The number of excess deaths registered in the UK during the Covid-19 outbreak has risen to just under 55,000, according to official figures, as a leading scientist suggested the country could experience days without deaths attributable to the virus by the end of June.
The Office for National Statistics (ONS) figure for excess deaths, revealed on Tuesday, records the number above the five-year average, including – but not limited to – those caused by coronavirus since the outbreak began in March.
Epidemics of infectious diseases behave in different ways but the 1918 influenza pandemic that killed more than 50 million people is regarded as a key example of a pandemic that occurred in multiple waves, with the latter more severe than the first. It has been replicated – albeit more mildly – in subsequent flu pandemics.
How and why multiple-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modelling studies and pandemic preparation, which have looked at everything from social behaviour and health policy to vaccination and the buildup of community immunity, also known as herd immunity.
Is there evidence of coronavirus coming back in a second wave?
This is being watched very carefully. Without a vaccine, and with no widespread immunity to the new disease, one alarm is being sounded by the experience of Singapore, which has seen a sudden resurgence in infections despite being lauded for its early handling of the outbreak.
Although Singapore instituted a strong contact tracing system for its general population, the disease re-emerged in cramped dormitory accommodation used by thousands of foreign workers with inadequate hygiene facilities and shared canteens.
Singapore’s experience, although very specific, has demonstrated the ability of the disease to come back strongly in places where people are in close proximity and its ability to exploit any weakness in public health regimes set up to counter it.
What are experts worried about?
Conventional wisdom among scientists suggests second waves of resistant infections occur after the capacity for treatment and isolation becomes exhausted. In this case the concern is that the social and political consensus supporting lockdowns is being overtaken by public frustration and the urgent need to reopen economies.
The threat declines when susceptibility of the population to the disease falls below a certain threshold or when widespread vaccination becomes available.
In general terms the ratio of susceptible and immune individuals in a population at the end of one wave determines the potential magnitude of a subsequent wave. The worry right now is that with a vaccine still months away, and the real rate of infection only being guessed at, populations worldwide remain highly vulnerable to both resurgence and subsequent waves.
It represents another grim milestone in the human toll of the virus but experts said the ONS data provided some cause for optimism.
It was the third week in a row that the ONS recorded a reduction in the number of deaths in England and Wales and the second consecutive week all regions in England and Wales showed a decline in Covid-19 mortality.
Although experts voiced caution, given the week ending 8 May included a bank holiday, on which only 88 deaths were registered, it continued a downwards trend.
Prof Carl Heneghan, the director of the Centre for Evidence-Based Medicine, University of Oxford, said: “I think by the end of June, we’ll be looking at the data, and finding it difficult to find people with this illness if the current trends can continue … but we will continue to have these sporadic up and down [days] for about four to six weeks.
“And I think this is the same as the infection outbreak, people shouldn’t panic or get out of context if suddenly, say, we’ve had no death for four days and now we’ve had eight. We’ll see that as we go down [to] lower numbers, a bit more variation in the actual data.”
There were 49,353 excess deaths in England and Wales between the week ending 13 March and that ending 8 May, of which 37,925 were Covid-related, according to the ONS figures. That stands above the government figure, calculated differently, for the whole of the UK, which was 34,796 on Monday.
Nick Stripe, the head of the health analysis and life events division at the ONS, said the UK total was just under 55,000.
Sarah Scobie, the deputy director of research at the Nuffield Trust health thinktank, said: “We are now seeing the number of deaths across all settings fall week to week. While this reflects efforts to slow the spread of the virus, it is a sad fact that the number of registered deaths is a third higher than we would typically expect to see at this time of year. We still have some way to go.”
In the week ending 8 May, the number of deaths in hospitals was 114 lower than the five-year average for the same week, but the number of deaths in care homes was above the five-year average in care homes by 2,247 – albeit down from 4,331 the previous week.
The ONS stats show the number of deaths in hospitals and care homes are converging as the latter falls more slowly than the former. Critics have said the government was too slow to protect care homes and that infected patients were discharged from hospitals into care homes.
Heneghan said deaths were likely to come down in June because of Covid-19 bringing forward some deaths but that getting a grip on the situation in care homes was key.
“There probably is about 38% of care homes have active outbreaks,” he said. “I think the key is that the other 62%, if you like, what happens to them now? And I’d be trying to ensure everything to make sure they do not have outbreaks in them. And so I think if that happened we can expect them to come down.”
Stripe said the ONS would publish more research in the next couple of weeks examining the excess deaths not attributable to Covid-19. He told the BBC that two of the possible reasons were fewer non-Covid-19 patients going to hospital because of hospitals being overwhelmed and/or fears about contracting the virus plus “cases where Covid is present but it is not obvious to the certifying doctor that that is the case”.
He added: “It may be the case that this big jump in the number of dementia and Alzheimer deaths could explain part of that reason there. It could well be that in the very old, if the patient is not able to describe their symptoms very well, there may be many other co-morbidities, that perhaps the doctor has not felt able, in the absence of a positive test, to put Covid on the death certificate.”