Number of death certificates with only Covid-19 is a bad estimate of the death toll

An infographic posted on Instagram claims to show different ways of calculating the Covid-19 death toll in the UK up to December 2021.

The figures are broadly correct but give a misleading impression without additional context. The infographic appears to endorse the idea that only around 6,000 people had truly died of Covid-19 in the UK by the end of 2021, when the true figure is above 150,000.

The first figure given (156,924) claims to show the number of deaths recorded within 28 days of a positive Covid-19 test in the UK. The true figure, as of 31 December 2021, was actually 149,989. 

Deaths within 28 days of a positive test is not a perfect measure of Covid-19 deaths, as it counts those who died of something else after testing positive for Covid-19, and doesn’t count those who died of Covid-19 but were not tested (which was fairly common during the early stages of the pandemic).

The next figure (18,939) represents the number of people who died of Covid-19 (which means their death certificate listed Covid-19 as the underlying cause of death) who did not have a pre-existing condition. (The infographic contains a typo claiming this is the number of Covid-19 deaths of people “with co-morbidities”, when this figure actually shows the opposite.) 

Also, this figure only represents deaths in England and Wales.

This is a very poor estimate of the number of Covid-19 deaths. The Office for National Statistics (ONS) has said, in reference to a similar figure representing the same measure, that “to suggest that figure represents the real extent of deaths from the virus is both factually incorrect and highly misleading[...]

“[I]t is very common for the person dying to have a pre-existing health condition of some sort, but this does not mean that the person was at imminent risk of dying from that condition, or even considered to have a reduced life expectancy.”

In the infographic this figure is also crossed out and a final figure (6,183) given, which is claimed to represent the number of deaths where only Covid-19 was listed on the death certificate. This figure also only covers England and Wales.

This measure, in effect, excludes people who died of something directly caused by Covid-19.

For example, someone with no pre-existing conditions but whose death certificate read that Covid-19 led to interstitial pneumonitis (a type of lung disease), which led to death, would be excluded from this data. 

For that reason, it is also a very poor estimate of the true Covid-19 death toll which is what it is suggested to be by the way it is presented in the infographic.

A better measure of the Covid-19 death toll is the number of people whose deaths were registered by a medical practitioner as being caused by Covid-19. 

To the end of 2021, there were 140,793 deaths with an underlying cause of Covid-19 in England and Wales, 10,899 in Scotland and, to the end of September 2021, 3,007 in Northern Ireland. 

This excludes the handful of deaths recorded as being caused by post Covid-19 conditions.  

Finally the post claims the average age of death from Covid-19 is 82.5 years old. This is about right for the median age of death (82) and a bit higher than the mean age of death (79.4). 

Image courtesy of Alberto Guiliani