an inquest. A medical certificate of cause of death (MCCD) is required for the death to be registered. The doctor who last attended the deceased has a legal responsibility to complete the MCCD, but if this isn’t possible for any reason, eg, if the doctor is self-isolating, the Coronavirus Act 2020 allows any doctor to complete the MCCD.
Among the personal details of the deceased person recorded on the death certificate by the registering doctor is the cause/causes of death. Every death will have an ‘underlying’ cause recorded, along with any other causes that may have contributed to the death (‘contributory’ causes) – taken together, these are called ‘mentions’ (deaths with a cause appearing anywhere on the death certificate).
For many conditions, eg, lung cancer and stroke, the ONS uses the underlying cause to count deaths. However, like influenza, Covid-19 can cause death directly or precipitate death from other causes, hence ONS uses ‘mentions’ to get a more complete count of Covid-19 deaths.
How are Covid-19 deaths counted?
There are two main data sources on numbers of Covid-19 deaths nationally. They use different definitions and serve different purposes:
- The Department of Health and Social Care releases daily updates (on GOV.UK) on the number of deaths in the UK and its constituent countries in all settings that occur within 28 days of testing positive for Covid-19, based on figures reported by public health agencies up to the previous day. These are deaths in people with Covid-19 and not necessarily due to Covid-19, and do not include deaths in people where Covid-19 was suspected but a laboratory test was not done or was negative. Some negative tests may be ‘false negatives’ if, for example, the virus was present in small amounts, or the specimen from the throat or nose wasn’t taken correctly, or because the tests are not always accurate.
Until 12 August, the data for England reported on GOV.UK included everyone who died after testing positive for coronavirus, however long after the test they died, whereas the data for the rest of UK included only deaths within 28 days of testing. Concerns that Covid-19 deaths in England could be over-stated without a cut-off date, as it increased the risk of including people dying from other causes, and the discrepancy with the definition used in the rest of the UK, led the Department of Health and Social Care to ask Public Health England to review its methodology for reporting daily Covid-19 deaths in England. Following the review, the definition used for reporting daily Covid-19 deaths in England was changed on 12 August to bring it into line with the rest of the UK.
The headline measure now reported on GOV.UK for the UK and its constituent countries is defined as the number of deaths that occur within 28 days of a first positive laboratory-confirmed test for Covid-19. This measure is intended to provide an indication of the impact of recent epidemic activity.
In addition, a supplementary measure will be the number of deaths that occur within 60 days of a first positive test and deaths that occur after 60 days if Covid-19 appears on the death certificate. This measure includes people who suffer a prolonged period of illness from Covid-19 before dying, and will provide a more complete measure of the burden of the disease over time.
Both the new measures reduce the cumulative number of Covid-19 deaths in England (and correspondingly in the UK) compared with the previous definition. The following figures show, for example, how these changes in the interval between the date of testing positive and death impacted on the numbers of Covid-19 deaths in England up to 7 August 2020:
- old definition with no time limit: 42,031 deaths
- new headline 28-day definition: 36,683 deaths
- new 60-day definition: 40,403 deaths.
Further details about changes in the method used for reporting daily Covid-19 deaths are available on GOV.UK.
- The ONS provides figures weekly based on deaths certified and registered in England and Wales with Covid-19 as an underlying or contributory cause of death (ie, all ‘mentions’ of Covid-19 on death certificates). The figures include all Covid-19 deaths, in all settings, whether tested for Covid-19 or suspected by the certifying doctor based on the deceased’s symptoms. ONS data has a reporting delay of 11 days from the date of death due to processes around death certification and registration.
- In addition to these two main data sources, NHS England and NHS Improvement publishes numbers of deaths in hospitals in England among patients who have tested positive for Covid-19 or where it was mentioned on the death certificate.
Strengths and limitations of data sources
The strengths and limitations of the GOV.UK and ONS data sources are as follows.
- Timeliness: timely monitoring of deaths from Covid-19 is vital for tracking the pandemic. The GOV.UK figures support such monitoring and are useful for informing the government’s response to tackling the pandemic because they are available quickly and indicate what’s happening to deaths daily. The ONS data entails a delay of 11 days, a significant limitation when numbers of deaths are changing rapidly.
- Coverage: the GOV.UK data doesn’t include deaths in people where Covid-19 was suspected but not confirmed by testing, which could underestimate the numbers. The ONS data includes deaths in people who have tested positive and those not tested but where the doctor believed Covid-19 to have caused or contributed to the death based on the deceased’s symptoms, making coverage more complete.
- Validity of cause of death: the GOV.UK data measures deaths following a positive test for Covid-19, but some of these deaths could be due to a different cause, whatever the interval from testing to death used for measuring them. The ONS data is derived from death certificates, and includes only deaths where the doctor believed Covid-19 caused or contributed to the death, making cause of death as involving Covid-19 more reliable.
- Potential for analysis: the GOV.UK numbers are simple counts without details about the people who died, so they cannot be analysed further. Because ONS data is based on death certificates that record details about the deceased, it can be analysed in different ways to examine mortality patterns, for example, by age, gender, cause of death, area, place of death. This is important because, for example, such analyses show that men, older people and those living in urban areas are at greater risk of dying from Covid-19. Ethnicity is not currently recorded on death certificates but changing this is under consideration by the government following the recommendation in Public Health England’s review of the impact of Covid-19 on Black, Asian and minority ethnic groups.
To enable comparison of the GOV.UK and ONS figures of Covid-19 deaths, and give an indication of the impact that the recent change of definition has had on the GOV.UK data for England, Figure 1 shows data on Covid-19 deaths in England up to 7 August 2020 from both data sources . The ONS reports that 49,318 Covid-19 deaths occurred in England to 7 August 2020, compared with the number to this date reported by GOV.UK of 36,683 using the new definition of deaths within 28 days of testing positive for Covid-19 – a difference of 12,635 deaths. The ONS figures are significantly higher than those reported on GOV.UK because they include all cases where Covid-19 was recorded as a cause of death irrespective of the interval between the date of testing positive and the death, and also those where there was no test but the doctor certifying the death believed Covid-19 to be a contributory factor to the death.
As the ONS data based on death certification provides the most complete coverage of Covid-19 deaths, and also provides details about those deaths, the subsequent descriptions are based on the ONS data. All the data is provisional and subject to revision.
What impact is Covid-19 having on overall mortality?
The 51,879 Covid-19 deaths registered in England and Wales from early March to 7 August have had a significant impact on overall mortality. Figure 2 shows the weekly number of Covid-19 and total deaths, and the five-year average of weekly total deaths, in England and Wales to 7 August 2020. Total deaths up to mid-March 2020 were in fact lower than or similar to the five-year average for 2015–19, in part due to a mild influenza season in the 2019–20 winter. But the sudden rise in Covid-19 deaths from mid-March caused a sharp spike in overall deaths, resulting in about 58,000 excess registered deaths to 7 August 2020 compared with the 2015–19 average for the same period.
From week ending 24 April total deaths started declining, reflecting falling numbers of Covid-19 deaths. And from about mid-June total deaths have been below the five-year average, possibly because in preceding weeks Covid-19 precipitated many deaths prematurely, for example, among older people and those with pre-existing conditions.
In addition to its direct impact on overall mortality, there are concerns that the Covid-19 pandemic may have caused an increase in deaths from other serious conditions such as heart disease. This is because the number of excess deaths when compared with previous years is greater than the number of deaths attributed to Covid-19. The concerns stem, in part, from the fall in numbers of people seeking and receiving health care from GPs, accident and emergency and other health care services for other conditions. Some of the unexplained excess is also likely to reflect under-recording of Covid-19 in official statistics: for example, non-Covid-19 excess deaths occurred predominantly among frail older people with underlying conditions, suggesting Covid-19 may not be identified in the presence of other co-morbidities. It is too early to say what the full impact of Covid-19 deaths on overall mortality, and the wider impact of the pandemic on deaths from other conditions, will be.
How do numbers of Covid-19 deaths compare with deaths from other causes?
The 51,879 Covid-19 deaths registered in England and Wales between early March 2020 to 7 August 2020 comprise almost 10 per cent of all deaths in England and Wales in 2019. Covid-19 deaths already significantly exceed the annual 2019 count of deaths from cerebrovascular disease (stroke) and malignant neoplasm of trachea, bronchus and lung (lung cancer), and are approaching the number of deaths from heart disease (see Table 1).
|Cause of death||Number of deaths||% of total deaths|
|Dementia and Alzheimer disease||66,424||12.5|
|Ischaemic heart diseases||55,064||10.4|
|Chronic lower respiratory diseases||31,221||5.9|
|Malignant neoplasm of trachea, bronchus and lung||29,463||5.6|
Where are Covid-19 deaths taking place?
ONS analyses show that in the five-year period 2015–19, 47 per cent of all deaths occurred in hospital, 24 per cent occurred at home, 22 per cent in care homes and 7 per cent elsewhere. This pattern changed when deaths related to Covid-19 and all deaths started to rise sharply in March 2020 (see Figure 3).
Total deaths in hospital increased sharply from late March 2020 to mid-April, reaching almost double the average number of hospital deaths during the same period in the past five years, but have fallen substantially since then (see Figure 3). From early March to 7 August about 33,000 Covid-19 deaths occurred in hospital. A high proportion of hospital deaths were certified as Covid-19; testing for Covid-19 in the earlier stages of the pandemic was focused on hospitals. Since late May deaths in hospital have fallen significantly below the five-year weekly average. Overall, from early March to 7 August about 22,000 fewer deaths that were not Covid-19 occurred in hospital compared with the 2015–19 average. Along with excess non-Covid deaths in care homes and at home compared with previous years, this suggests that some deaths that would normally have occurred in hospital have occurred elsewhere.
Total deaths in care homes increased even more sharply (see Figure 3) to more than three times the five-year average for mid-April, and by end April they equalled the number of deaths in hospital. Deaths in care homes started to decline from week ending 24 April 2020, and since mid-June have been below the five-year average. This could reflect the impact of Covid-19 in precipitating some deaths among frail older people prematurely during previous weeks. About 26,500 excess deaths occurred in care homes from early March to 7 August compared with the 2015–19 average, of which about 15,500 were Covid-19 deaths. The relatively low proportion (58 per cent) of excess care home deaths attributed to Covid-19 may reflect the later roll-out of testing in care homes compared with hospitals and some under-recording of Covid-19 as a cause of death among older people with multiple co-morbidities. Almost half (46 per cent) of all excess deaths in England and Wales to 7 August were in care homes.
Data from several European countries suggests that up to half of those who have died from Covid-19 were residents of care homes. Although international comparisons are not straightforward because of differences in data, definitions and how care is structured, the lower figure for England and Wales of 30 per cent up to 7 August 2020 may reflect some under-recording of Covid-19 deaths in care homes for the reasons cited above.
Total deaths at home also increased sharply since the start of the pandemic (see Figure 3), to more than double the five-year average by mid-April. They started falling in late April but remain well above the five-year average as of 7 August, even though overall deaths in England and Wales have been below the five-year average since-mid June. It is possible that some of these home deaths would, under normal circumstances, have occurred in hospital but were ‘displaced’ because of the large numbers of Covid-19 patients in hospital during April/May; since late May hospital deaths have been below the five-year average, also suggesting some displacement. About 23,500 excess deaths occurred at home from early March to 7 August compared with the 2015–19 average, of which about 2,500 were Covid-19 deaths. Unlike deaths in other settings, a relatively small proportion (10 per cent) of the excess deaths at home were coded as Covid-19. Furthermore, 26 per cent of Covid-19 deaths at home were in people aged under 65 years whereas most Covid-19 deaths in hospitals (86 per cent) and care homes (99 per cent) were among older people (65 years and over).
What is the impact of Covid-19 on different population groups?
Data from the UK and globally shows that some groups have a higher risk of dying from Covid-19.
Age: while some young and middle-aged adults can develop serious complications or die from Covid-19, the risks rise sharply with age because immune systems tend to deteriorate with age and because older people are more likely to have chronic conditions. For example, the mortality rate from Covid-19 in England and Wales at age 80–84 is about eight times greater than at age 60–64.
Gender: the mortality rate from Covid-19 among males is more than fifty per cent higher than that of females. Various reasons have been suggested for this gender difference, but none has been scientifically established yet.
Pre-existing disease: about 91 per cent of deaths involving Covid-19 occur in people with pre-existing conditions such as dementia and Alzheimer’s disease, and heart disease, high blood pressure, respiratory disease, diabetes or kidney disease which may weaken immune systems and reduce the ability to fight infection.
In the UK, mortality from Covid-19 is higher also for people in some other groups.
Deprivation: Socio-economic inequalities in health and mortality in England and Wales have been reported for decades and are widening. The direct and indirect impacts of the Covid-19 pandemic can exacerbate this inequality, eg, because of differences in occupational exposure to infection and higher levels of pre-existing disease, obesity and household density among more deprived groups. The impact of Covid-19 has been greatest in more deprived areas. ONS data for 1 March to 30 June 2020 for England shows that the Covid-19 death rate in the most deprived decile of areas (139.6 deaths per 100,000 population) was 120 per cent higher than the rate in the least deprived decile (63.4). This exceeded the 92 per cent differential between the overall mortality rates for the most (570.0 per 100,000 population) and least (296.2) deprived areas. Rates were highest in London and the northern regions, and lowest in the South West. Nine of the ten local authorities with the highest mortality rates were in London (Brent, Newham, and Haringey being the highest).
Ethnicity: People from some Black, Asian and minority ethnic groups have a significantly higher risk of being diagnosed with Covid-19, developing serious complications and dying from it. ONS analyses show that, after adjusting for geographical, socio-demographic and household characteristics, mortality from Covid-19 among people of Black ethnicity is almost double that of the white group; in males from Bangladeshi, Pakistani and Indian groups it is about 1.5 times higher. Higher mortality is reported also for NHS and social care staff from Black, Asian and minority ethnic groups. Reviews by Public Health England identified ethnic differences in Covid-19 mortality and some of the factors contributing to them. People from Black, Asian and minority ethnic communities are at increased risk of acquiring Covid-19 because they are more likely to live in urban areas and overcrowded households, experience socio-economic deprivation, and work in occupations (such as health and social care, transport) that expose them to higher risk. Once infected, they are at greater risk of severe disease and death, in part because of a higher prevalence of some co-morbidities, such as diabetes and hypertension, and obesity. It was also noted that racism and discrimination can have an adverse impact on the health of people from Black, Asian and minority ethnic groups. However, the reasons for the ethnic differences in Covid-19 outcomes are not yet fully understood.
Occupation: Mortality rates from Covid-19 are higher among people working in some public-facing occupations, such as nurses, social care workers including home carers, security guards, transport workers, sales and retail assistants. The factors associated with these occupational risks include exposure to infection, where people live (mortality is higher among people living in deprived, urban areas), and the proportion of workers from ethnic minority groups.
Obesity: Excess weight is associated with an increased risk of a positive test for Covid-19, hospitalisation, severe disease and death. The risks increase progressively with increasing body mass index (BMI) above the healthy weight range.
How do the numbers of Covid-19 deaths in UK compare with other countries?
International comparisons of Covid-19 deaths are unreliable because, for example, there are differences in the way deaths are counted (eg, hospital-only or all settings) and how many people are tested. However, all-cause mortality avoids many of these problems and takes into account the indirect impact of the pandemic, such as deaths from other causes that could be related to delayed access to health care.
If viewing this chart on mobile, rotate your phone to landscape mode to see the chart in full.
ONS analysed excess all-cause mortality in European countries, including the UK countries, from week ending 3 January to 29 May 2020 relative to the average for the same period in 2015–19 (see Figure 4). The percentages in the graph measure excess mortality during this period in 2020 compared with 2015–19: a plus value shows higher mortality and a minus value shows lower mortality.
The ONS results show that over the period as a whole, England had the highest excess mortality rate of 23 countries, followed by Spain and Scotland. The rate was lower in Wales and Northern Ireland. Excess mortality was geographically widespread throughout the UK during the pandemic, whereas it was more geographically localised in most Western European countries. The pandemic had little or no impact on all-cause mortality in Norway, Finland, Denmark, Austria and Eastern European countries.
Weekly data shows that the pandemic affected different countries at different points in time, some countries having a very high peak excess mortality but a relatively short period before returning to average levels (like Spain, Belgium and Italy). In contrast, England had the second highest weekly peak of excess mortality (after Spain), and the longest continuous period of excess mortality of any country compared. In most countries excess mortality had returned to near normal levels by early June.
Covid-19 and the wider impacts of the pandemic to date have had a significant impact on overall numbers of deaths, where they occur and some population groups. The virus precipitated many deaths prematurely among vulnerable groups, and cut short many other lives (eg, 11 per cent of Covid-19 deaths were among people aged under 65 years). This is unprecedented in recent decades and has contributed to a period when deaths have now fallen below the five-year average.
The overall age-standardised mortality rate for England from 1 January to 31 July 2020 was the highest since 2009. Mortality trends henceforth depend on the future trajectory of the pandemic, the severity of the 2020/21 flu season, and deaths among people who are not receiving health care for non-Covid conditions because of the wider effects of the pandemic. The likely impact of the pandemic on life expectancy in 2020 will become clearer in due course.
Excess deaths in the UK thus far from the pandemic are the highest in Europe. While future trends are unpredictable, it will require a sea change to alter the UK’s unfavourable ranking significantly. And as the UK already trails many European countries in terms of life expectancy, it could slide further down life expectancy league tables.
A very clear, comprehensive and helpful overview. Thank you!
Excellent summary, very helpful and informative. Thank you
I would like to know how many people under 65 yo who were otherwise healthy with no underlying health issues have died in the UK from covid19?
All data up to 5pm 26 May 2020 - Nhs England -Pre existing condition
0 - 19 yrs 3
20 - 39 32
40 - 59 244
60 - 79 538
Not many is it
Why if the statistics [now weeks old] show that 98% of deaths are from people over 65 or have underlying health problems - do the authorities not protect the vulnerable and allow the rest of the population to carry on as usual with some sensible behaviour changes, ie washing hands regular , hygiene precautions, wearing gloves/masks, social distancing where possible - instead of a one size fits all
How many deaths are there that are purely Covid-19 related? i.e no underlying health issues etc?
A a retired person approaching 70 years of age I fully accept I'm in the age group mostly likely to be effected by covid-19.
And because I'm in that age bracket, I therefore fully understand the need to strictly follow the government guidance on social distancing etc.
So in the first instance, I'm not to sure why closing down the entire population was necessary.
I accept hindsight is a lovely tool which we mia mortals do not posses.
So maybe in future a more targeted information campaign aimed specifically at the older generation may be a more beneficial and practical way forward.
Thank you for the opportunity to express my views.
Previous comments are correct we should not have isolated everyone for so long. Over 90% of deaths had 'known' underlying issues Chart 3 deaths at home non covid related in excess of 5 year average is worrying in that far more people are dying of non covid deseases. It is time to get the economy and NHS back on track
These figures could be very helpful in advising the re-opening of nurseries, schools and universities.
Why has covid 19 been put in mentions onbthe death certificate of numerous people who died at home with no symptoms and no tests carried i have witnessed this 3 times now this was not reported by the attending doctor nor by the family member when report to the registrar.
Why are not do antibody testing the people who came down with symptoms in feb/march 2020 before any guidance was given? Peopke like my self bed ridden for 7day temp 37.5 sore throat loss if taste and smell, very tight chest confused fir several day. Fatigued. But there was no method of reporting at the time call gp told to take paracetamol. How many people have been exposed and not recorded