COVID the strange the inexplicable and the weird
This is so weird and inexplicable I can’t fathom it: why did deaths in people aged 15-44 spike during lockdown, & only in England?
As a doctor, I occasionally get confronted with difficult, unexplainable things, but this is a mystery I cannot solve. What lies behind this unusual rise in deaths in an age group that isn’t vulnerable to COVID-19?
It has been almost impossible to make any sense of the figures on COVID -19 deaths from around the world. They do say that the first casualty of war is truth. However, the enemy, in this case, does not much care what anyone says, so there is no point in lying to it.
All it wants to do is move from one host to another and propagate itself. Why does it wish to do this? We don’t really know, it just does. COVID -19 doesn’t do interviews, but we can guess that its mission is to completely dominate the world.
Faced with the same implacable enemy, you would expect that every country would see similar patterns of infection, and death. Or, you might expect to see the same figures from countries that carried out the same actions. Essentially, did a country lock down, or not.
However, if you do try to compare lock down vs. no lock down, the COVID mortality figures appear incomprehensible. Belgium, for example, entered lockdown on the 18th of March, whilst Belarus did not lock down at all. Belgium has a population of 11.5 million, while Belarus has 9.5 million.
Belgium, as of the 22nd of June, had suffered 9,696 COVID related deaths.
Belarus, as of the 22nd of June, had suffered 346 COVID related deaths.
The death rate in Belgium, per million of population, is 847.
The death rate in Belarus, per million of population, is 36.
Which means that the death rate in Belgium is over twenty-three times as high as in Belarus. Yes, two European countries sitting at approximately the same latitude, both starting with the letter ‘B’, and they have a vastly different rate of death. What can we make of such statistics? The simple answer would be to say that I don’t believe the figures from Belarus.
Alternatively, you could say that you don’t believe the figures from Belgium either, because they have the highest death rate from COVID, per million, in the entire world. Why? Who knows? However, I would caution against dismissing figures that you don’t like, or don’t feel make sense.
After all, there are other countries that did not lock down to any extent, such as Japan, where there has been a death rate of seven per million, or one fifth that of Belarus. I think it would take someone very bold to simply dismiss the Japanese figures.
In fact, the death rate in Japan is very nearly the same rate as the rate in New Zealand, which has had only twenty-two deaths, and has been lauded for its aggressive lockdown policy and low rate of deaths. The NZ death rate is 4.9 per million.
In short, if you look around the world, there are no patterns to be seen, and the death rates between countries vary by more than hundred-fold. However, nowhere in the world have they been weirder, or more difficult to interpret, than in England, and – even more curiously – in younger people.
Around ten days ago, someone pointed out to me an anomaly so strange, so unexpected, that I have since spent a considerable amount of time speaking to other doctors, and statisticians, to find an explanation. With no luck so far.
First, to provide some context. The most accurate figures to use, in studying the COVID epidemic, are excess deaths. That is deaths from all causes, over and above the average from the last few years. If, say, 10,000 people normally die in the first week in April, a figure of 15,000 deaths, in the same week this year, would represent 5,000 “excess” deaths.
This figure is of crucial importance. Mainly because it can be fully relied on. From personal experience, I know that what is written on a death certificate is often no more than an educated guess. I also know that there have also been huge differences across countries in the way that doctors have been instructed to record COVID related deaths.
If an elderly person goes downhill rapidly and dies in a care home, and they did not have a test, did they die of COVID, yes or no? Probably, possibly? Doctors in the UK have been advised to write yes, while in other countries they are more likely to write no. On the other hand, there are tales of doctors in the US being coached to write COVID on almost all death certificates, because the hospital is paid more money if they do so.
Which means that relying purely on the statistics for COVID recorded deaths may be highly misleading. However, you can absolutely rely on the diagnosis of death. It is a tricky clinical condition to miss.
So, if you want the outcome that is the most reliable indicator that something truly significant is going on, you need to look at excess mortality rates. If they stay the same, you can be reassured nothing serious is happening. This is true however much the diagnosis of a single condition rises.
To provide this data, as close to real-time as possible, EuroMOMO (European mortality monitoring activity) was established. Currently, it monitors changes in overall mortality in 24 different European countries. England, Wales, Scotland and Northern Ireland are treated as separate countries. This becomes important.
EuroMOMO showed absolutely no change in mortality across all 25 countries until week eleven, the second week in March. It then rose rapidly, topping-out in week fourteen. By the end of May, everything had fallen back to normal. Which means the COVID mortality spike lasted ten weeks, from start to finish. Overall mortality rates are now lower than normal
It is fascinating that some countries showed a sharp rise in mortality, and some showed nothing. For example, Austria, Denmark, Finland and Germany – nothing. France, Belgium, Spain, the Netherlands, England – major spikes. Thirteen countries spiked, twelve did not.
Then, and here we get to the really weird part, is the data that was tucked away in a sub-section. A massive rise in mortality that was seen in only one country out of the twenty-five, and nowhere else. And a spike in the age group 15 to 44… one of age groups least vulnerable to COVID -19… and in England alone. Not in Scotland, Northern Ireland or Wales. It lasted five weeks and then disappeared.
Frustratingly, the figures on causes of death are not available – some types of death can take a long time to be recorded e.g. deaths from accidents, or suicides. So, were all the excess deaths from COVID, it seems unlikely as the total number of recorded deaths in this age group has been less than five hundred since the start of the epidemic and that is not going to create such a spike.
Might lockdown have, in some way, have caused it? Might the loneliness of it have caused a rise in suicides? Or a surge in drug overdoses? Or other reckless behaviour?
I don’t know… but if we are to truly understand what happened during the pandemic, we need to find out.