Scientists Warn UK Must Do More to Suppress COVID-19

Peter Russell

March 23, 2020

Stronger suppression measures to combat the spread of COVID-19 will be needed to avoid tens of thousands of excess deaths from the virus, a group of experts said.

An analysis led by University College London (UCL), the University of Cambridge, and Health Data Research UK estimated that a strategy of 'mitigation' designed to slow the spread of the virus could lead to at least 35,000 to 70,000 excess deaths over one year.

Researchers used NHS records from 3,862,012 adults aged 30 or older in England to estimate excess deaths caused by COVID-19 in relation to underlying medical conditions and age.

The study, which has not been peer-reviewed, concluded that current UK measures to combat the new coronavirus have not gone far enough to slow its spread nor identify the most 'at-risk' groups.

Dr Amitava Banerjee, an associate professor of clinical data science at UCL, who led the analysis, said: "The UK Government is currently following a partial suppression policy of population-wide social distancing, combined with home isolation of cases, as well as school and university closures, but this is currently not mandated.

"Our study indicates that the Government should implement more stringent suppression at population level to avoid not just immediate deaths but also long-term excess deaths."

Excess Deaths and At-Risk Groups

The study estimated that 13.4 million in the UK population (20.0%) were at high risk from COVID-19, of which 13.7% were over the age of 70, and 6.3% aged 70 or younger.

Underlying health conditions leading to the most significant risk were cardiovascular disease, diabetes, steroid therapy, severe obesity, chronic kidney disease, and chronic obstructive pulmonary disease (COPD). Multi-morbidity was seen in 10.1% of these individuals.

The 1-year mortality rate in the at-risk population was 4.46%, with age and underlying conditions combining to influence that risk.

Until recently, almost all deaths related to COVID-19 had occurred in older people as well as those with underlying health conditions, the researchers noted. However, recent clinical experience suggested that this pattern might be changing. 

They said that if the emergency were associated with a 20% increased mortality risk (of similar magnitude to the normal excess of winter versus summer mortality), that could translate to 13,791 excess deaths under a policy of mitigation, 110,332 excess deaths under a 'do nothing' scenario, compared with just one excess death under a policy of full suppression.

The COVID-19 pandemic might cause excess mortality over the next 12 months both from deaths among those infected, and from social and economic upheaval, while the extra strain put on health services threatens the ability to provide high quality of care.

Commenting on the Government's recent decision to target around 1.5 million people (around 2.7% of the population in England) with underlying health conditions for social isolation, Dr Banerjee said: "Cardiovascular disease, for example, is not on the Government list of conditions announced today. But in this paper, we show that the one-year mortality for people with cardiovascular disease is 6%; and for people with two or more underlying health conditions [it] is 11%. 

"To date, only people with single disease risks have been included in the high-risk group, and not those with multiple diseases who are at a greater risk. 

"We urge the Government to be transparent about how 'extremely vulnerable' groups are identified."
 

Delaying Deaths

Commenting on the paper, Robert Dingwall, professor of sociology at Nottingham Trent University, said he was sceptical that the call for greater efforts at suppression was fully backed up by the data. He said: "Suppression efforts would not prevent deaths, merely delay them, and it is misleading to imply otherwise.  

"What the paper shows is that COVID-19 is probably going to bring forward a lot of deaths that would have occurred anyway in the next 12 months.  

"If we take the mid-point of a very wide confidence interval and use 2018 deaths in England as the denominator, so we are talking about roughly 50,000 deaths as a proportion of roughly 506,000, we end up with an increase of around 10%.

"A proportion of these will be deaths brought forward from the next 12 months.  It should not need to be said that each of these deaths is a sad loss for families, friends, neighbours, workmates, etc.  At a population level, however, we can reasonably ask whether the collateral damage to society and the economy from more aggressive suppression is justifiable.  If the benefit is so modest, we might also wonder whether it will actually be exceeded by mortality from other causes such as suicides resulting from the mental health impact of self-isolation, cardiac events prompted by the associated inactivity, or longer-term mortality resulting from unemployment, and reduced living standards."
 

Government Warns on Further Restrictive Measures

Publication of the analysis came as the Government warned that further restrictive measures on movement could be needed if people ignored advice to practise social distancing.

Pictures emerged over the weekend of people gathering in large numbers in parks and open spaces in many parts of the UK.

Asked this morning whether Ministers might introduce tougher rules, Matt Hancock, Secretary of State for Health and Social Care, said: "Nothing is off the table. Of course we are looking at what other European countries are doing."

Prof Keith Neal, emeritus professor in the epidemiology of infectious diseases, University of Nottingham, said questions remained how any 'lockdown' might be enforced. He told the Science Media Centre: "Key workers will need to get out, people need to go shopping regularly especially if they have not hoarded stuff, people need to attend medical appointments, etc. 

"In France you can walk your dog and also take exercise as long as you do it alone. 

"The German solution has much to recommend it. No group larger than two can meet and they must be 2 metres apart.  This has advantages in that it enforces the distance concept, people can get their shopping done, and the police or other bodies can readily enforce it. Stopping people to check they fit the right criteria to be out is time consuming and could increase the risk to the police."

Estimating excess 1- year mortality from COVID-19 according to underlying conditions and age in England: a rapid analysis using NHS health records in 3.8 million adults. Preprint PDF.

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