Question to the Cabinet Office:

To ask Her Majesty's Government what assessment they have made of the possible reasons for the excess deaths in the UK since 1 March in which the cause of death was not recorded as COVID-19.

The information requested falls under the remit of the UK Statistics Authority. I have therefore asked the Authority to respond.

Dear Lord Kennedy,

As National Statistician and Chief Executive of the UK Statistics Authority, I am responding to your Parliamentary Question asking what assessment has made of the possible reasons for the excess deaths in the UK since 1 March in which the cause of death was not recorded as COVID-19 (HL6132).

The Office for National Statistics (ONS) has investigated deaths not recorded as due to COVID-19 for England and Wales extensively, and published their findings on the website. The analysis presents excess deaths by age, sex, region of England, place of death and cause of death. Possible explanations for trends are put forward, and the extent to which weekly deaths registrations data support or contradict each suggestion is assessed. The main points of this analysis are outlined below:

• Between 7 March and 1 May, a total of 130,009 deaths were registered across England and Wales. This is an excess of 46,380 death registrations compared to the five-year average. 12,900 of these deaths (27.8%) did not involve COVID-19.

• The ONS’ article is based on 98.1% of the total deaths registered and 43,903 excess deaths, because a small proportion of deaths take longer to be fully coded and validated for analysis.

• Non-COVID-19 excess deaths occur predominantly in older age groups, to a greater extent with increasing age, and especially for the frail elderly with underlying conditions. Undiagnosed COVID-19 could help explain the rise in these deaths.

• In the period from week ending 13 March to week ending 1 May, over 8,000 fewer deaths were registered in hospitals, which is a 20.9% decrease in comparison to the corresponding period in the five-year average. In contrast, almost 11,000 more deaths (an increase of 60.5%) were registered in care homes, and over 8,000 more deaths (an increase of 42.6%) were registered in private homes,

• In the same period, the largest increases in non-COVID-19 deaths compared to the five-year average are seen in deaths due to ‘dementia and Alzheimer disease’ (5,404 excess deaths, an increase of 52.2%) and ‘symptoms, signs and ill-defined conditions’, which indicates old age and frailty (1,567 excess deaths, an increase of 77.8%). Together, these comprise two thirds of total non-COVID-19 excess deaths in this period.

• Deaths due to causes such as asthma and diabetes increased up to the week ending 24 April and occurred increasingly outside hospital. This could suggest that a delay in care for these conditions is leading to an increase in deaths, although it could also be related to undiagnosed COVID-19.

• Changes to death registration processes implemented in the Coronavirus Act 2020 have led to an increased number of death registrations made by doctors, increasing registration efficiency overall. At present, it is not clear whether increased efficiency is a cause or result of an increase in weekly registrations, but some further effects may become apparent in the future for conditions where deaths have a longer registration delay.

• The other theories investigated were reduced hospital capacity, and increases in deaths caused by stress-related conditions, but these cannot explain much of the increase in non-COVID-19 death registrations.

A full analysis of non-COVID-19 excess deaths will only be possible in several months' time when longer-term effects and additional data, both death registrations and other sources, can be considered. This analysis only investigates death registrations in England and Wales, as the ONS does not hold data on death registrations in the rest of the UK. Given the novel and exploratory nature of this analysis, this report published in early June presented findings about death registrations up to 1 May. This was a stand-alone release, rather than a regular series. We are currently designing a follow-up, however we have no provisional date for release as yet.

The latest information on excess deaths in general are available in our weekly deaths registration data, with latest available for week ending 19 July.

Yours sincerely,

Professor Sir Ian Diamond