Covid-19: England and Wales among highest per capita death tolls

Deaths from all causes 37% higher than expected during first wave of pandemic

NHS workers take a patient from an ambulance at Queens Hospital in April

Only Spain suffered worse than England and Wales between mid-February and the end of May according to the study, where all-cause mortality rose 38%.
Photograph: Justin Setterfield/Getty Images

England and Wales have suffered among the highest per capita death tolls of the coronavirus pandemic, according to research into the impact of the first wave of infections on 21 industrialised countries.

Deaths from all causes were 37% higher than expected in England and Wales between mid-February and the end of May, a grim statistic that was only marginally worse in Spain, the hardest-hit country in the study, where all-cause mortality rose 38% over the same period.

In all three of the nations, the rise amounts to 100 extra deaths per 100,000 people and includes those who died directly from coronavirus but also people who lost their lives to indirect causes of the pandemic, such as cancelled medical treatment and a reluctance to go to hospital when they became ill with other conditions.

The analysis published in Nature Medicine reveals that countries that fared well went into lockdown early or had effective and robust community-based test and trace programmes in operation throughout the first wave. The UK went into lockdown late compared with other countries and halted test and trace efforts because it did not have the capacity to continue them.

Scientists at Imperial College London said there were lessons to learn from the study that could help countries protect their populations better this autumn and winter.

“As we enter the second wave, test and trace programmes, and supporting people who need to isolate, are our most important lever to minimise the impact of the pandemic on direct Covid-19 deaths and deaths from other conditions,” said Dr Jonathan Pearson-Stuttard, a co-author on the study.

Since the virus spread around the world, many scientists, along with politicians in poorer-performing countries, have argued that nations should not be judged on their Covid death tolls because of the differences in how the cases are counted.

Rather than compare countries by their coronavirus deaths alone, the Imperial-led study took a different approach. They combined multiple computer models to estimate the most likely death tolls in each of 21 countries had there been no pandemic in the spring. They then overlaid national data on all recorded deaths between mid-February and the end of May. This revealed which countries had experienced the most and the least excess deaths since the virus arrived.

While Spain, England and Wales, Italy and Scotland witnessed the most per capita deaths, ten countries saw their excess deaths rise by only 5% or less, namely Norway, Denmark, Finland, Poland, the Czech Republic, Hungary, Slovakia, Bulgaria, Australia and New Zealand. Among all the countries studied, the under-65s fared worst in England and Wales where deaths rose 26% for men and 22% for women.

uk deaths per day

Pearson-Stuttard said three broad factors underpinned a country’s resilience to the pandemic: the nation’s health, the strength of its health and social care system, and the nature of its response to the outbreak.

“It’s fair to say that what the Covid pandemic, in that first wave, has done is identify just how frail and vulnerable our society and economy are to our public’s health,” he said. “We have known this for some time, but this has really brought it to the fore.”

Across all 21 countries in the analysis, the scientists believe an extra 206,000 people died during the pandemic, either from the virus or as a consequence of its impact, an increase of 18% in the countries combined. England and Wales accounted for 28% of the extra deaths, with Italy and Spain accounting for 24% and 22% respectively. The scientists found very little difference between men and women, with 105,800 deaths in men and about 100,000 in women.

Prof Majid Ezzati, a senior author on the paper, said more investment was needed in the health service so it could cope with the demands of a pandemic without abandoning routine care for other medical conditions. “We cannot dismantle the health system through austerity and then expect it to serve people when the need is at its highest, especially in poor and marginalised communities,” he said.