England, Wales and Scotland among nations with highest death toll in first coronavirus wave

England, Wales and Scotland were among the nations with the highest death tolls during the first coronavirus wave, research suggests.

Scientists from Imperial College London analysed 21 developed countries between mid-February and the end of May.

Across all the nations, 206,000 more people died from any cause – not just the coronavirus – than would have been expected if the pandemic had not occurred.

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More than a quarter (28%) of these deaths occurred in England and Wales. Scotland also made up one of five nations that fell into the “highest number of deaths from any disease” group.

Early in the outbreak, experts flagged excessive fatalities were occurring even among people who did not test positive for the coronavirus.

This may have been down to cancelled treatments or a fear of catching the infection putting patients off going to hospital.

Since the coronavirus outbreak was identified at the end of 2019, more than 1 million deaths have been reported globally.

The US is the worst affected, with more than 215,000 people having died with the infection. The UK fares the worst in Europe, with over 43,000 confirmed fatalities.

To provide a clearer view of how the pandemic has impacted death rates, the Imperial scientists analysed the number of people who died from any cause between February and May.

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“The pandemic has affected people’s lives and health in so many ways,” said lead author Dr Vasilis Kontis.

“For instance, some people may have had an operation or treatment delayed, or might have lost the support they need with their day to day medical needs.

“Taking these factors into account, looking at deaths from COVID-19 [the disease caused by the coronavirus] infection alone is too limited.

“Looking at deaths from all causes allows us to better understand how well countries handled the pandemic and how well they have supported their people during lockdown measures.”

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Test and trace among the ‘most important levers’

The scientists looked at the death rates in 19 European countries, as well as Australia and New Zealand. Nations were only included if their population exceeded 4 million and the relevant data was available.

Statistical models estimated the “normal” number of deaths that would have been expected to occur in the absence of the pandemic.

Results, published in the journal Nature Medicine, suggest 206,000 “extra” fatalities occurred across the 21 nations between mid-February and the end of May – an 18% increase on what is “normal”.

The scientists grouped the countries into four categories. The first was made up of those that “avoided a detectable rise in deaths” – Bulgaria, New Zealand, Slovakia, Australia, Czechia, Hungary, Poland, Norway, Denmark and Finland.

The second group experienced a low impact as a result of the pandemic – made up of Austria, Switzerland and Portugal.

France, the Netherlands and Sweden were in the third “medium” impact group.

The fourth group was made up of countries that experienced around 100 excess deaths per 100,000 people – Belgium, Italy, Scotland, Spain, and England and Wales combined.

Spain was worst affected, with deaths rising by 38%. This was closely followed by England and Wales, at 37%.

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The scientists hope their study will help guide officials’ decision making as the pandemic unfolds.

For example, the UK, Spain, Italy and France could learn from New Zealand and Denmark, where lockdown was introduced before the coronavirus had really taken hold in communities.

England and Wales, together with Sweden – the only country with voluntary social distancing – had the longest duration of excess mortalities.

“Our research suggests a number of factors may influence why some countries had higher number of deaths than others,” said co-author Dr Jonathan Pearson-Stuttard.

“Countries with comprehensive and effective community-based testing and contact tracing programmes, or those without such systems but who implemented early and effective lockdowns, had lower death tolls during the first wave.

“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.

“Such programmes also reduce the need for further prolonged lockdowns.”

Makes for ‘stark reading’

Deaths were also lower in countries that had greater investment into their healthcare systems, the scientists pointed out.

For example, Austria, which had a low number of deaths from any cause, has nearly three times the number of hospital beds relative to the population as the UK.

“Long-term investment in the national health system is what allows a country to both respond to a pandemic and to continue to provide the day to day routine care that people need,” said co-author Professor Majid Ezzati.

“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.

“The conversation must now go beyond a narrow vision of pandemic preparedness and focus on creating holistic and equitable health protection and promotion.

“A strong and equitable health system is the only way to tackle existing inequalities, and to make the nation resilient to future pandemics.”

Professor Sylvia Richardson from the University of Cambridge called the study “important and well conducted”.

“The conclusion of their analysis makes stark reading for the overall effect of the pandemic in these countries, with over 200,000 estimated excess deaths,” she said.

“Such well conducted international comparisons are useful for learning best international practise for pandemic management.”

Professor Kevin McConway from The Open University pointed out, however, the Imperial scientists only analysed data up to the end of May.

“I don’t think it can provide much clear guidance on policies that should be used in the situation in which we currently find ourselves,” he said.

“I imagine it will be relatively straightforward for the researchers to extend the timescale covered. That might throw further useful light on what works under different circumstances.”

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