Vulnerable People 'Need Protection' as Lockdown Eases

Peter Russell

May 13, 2020

Tens of thousands of excess deaths could occur because of measures to ease the COVID-19 lockdown unless steps are taken to protect the most vulnerable, UK researchers said.

The study, published online in The Lancet,  emerged as the Government implemented the first tentative steps in returning the country to normal life – in England, at least.

The researchers, led by University College London (UCL), found that between 37,000 and 73,000 excess deaths could occur from direct and indirect effects of the pandemic within 12 months.

The number of possible excess deaths depended on how lockdown restrictions were lifted.

Dr Amitava Banerjee from UCL's Institute of Health Informatics said in a news release: "Older people, those with one or more underlying conditions, and their carers, are asking what easing the lockdown might mean for their health.

"Using data modelling on a number of different scenarios, our findings show the mortality risk for these vulnerable groups increases significantly, and could lead to thousands of avoidable deaths."

Identifying High-risk Groups

The population-based cohort study was based on more than 3.8 million primary and secondary care health records from England.

The researchers estimated that more than 20% of the study population, roughly divided equally between men and women, were in a 'high-risk' category. Of those, 13·7% were older than 70, and 6·3% were aged 70 or younger with at least one underlying condition.

The risk of mortality in 12 months in the high-risk group was estimated to be 4·46%.

The underlying health conditions include:

The authors developed an online 'risk calculator' showing how age, sex, and underlying health conditions can affect mortality rates in different scenarios of the pandemic.

The relative risk includes both the direct effects of infection from SARS-CoV-2, as well as indirect effects, such as a strain on the NHS.

Dr Banerjee explained: "For example, we show how a 66-year-old man with chronic obstructive pulmonary disease (COPD) has a 6% risk of dying over the next year."

He said: "The calculator estimates 164 excess COVID-related deaths on top of the expected 1639 deaths over a year in patients in a similar situation."

Protecting the Vulnerable

Senior author, Professor Harry Hemingway from UCL, added: "This research is relevant for the NHS policy on 'vulnerable' patients based on their underlying conditions.

"Our findings emphasise the importance of delivering consistent preventive interventions to people with a wide range of diseases, who are cared for by a wide range of clinical specialties."

Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, said: "There is a relatively small group – around 2% – who have co-morbidities or underlying health conditions and have been advised to 'shield' themselves from infection.

"There is a much larger group – everyone over 70 years old, almost 20% – who have been advised to carry out 'enhanced' social distancing.

"This paper illustrates why shielding and enhanced social distancing are so important."

However, he told the Science Media Centre that the study was not a direct examination of the effects of easing the lockdown.

"They estimate a worst case of 73,000 excess deaths within one year from the direct and indirect effects of the COVID-19 pandemic; but it is important to stress that this is a worst case – the actual number of excess deaths may well turn out to be considerably lower," he added. 

Harnessing behavioural science in public health campaigns to maintain ‘social distancing’ in response to the COVID-19 pandemic: key principles doi 10.1136/jech-2020-214290

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