73,444 deaths registered in 2020 in England and Wales had Covid-19 as the underlying cause

“There is no clear way to measure covid mortality. We measure excess death rates, those who died within 28 days of a positive test and those who have covid on their death certificate, but that does not tell us what we really need to know: who actually died of covid as the primary infection, who died with covid—died of something else but was diagnosed as being positively exposed—and who died as a result of covid, either because of the lack of access to healthcare during the lockdown or because of the diminution of healthcare capacity because of high infection rates.”

In parliament last week, Conservative MP Dr Liam Fox suggested that we didn’t have the data we needed to clearly measure mortality from Covid-19. 

He said that while we measure excess death rates, people who have Covid-19 on their death certificates, and people who die within 28 days of a positive test this doesn’t tell us what we really need to know. Namely how many people died with Covid-19 as the primary infection, how many died of something else but were diagnosed as being positively exposed, and how many died because of healthcare capacity being affected by Covid-19.

We’ve asked Dr Fox’s office what exactly he meant by this because we do know some of the information he suggests isn’t available. We’ll update this piece if he responds. 

We know how many people died with Covid-19 on their death certificate, as Dr Fox says, but we also know how many had Covid-19 listed as the underlying cause of death on their death certificate, which was 73,444 in England and Wales in 2020. 

The underlying cause is defined as the disease or injury which initiated the train of events leading to death, and is determined by a medical professional or coroner. 

We also know how many people died where Covid-19 was mentioned on the death certificate in any capacity, as Dr Fox says, whether as the underlying cause of death or as a contributing factor.

This was 80,830 in 2020 in England and Wales.

The difference leaves 7,386 people whose underlying cause of death was not Covid-19, but whose death was, in part, deemed to be caused by Covid-19. 

We also know how many people died in England and Wales in 2020 within 28 days (and within 60 days) of a positive Covid-19 test. This will include some people who tested positive but died of an unrelated condition. However, it also doesn’t capture anyone who died of Covid-19 but was not tested for it, which included many deaths at the beginning of the pandemic when testing was less common. 

The number of people who died in England and Wales in 2020 within 28 days of a positive test was 70,013 if you look at the date of death, and 67,611 if you look at the date the death was reported.

This shows that the deaths within 28 days of a positive test is actually lower, not higher than the number of deaths which doctors deemed Covid-19 to be the underlying cause.  

Dr Fox is right in noting that we don’t have data on how many people are dying due to the impact of Covid-19 on the healthcare system, and not from Covid-19 itself, though it is hard to see how that could be calculated in any objective manner. 

Back in July, the Office for National Statistics (ONS) and other public bodies estimated that, over the long term, Covid-19 would have a bigger impact on mortality and morbidity indirectly (for example through impacts on non-Covid treatment) than Covid-19 itself.

How does 2020’s death toll compare?

In parliament Dr Fox also drew attention to what he claimed was “sensationalist reporting” in the BBC that 2020 saw the most excess deaths since World War Two.

This refers to the number of deaths in 2020 that were above the average for the past five years. 

Dr Fox said further down the report it said that when the age and size of the population is taken into account, 2020 saw the worst death rate since the mid-2000s. 

Both of these things are true.

The BBC reported that deaths were 14% higher than the average over the past five years, even though the 2020 data they used at the time only went up to November. That was the biggest increase since the Second World War.

The ONS also reported something very similar: “Looking at individual years, the number of deaths [in 2020] was 77,161 higher than the number registered in 2019, the biggest year-on-year increase since 1940.”

The year’s mortality rate (adjusted for changes in both the size and structure of the population) was at its highest since 2008. 

In other words, the increase in deaths in 2020 is unprecedented in peacetime. But the actual number of deaths is not unprecedented. 

That’s because the death rate has steadily fallen over time as life expectancy has increased.