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Covid 19, Plan B and other causes of dea

The Government has been under pressure from various sources to implement their ‘Plan B’ to reduce Covid cases.  This would involve things like mandated mask wearing in crowded places, vaccination passports and encouraging working from home.  Up until now the Government has resisted these calls (although at the time of writing there seem to be indications they may be about to relent).

There are all sorts of arguments: about whether the current demand on hospitals is ‘sustainable’ (hanging on to a clifftop with your fingertips is sustainable – until you drop); the risks of more cases (including the possibility of variants that are harder to control, and of more long Covid); and the cost-effectiveness of the measures (they are used and seem to be having an effect in most of Europe, but leaks suggest they could cost £18bn over six months).

One key part of the argument that I haven’t seen addressed (except, to some extent, in relation to flu) is the current level of deaths and our attitude to their acceptability.

First, the context of the overall number of deaths.  I was alerted to this by a ‘somewhat’ tendentious webpage that noted that in five years from 1999 to 2003, the annual death rate was higher than in 2020.  Actually, if I have understood it correctly, you don’t have to go back as far as that, as according to the ONS, the age-standardised mortality rate per 100,000 population in England and Wales was 1,048 in 2020 and 1,089 in 2008.  Nevertheless, the increase in 2020 seems to reverse a general long-term decline.  So, yes, more people have died in the past, but 2020 still represented a significant increase from the recent prevailing numbers.

The NHS Confederation, in their call for plan B, noted that deaths were averaging 120 a day.  That suggests an annual rate of about 43,800.  How does that compare to deaths from other causes? 

There were 1,752 reported road deaths in 2019 in Great Britain (this fell to 1,460 in 2020 because of the Covid lockdown).  So, the current Covid-19 death rate is about 25 times higher.  But we wear seat belts, try to stop drink driving and promote road safety.  So is it too much bother to wear face masks?

According to Cancer Research UK, the four most common causes of death from cancer in the UK in 2018 were: lung, 34,954; bowel, 16,659; prostate, 11,890; and breast, 11,605.  Yet we are encouraged to check for lumps, report symptoms and contribute to research to help reduce cancer deaths.

Since 2000, when widespread flu vaccination was introduced, the number of deaths due to flu and pneumonia in England and Wales has varied from a low of 25,406 in 2019 to 34,496 in 2003, so significantly lower than the current Covid death rate.  Numbers from flu alone are less (I have seen estimates of around 10,000 to 23,000 annually but can’t find a definitive source.  There are figures in the ONS’s Nomis database, but they don’t seem to match those generally given elsewhere).  Apart from annual vaccinations, we don’t generally take more precautions to prevent the spread of flu.  But perhaps we should, especially in relation to more vulnerable people.

The number dying as a result of long term exposure to air pollution is estimated at between 28,000 and 36,000 annually in the UK.  (Of course this is measuring a different thing from the other figures above, because the final cause of death could be anything from coronary heart disease to lung cancer, with air pollution nevertheless an underlying cause.)  This is an example where we could probably do a lot more to reduce the numbers, and if, for instance, this was done by increasing active travel instead of using the internal combustion engine, it would also have wider benefits to public health and for the planet.

This was all originally designed to show that the numbers dying from Covid are quite high compared to other causes of death, so it is worth taking relative modest efforts (mask wearing, working from home etc.) to reduce the numbers.  It doesn’t completely make that argument without more detailed evidence of the effectiveness (and cost effectiveness) of those measures.  But at the least, it suggests more attention should be given to such things than is currently being given.

However, it is also useful to consider some of the common causes of death and what we can do to reduce premature mortality.  A common argument has been that Covid is much like flu (though it isn’t: it is much more virulent), and we don’t take much notice of that, so we should just ignore Covid.  But the other argument might be that we ought to take notice of Covid, and when you stop to think about it, maybe we should do more about some of those other causes of death too.

As an aside, when I started this, it was to make a point that I thought was worth making, but I also thought it would be a nice quick blog to write.  I was broadly aware of the numbers dying from the various causes listed and thought I could just quickly look them up to be sure.  However, while there are lots of statistics available, I found it very difficult to find exactly what I was looking for.  I am not sure what the implications or lessons of that are, but I found it surprising.

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