Nineteen local authorities in England have recorded excess death rates of more than twice the UK average during the Covid-19 crisis.
Local authorities in London have been hardest hit, with 16 of the 20 local authorities with the highest excess death rates located in the capital. Excess deaths in Harrow and Brent are three times that of the national average, at 64% and 63% respectively.
At its peak in the week to 17 April there were 138 deaths registered in Harrow, five times the average for the equivalent week in previous years.
Poorer boroughs including Newham and Haringey were also among the worst affected. Data from the ONS has previously shown that people living in the poorest parts of England and Wales were dying at twice the rate of those in the richest areas.
The death toll across the UK in the year to date shows that the excess death rate stands at 20.5%
Excess deaths are calculated by taking the total number of people whose deaths were registered in 2020 and comparing it with the average number of deaths in the five years prior. The difference represents the excess.
This measure is considered the gold standard when it comes to measuring the impact of the Covid-19 crisis as it accounts not just for people who have died directly as a result of coronavirus. For example, those who may not have sought or received treatment due to lockdown measures, deaths caused by a lack of basic care or nutrition and undiagnosed coronavirus deaths.
The data also reveals that certain parts of Great Britain experienced higher death rates at different times. For example, Liverpool’s excess death rate peaked in the week ending 10 April but it would be another three weeks before Leeds experienced its peak.
Birmingham had more excess deaths than any other local authority for four weeks running , recording 415 excess deaths in the week to 17 April, almost two-and-a-half times the norm.
There is a strong correlation between high excess death rates and age. For example, the rural South Lakeland area’s excess death rate stands at 39%, almost twice the national average, and the area is one of the oldest in the UK when measured by median age.
Some parts of the country have remained relatively unscathed. In the south-west, Torbay, mid-Devon and east Devon experienced excess death rates within 2% of the norm as did Hastings and Eastbourne in the south-east and the Orkney Islands.
Na h-Eileanan Siar council area and the Shetland Islands did not experience any excess deaths while South Hams, Conwy in Wales, North East Lincolnshire, North Devon, South Hams and the Isles of Scilly have experienced fewer deaths this year than in previous years.
Epidemics of infectious diseases behave in different ways but the 1918 influenza pandemic that killed more than 50 million people is regarded as a key example of a pandemic that occurred in multiple waves, with the latter more severe than the first. It has been replicated – albeit more mildly – in subsequent flu pandemics.
How and why multiple-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modelling studies and pandemic preparation, which have looked at everything from social behaviour and health policy to vaccination and the buildup of community immunity, also known as herd immunity.
Is there evidence of coronavirus coming back in a second wave?
This is being watched very carefully. Without a vaccine, and with no widespread immunity to the new disease, one alarm is being sounded by the experience of Singapore, which has seen a sudden resurgence in infections despite being lauded for its early handling of the outbreak.
Although Singapore instituted a strong contact tracing system for its general population, the disease re-emerged in cramped dormitory accommodation used by thousands of foreign workers with inadequate hygiene facilities and shared canteens.
Singapore’s experience, although very specific, has demonstrated the ability of the disease to come back strongly in places where people are in close proximity and its ability to exploit any weakness in public health regimes set up to counter it.
In June 2020, Beijing suffered from a new cluster of coronavirus cases which caused authorities to re-implement restrictions that CHina had previously been able to lift.
What are experts worried about?
Conventional wisdom among scientists suggests second waves of resistant infections occur after the capacity for treatment and isolation becomes exhausted. In this case the concern is that the social and political consensus supporting lockdowns is being overtaken by public frustration and the urgent need to reopen economies.
The threat declines when susceptibility of the population to the disease falls below a certain threshold or when widespread vaccination becomes available.
In general terms the ratio of susceptible and immune individuals in a population at the end of one wave determines the potential magnitude of a subsequent wave. The worry right now is that with a vaccine still many months away, and the real rate of infection only being guessed at, populations worldwide remain highly vulnerable to both resurgence and subsequent waves.
All but one of the 50 worst-hit local authorities are in England, the exception being Inverclyde in Scotland where the total deaths in the year to date are 36.5% higher than in an average year, far higher than the Scottish average of 16%.
Previous analysis showed that people living in the most deprived areas of Scotland were more than twice as likely to die from Covid-19 as those living in the wealthiest parts. A large proportion (18.6%) of Inverclyde is made up of highly-deprived areas, and some of the most deprived parts of Scotland are found in Greenock and Port Glasgow.
Among the areas where excess deaths rates were above the UK average were East Dunbartonshire (26.7%), Edinburgh (24.3%) and Clackmannanshire (24%).
Three local authorities in Wales: Blaenau Gwent, where the excess death rate stands at 22.6%, Rhondda Cynon Taf and Newport, had an excess death rate above the UK average.
Northern Ireland does not produce data at a local authority level but excess deaths in the country are running at 10%, far below the UK average.
David Leon, professor of epidemiology at the London School of Hygiene & Tropical Medicine, said the data showed how the overall impact of Covid-19 on mortality has varied across the UK.
“This epidemic has clearly had a serious impact on many local authorities that are not highly urbanised. Going forward understanding the reasons for this substantial geographic variation will be crucial in drawing lessons for the future for how to cope with any resurgence of Covid-19 or another pandemic.â€
The three statistical agencies for the four nations: the Office for National Statistics (ONS) for England and Wales, the National Records of Scotland (NRS) and the Northern Ireland Statistics and Research Agency (NISRA), release their figures on different days. The figures run to week 24 for England and Wales and Scotland and week 22 in Northern Ireland.