From New Scientist today:
The UK has seen an unexplained surge in deaths in recent months, causing concern among the country?s chief medical officers.
Many suggestions have been put forward for why there have been about 22,500 more deaths between April and August than would normally be expected, but there is little agreement so far on the cause or causes. A spokesperson for the UK government's Department of Health and Social Care, for example, says: "Analysis is ongoing, however early investigation suggests circulatory diseases and diabetes may be partly responsible for the majority of excess deaths."
But Adrian Boyle, president-elect at the UK?s Royal College of Emergency Medicine doesn't agree that conditions like this, potentially worsened by coronavirus lockdowns delaying routine appointments, are likely to be the cause. "It takes time to die from cancer, it takes time to die from heart failure," he says. "These are all things that may have got worse during lockdown, but I'm not sure that is going to be driving the sudden and precipitous increase that we?ve seen in deaths this year.""
"The data suggest that it is very likely that something substantial is happening," says Michael Murphy at the London School of Economics.
So, researchers are scrambling to figure out what is going on, with National Health Service (NHS) problems, an ageing population, heatwaves and a resurgence of covid-19 all also being mooted as possible causes for the sudden hike in deaths. The fear is that this trend could worsen in the winter when healthcare systems are typically under most pressure.
The increase in deaths has been seen across the UK. Between 2 April and 12 August in England and Wales, for example, 202,491 deaths were registered, according to the Office for National Statistics (ONS). This is 19,756 higher than the five-year average for this period ? about an 11 per cent increase (see graph, below). The sudden drop in recorded deaths at the start of June is probably due to the extra Jubilee bank holiday in the UK and reflects the closure of registration offices, according to the ONS.
Meanwhile, in Scotland, between 4 April and 21 August, 23,009 deaths were registered, according to the National Records of Scotland, which is about 10 per cent higher than the five-year average of 20,854 deaths. In Northern Ireland, between 2 April and 12 August, 5980 deaths were recorded, according to the Northern Ireland Statistics and Research Agency, when the five-year average is 5378, about an 11 per cent increase.
That adds up to more than 22,500 more deaths than expected across the UK. What could be behind these worrying figures? Several researchers told New Scientist that it is too early to say for sure, but they point to a range of possibilities.
Perhaps the most obvious one is the coronavirus. The current five-year average mortality statistics from the various UK statistics agencies are calculated in the same way: averaging each week?s death rates from 2016, 2017, 2018, 2019 and 2021, but excluding 2020 figures because of the uniquely high levels of death caused by covid-19 that year. Could the coronavirus again be throwing things out of whack and pushing up the death rates?
The virus has contributed to the excess deaths; according to the data: there were twice as many deaths involving covid-19 this summer than there were in summer 2021 in the UK. But these deaths between the relevant dates in April and August numbered just under 13,000. This accounts for over half of the increase, but it still leaves more than 9500 unexplained deaths.
Covid-19 might also play a role in more deaths, though. This summer has seen rising infection levels. In early June, about 990,000 people in the UK were infected with the virus ? driven mainly by the BA.4 and BA.5 subvariants of omicron, and more than 1.7 million people were estimated to be infected with the virus in early August.
The number of covid-19 cases probably indirectly boosted the number of deaths from other things too, says Murphy. Studies suggest that getting infected with covid-19 increases the mortality risk for other conditions. "It's highly likely that Covid would be implicated to some extent," says Murphy.
High covid-19 caseloads also disrupt healthcare systems, although it is unclear whether any resultant rise of deaths would be observed yet, particularly for medical conditions that progress over many years, such as cancer, diabetes and heart problems.
"Cancer screening effectively stopped for a few months, the number of people being referred for tests dropped, and many tests and treatments were delayed," says Michelle Ferguson at Cancer Research UK. "So, there will absolutely be knock-on effects, we just don?t know the scale yet."
A study published in June estimated that 460 extra people would die from bowel cancer in Australia between 2020 and 2044 due to healthcare system disruption caused by the pandemic and 437 would die earlier than expected.
"There is a reason for having treatment time targets for cancers; the delays matter," says Simon Wood at the University of Edinburgh, UK.
The pandemic has also led to a backlog in routine diabetes care and many people with the condition still haven't had vital health checks for two years, says a Diabetes UK spokesperson. More than 700 people with diabetes die prematurely in the UK each week, according to the charity.
"It is important the government investigates this issue, particularly the question of whether delays in treatment are contributing to excess deaths," says Azeem Majeed at Imperial College London.
Other issues in the health services could also be causing problems. Some of the unexpected deaths could be the effects of longer-term NHS management issues starting to become apparent, says Michael Marmot at University College London.
Since 2010, the health services have lost almost 25,000 hospital beds across the UK, according to the Royal College of Emergency Medicine. The UK also has fewer beds per 1000 inhabitants than 21 EU nations, according to the college.
The health services also face a staffing crisis. Research by UK health think tank Nuffield Trust suggests that NHS England, for example, is short of 12,000 hospital doctors and more than 50,000 nurses and midwives. The 2021 NHS staff survey in England found that just 27 per cent of staff say there are enough people in the organisation for work to be carried out effectively.
This has led to rises in waiting times for emergency care and ambulance responses. "Ambulances have been held up in hospitals because they can't transfer patients into emergency departments that have reached full capacity, says Boyle. "We know that the time it takes for an ambulance to reach someone in cardiac arrest affects their chance of survival," he says.
"This is a chronic problem that's been allowed to keep building up," says Marmot. "We then had the pandemic and now we have the cost-of-living crisis, which is only going to drive health inequalities."
"It's reached a tipping point," says Boyle.
NHS problems aren't the end of the list of possible causes for the rise in deaths. One less unexpected contributor could be ageing. The median age of the UK population in 2001 was 37.9, but by 2020 it had risen to 40.4 years. The country?s population is also steadily growing. In 2015, the population was about 65 million, whereas in 2019 ? before the pandemic ? it was estimated to be 66.8 million.
Even without the pandemic, the ONS had predicted that more deaths would have been registered in 2022 than in previous years.
In England, most deaths between 2 April and 5 August have been in people aged over 85. More than 70,000 people above the age of 85 died in this period as did some 19,200 people who were between the ages of 50 and 64. Both age groups have seen an 11 per cent rise in deaths compared with a five-year average, which is more than 63,000 in the over 85s and more than 17,000 among 50 to 64-year-olds. More than 81,000 people aged between 65 and 84 died in this period, about 8.5 per cent higher than the average.
"More deaths in these age groups were to be expected, but this doesn?t explain all the extra fatalities," says Majeed. "Correcting for this idea does reduce but not eliminate the increase in deaths," he says.
One factor that would have particularly affected older age groups was the unprecedented heatwave that hit the UK over the summer. Studies show that heatwaves are linked to higher rates of deaths from cardiovascular and respiratory diseases.
This summer saw both the hottest temperature ever recorded in the UK, 40.3?C (104.5?F), and the highest daily minimum temperature ever observed in the country at 26.8?C (80.2?F).
Determining how many deaths are caused by hot weather is difficult, because many will be due to underlying health conditions exacerbated by temperature stress.
One estimate comes from Antonio Gasparrini at the London School of Hygiene & Tropical Medicine. He has calculated that 948 extra people died between 17 and 19 July in England and Wales, when temperatures were highest during the heatwave. But large as this number is, it would cover only about 12 per cent of the non-covid deaths.
The ONS is scheduled to release a report into the deaths in early September, yet determining what is driving the jump in UK deaths will be no easy matter.
We may never know for sure what is causing the increase in deaths, but that doesn''t mean efforts to halt it have to wait "The solution to most of these problems is to stop underinvesting in the NHS and reform social care, " says Boyle.
