England, Wales and Scotland among nations with highest death toll from the COVID-19 pandemic

England, Wales and Scotland had among the highest rate of deaths from all causes, including COVID-19, as a result of the first wave of the pandemic, according to an international study.

The research, led by Imperial College London and published in the journal Nature Medicine, analysed weekly death data from 21 industrialised countries between mid-February and end of May.

Analysing deaths from all causes, not just from COVID-19, provides a comprehensive picture of the impact of the pandemic across each nation.

Although there have been over one million confirmed global deaths from COVID-19 infection, the pandemic can also result in an increase in deaths from other health conditions, due to a disruption in healthcare services, or economic and social factors.

To assess the total number of deaths in the first wave of the pandemic, from COVID-19 and all other causes, the researchers used a range of statistical models to estimate the ‘normal’ level of deaths that would have occurred in these nations without the pandemic, between mid-February and end of May. They also took into account a host of factors including temperature and other seasonal fluctuations, and general short-term and long-term trends in these countries.

These normal levels were then compared to the actual deaths, which showed the total death toll of the first wave of the COVID-19 pandemic.

Assessing rises in mortality over the period in the 21 countries

Between mid-February and end of May, 206,000 more people died from all causes in these 21 countries than would have been expected had the pandemic not taken place. This amounts to an 18% increase in deaths over this period in these countries combined.

The study team included researchers from Imperial’s MRC Centre for Environment and Health and Abdul Latif Jameel Institute for Disease and Emergency Analytics, and from collaborating institutions throughout Europe. They included countries in the analysis if their total population in 2020 was over four million, and if the team could access weekly data on total mortality, divided by age group and sex, that went back at least to 2015 and extended through late May 2020.

The 21 countries in the analysis were Australia, Austria, Belgium, Bulgaria, Czechia, Denmark, England and Wales, Finland, France, Hungary, Italy, Netherlands, New Zealand, Norway, Poland, Portugal, Scotland, Slovakia, Spain, Sweden and Switzerland.

There was very little difference in the death rate between men and women – 105,800 deaths were in men and 100,000 in women. This suggests the total death toll of the pandemic on men and women, during this study period, was similar.

Impact varies by country

The research team were able to use their findings to group the countries in the study into four categories, depending on each country’s overall death toll during the first wave of the COVID-19 pandemic.

England and Wales and Spain experienced the largest impact: around 100 excess deaths per 100,000 people, equivalent to a 37% relative increase in deaths in England and Wales, and 38% relative increase in deaths in Spain.

Different policies to combat the epidemic

This data suggests a number of lessons, say the team, some of which may help avoid future waves of the pandemic from becoming as fatal as the first. For example, compared to countries such as New Zealand and Denmark, the UK, Spain, Italy and France introduced a lockdown after the pandemic was further along in the community.

England and Wales, together with Sweden (the only country that did not put in place a mandatory lockdown and only used voluntary social distancing measures), had the longest durations of excess mortality.

The team add that the nations with the highest excess deaths in the study period are also typically those who have had a lower investment in their health systems and health protection. For instance, Austria, which had very low numbers of deaths from all causes, has nearly three times the number of hospital beds per head of population than the UK.

Source: "Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries", Nature medicine.

Contact: Michel Guillot (Ined)

Online: October 2020