By Tess Lawrie
IN December 2020 I drafted an editorial for the British Medical Journal that never saw the light of day. The article has been in a folder on my desktop until today when, after having recently been reminded about the Scottish Covid Inquiry, I thought to dig it out and share it with you.
To give you an idea what the paper is about, here are the British Medical Journal’s standard questions on submission and my answers to the questions in December 2020:
Q. Title or Topic
A: ‘Hospital deaths in Scotland have gone down, not up, during the Covid 19 pandemic’.
Q: Why is this topic important now?
A: Excess death during the Covid 19 pandemic is very topical and what most people want to know, as this is an important factor determining Government policy. However, the reporting of these data by the UK Government has been very limited.
Q. Why is this (topic) relevant to a general medical audience? *
A: Health professionals and the public are under the impression that hospital deaths in the UK have increased during the pandemic.
Q:. Please list 1-3 take-home messages for readers (one sentence on each take home message)
A: 1. Hospital deaths in Scotland were down overall during the Covid 19 period between week 12 and week 51 of 2020 and virtually all excess deaths occurred at home or in care homes.
2. More than 1000 deaths from respiratory disease may have been mistakenly attributed to Covid 19.
3. A substantial number of excess deaths may have occurred due to the secondary effects of the Covid 19 pandemic.
Q: What does your proposed article add to previous BMJ coverage of this topic? *
A: To my knowledge, this topic has not been covered by the BMJ before. However, it adds to the recent editorial by Kamran Abbasi about the procurement of suboptimal PCR tests, which I posit may be the reason for the misclassification of a large number of non-Covid 19 deaths in Scotland as Covid 19 deaths.
Publishing for the first time, here is the brief report I prepared in December 2020 for the BMJ to illuminate the Scottish excess deaths situation:
(Dec 2020) Hospital deaths in Scotland have gone down, not up, during the COVID-19 pandemic
The National Records of Scotland (NRS) website has reported that “as at 20 December 2020, 6,298 deaths have been registered in Scotland where the novel coronavirus (Covid 19) was mentioned on the death certificate”.1
Also published on the website on the 23rd December 2020, Pete Whitehouse, Director of Statistical Services at the NRS, is quoted saying, with reference to week 51: “The majority of [Covid 19] deaths occurred in hospitals, representing 124 deaths. 71 [Covid 19] deaths occurred in care homes, and 8 [Covid 19] occurred at home or in a non-institutional setting.”1
As the denominators of these reported statistics were unclear, I decided to examine the NRS excess deaths data to gain a better understanding of the Covid 19 situation in Scotland.
The NRS stratifies its data on excess deaths according to the location of the registered deaths, namely at home, in care homes, in hospitals and in ‘other institutions’, such as prisons, clinics, and schools. For the purposes of calculating excess deaths, it records weekly deaths from the 16th of March 2020 (week 12) for the following six classes of deaths: cancer, dementia/Alzheimer’s disease, circulatory disease (including heart disease and stroke), respiratory disease, Covid 19 and ‘other’ and compares these figures with the five-year average for that week.
At the time of writing, these weekly data on excess deaths were available for the period up to the 14th of December 2020 (week 51).2 Data presented in Table 1 are derived directly from the NRS spreadsheet for this 39-week period,2 accompanied by simple percentage calculations.
The NRS spreadsheet entitled “covid-deaths-data-week-51” as downloaded from the NRS website on the 27th December 2020 indicates that, for the past five years, deaths in Scotland over this 39-week period averaged 42,428.2
Compared with this five-year average, 6,406 excess deaths occurred over the same period in 2020, representing an increase in the overall number of deaths of 15.1% (Table 1). Covid 19 was attributed to 5,717 of the 2020 excess deaths (89.2 per cent).
Overall, however, hospital deaths were down by three per cent compared with the five-year average, while deaths at home and in care homes were up by 40.8 per cent and 23.6 per cent, respectively. The vast majority of excess deaths (4,710 deaths; 73.5 per cent) occurred at home, while virtually all other excess deaths (2,311 deaths; 36.1 per cent) occurred in care homes.
Surprisingly, the NRS data also show that deaths from non-Covid 19 respiratory disease in Scotland were down by 22.3 per cent overall during the 39-week Covid 19 period. This suggests that excess deaths due to Covid 19 may have been artificially inflated by deaths that would usually have occurred due to influenza, pneumonia and other respiratory illnesses.
Notably, it appears that hospital deaths in Scotland from (non-Covid) respiratory disease decreased by a staggering 33.8 per cent during the Covid 19 pandemic. Similarly, hospital deaths from cancer (decreased by 22.4 per cent), dementia (decreased by 25.9 per cent) and circulatory disease (heart disease and stroke) (decreased by 14.2 per cent) were all substantially reduced compared with the five-year Scottish average for Scotland.
Could these consistent and substantial decreases across the usual causes of hospital deaths be due to false positive PCR tests? Much has been published about false negative PCR tests but little appears to have been published about false positives.3 More research on the accuracy of diagnostic tests for Covid 19 is clearly needed to ensure that positive tests can be trusted. This is particularly important in light of a recent BMJ editorial highlighting that the UK Government has procured suboptimal PCR tests.4
For deaths occurring at home, which comprised the majority of excess deaths, cancer deaths increased by 47.0 per cent, dementia deaths increased by 80.5 per cent and home deaths from other conditions increased by 39.3 per cent (Table 1).
These data on home deaths suggest that many people in Scotland have not been able to access essential medical care during the pandemic. The latter is also suggested by the increase in excess deaths due to dementia, circulatory disease and ‘other’ conditions by 1769 deaths overall since the start of the Covid 19 monitoring period.
By contrast, deaths occurring in care homes due to cancer and non-Covid 19 respiratory disease were down by 16.9 per cent and 17.8 per cent, respectively. As with the hospital data, these care home data suggests that a significant proportion of the excess care home deaths in Scotland may have been incorrectly attributed to Covid 19.
In summary, non-Covid deaths in Scotland increased during the Covid 19 period compared with the five-year Scottish average. Hospital deaths were down overall and virtually all excess deaths occurred at home or in care homes.
More than 1000 deaths from respiratory disease may have been mistakenly attributed to Covid 19. A substantial number of excess deaths may have occurred due to the secondary effects of the Covid 19 pandemic, as a result of disruption in health care provision to people with other serious and commonly occurring acute medical conditions and disruption to mental health.5
Conflicts of interest
None
Funding
None
References
National Records of Scotland. 2020 https://www.nrscotland.gov.uk/print/3493 (accessed 27/12/2020)
National Records of Scotland. 2020 https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/weekly-and-monthly-data-on-births-and-deaths/deaths-involving-coronavirus-covid-19-in-scotland (accessed 27/12/2020)
Esteve C, Catherine FX, Chavanet P, Blot M, Piroth L. How should a positive PCR test result for COVID-19 in an asymptomatic individual be interpreted and managed?. Med Mal Infect. 2020;50(8):633-638. doi:10.1016/j.medmal.2020.09.014
Abbasi K. Covid-19: politicisation, “corruption,” and suppression of science. BMJ 2020; 371:m4425.
Ioannidis JPA. Global perspective of COVID‐19 epidemiology for a full‐cycle pandemic. Eur J Clin Invest. 2020 Dec;50(12):e13423. doi: 10.1111/eci.13423
This article was originally published on Tess Lawrie’s substack. You can read and subscribe to her substack by clicking here.