Analysis: Why the second Covid wave is nothing like the first

Dig into the data, and the narrative that the current wave is deadlier than the one that hit in the spring begins to unravel

Mortality rates graphic
The UK has yet to hit the daily death levels seen in the first wave

On Jan 13, Dr Yvonne Doyle, the medical director at Public Health England (PHE) issued an alarming statement claiming that Britain had reported the highest number of coronavirus deaths on a single day since the pandemic began.

She also alleged that there have now been more deaths in the second wave than the first.

Both these statements were "technically" true. On that day, 1,564 people were added to official mortality figures, the highest number ever, while the 44,198 "second wave" coronavirus deaths passed the 40,563 recorded up to August 31. 

Yet dig a little deeper and the narrative that the second wave is more deadly than the first begins to unravel. 

I make an early caveat here that I firmly believe we are having a deadly second wave, and thousands more people are dying than would be expected ordinarily at this time of year. But it is not the tens of thousands more PHE would have you believe.

According to some figures, the second wave was five times less deadly than the first wave by December and is now around three times. This is in spite of the fact we have a new variant which is between 50 and 74 per cent more infectious.

To get a real feel for how the waves compare, it is necessary to look at excess deaths rather than crude reported deaths.

According to the Continuous Mortality Investigation (CMI), set up by the Institute and Faculty of Actuaries, there were 72,900 excess deaths from the start of the pandemic in March to the end of December.

Some 60,800 of those occurred in the first wave, but just 12,100 in the second.

(The latest CMI update to these figures published after this article went to press, show there are now  80,100 excess deaths in the UK from the start of the pandemic to 8 January 2021.  Of these, 19,400 have occurred in the second wave, fewer than a third of the first wave.)

For comparison, in a bad winter flu season, around 22,000 excess deaths would be expected.

It means that, unlike the first wave, many people included in the coronavirus death figures would have been expected to die of other causes in the past few months. 

Look at Office for National Statistics (ONS) graphs showing deaths over time and this becomes startlingly clear. While there is a mountainous peak in April as deaths soared over the average, now we are trending a little above the five-year average line. On some days towards the end of December, we were actually below it. 

Dr Jason Oke, of the Centre of Evidence Based Medicine (CEBM) at the University of Oxford, said it was difficult to understand the pandemic from the graphs published on the Government's daily coronavirus dashboard.

While the "deaths within 28 days" graph appears to show that the second wave is as bad as the first, the "weekly deaths by date registered" shows no such correlation.

"If you look at the 28-day graph and the hospital data you could well believe it is as bad as the first wave," Dr Oke said. "The first graph suggests we are now at the same place as the first wave (and due for worse) whereas the second graph tells a different story – half the first wave currently and no increase in December."

The CMI also reported that during week 53, from December 28 to January 3, there were 19 per cent fewer deaths registered in England and Wales than would have been expected if Standardised Mortality Rates had been the same as in week one of 2020.

These December figures will undoubtedly rise as more deaths are registered, and have suffered from the Christmas and New Year holidays when fewer deaths than normal were recorded. But they are not likely to rise so significantly as to take us back to the extraordinary excess deaths of April.

This week's Monthly Mortality Analysis from the ONS also makes this point very well. The report states: "Although mortality rates due to Covid-19 have increased between October and December 2020, these remain significantly lower than in April 2020." 

In fact, in England, age-standardised mortality rates (ASMR) were 62.5 per cent lower in  December than April. They have fallen from 623.2 per 100,000 people in April to 233.6 per 100,000 in December. 

The same is true in Wales, although to a lesser extent. In April the ASMR was 495.1 deaths per 100,000 people, and it was 374.4 per 100,000 in December, a 24.4 per cent decrease.

Dr Doyle's claim that daily deaths are now running higher than the peak of the first wave in April is also not helpful to understanding how the waves compare. 

The UK has yet to hit the daily death levels seen in the first wave, in which 1,072 people died on April 8. The worst day in the second wave was on January 11 when 1,041 people died. On Monday there were 599 reported deaths, although there will be a weekend lag.

Although 1,564 deaths were indeed "reported" on January 13, those people died on many different days, with some deaths going back to November 

That is not to say that daily deaths will not pass the April peak. Case rates have only just started falling, so we could still see the peak of the second wave passing the first, but we would expect that at this time of year because of usual winter pressures.

As Professor David Spiegelhalter pointed out in a recent BBC interview, non-Covid deaths are running very low, and it is important "not to make so much of the announcements of reports of daily cases".

"These fluctuate enormously depending on the reporting even just the day of the week, we've known that since March," said Prof Spiegelhalter, the Winton Professor of the public understanding of risk at the University of Cambridge.

"It's quite possible once the vaccine starts working that our overall death rate might come down to very reasonable levels, partly because non-Covid deaths are running at a very low rate at the moment, and there are a number of reasons for that.

"First of all there's almost no flu circulating, which is very big and due to the measures that have been taken [against Covid] and, and also that very sadly, a number of elderly vulnerable people lost their lives that are there in the spring."

The most recent ONS figures also show that while December was undoubtedly a deadly month, 2010 was worse and the mortality rate is "significantly lower" than December 2003.

The mortality rate in December 2020 was 1,339.8 deaths per 100,000 males, compared with 1,674.7 in December 2003, and 950.4 deaths per 100,000 females, compared with 1,217.4 in December 2003.

The ONS estimates that there were 50,882 more deaths in England in 2020, and 71,110 were due to coronavirus. 

This means that at least 20,000 people who died from coronavirus last year would have been likely to have died from something else. The figure is likely to be higher because many more people have died from the impact of lockdown and cuts to NHS services, which will also be caught in the excess figures. 

It may well be that lives were shortened by many months and so the fact their deaths were expected in 2020 should not be trivialised. But it does show that the numbers cannot be taken at face value when you are dealing with a disease that disproportionately impacts the elderly and vulnerable. 

Looking at crude death figures also fails to take into account the changing population. In recent years, the population of England and Wales has grown and its average age has increased. This would have led to deaths in England and Wales rising by around 1.5 per cent between 2019 and 2020 anyway, even if mortality rates did not change – an increase of nearly 8,000.

Some commentators have also pointed out that 2019 had lower levels of death than normal, two per cent lower than 2018, so we entered 2020 with a more vulnerable population than usual. 

This analysis should not be used by lockdown sceptics to justify why severe restrictions were unnecessary. It was clearly essential to control the growing pandemic, particularly at a time when we were not sure how deadly the new variant would be. 

And it is vital that we keep cases and hospital admissions down, not only to protect the health service but also to prevent large numbers of people from ending up with debilitating long Covid.

However, to maintain trust, public health officials must avoid needlessly alarmist pronouncements. The pandemic death figures are bad enough already. They do not need any help. 

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