Oxford University study reveals even the ONS did not have a clear definition for fatalities, leaving ‘everyone seriously confused’
Researchers say it is unlikely that a Covid infection on its own could cause death without contributing factors such as other illness
The number of people who have died from Covid in Britain during the pandemic is impossible to determine because of the inconsistent definitions of what is meant by a coronavirus death, researchers have concluded.
Experts from Oxford University discovered that public health and statistics organisations across the UK are operating under 14 different definitions to classify a death from Covid.
Freedom of Information (FOI) requests, collated for a new report published on Saturday, show that many people who died in the first wave never tested positive for the virus, particularly older people who died in care homes.
Instead, their deaths were registered as Covid simply based on a statement of the care home provider, and because coronavirus was rife at the time.
In some care homes, more than half of the Covid deaths were registered in people without pre-existing conditions, which the report authors said was “implausible” for people who needed residential care.
The authors also point out that it is unlikely that a Covid infection on its own could cause death in the absence of contributing factors, such as other illness, or the infection leading to a more deadly condition such as pneumonia.
The report also found that in some trusts, up to 95 per cent of Covid deaths were in people with Do Not Resuscitate (DNR) orders.
A care home resident after receiving the coronavirus vaccine at Andrew Cohen House in Birmingham. The study found many people who died when the pandemic began in 2020 never tested positive for the virus
Ravages of human stupidity’
The team said the confusion meant they were unable to separate deaths caused by Covid from those triggered by the pandemic response, and called for a proportion of deaths to be verified by post-mortem in future pandemics to determine the true reason.
Dr Tom Jefferson, of the Centre for Evidence Based Medicine (CEBM) at Oxford University, said: “Every night we were given this diet of cases, admissions and deaths. But we found that even the ONS doesn’t have a standard definition for deaths. We found 14 different ways to express the cause of death.
“There are a number of death certificates where Covid-19 is the only cause of death, and that is not possible. It has to be something like Covid-19 induced pneumonia, if it goes to the kidneys and you get kidney failure.
“We found some organisations coded Covid deaths even in the absence of positive Covid tests. Some nursing homes had allocated causality to Covid-19 not on the basis of tests but when those deaths occurred, usually in the Spring of 2020. Nursing homes decide themselves what was the cause.
“All of this means that we don’t really know who has died of Covid, or how severe it is, and this continues to this day. Separating the ravages of the virus from the ravages of human stupidity is not possible.”
At organisations across Britain, Covid deaths were variously defined as: Due to Covid, Covid as an underlying cause, Covid as an underlying main cause, Covid as a direct cause, death involving Covid, died within 28 days of a Covid test, died within 60 days of a Covid test, Covid mentioned on the death certificate, Covid as sole cause, Covid as only cause, Covid as immediate cause, Covid based on statement of the care home provider and Covid contributing to death.
An FOI response from North Tees and Hartlepool NHS Foundation Trust in March 2021 said it was impossible to determine the true cause of death among those listed as solely dying of Covid because no post-mortems had taken place.
“The trust does not undertake post mortems and therefore we are unable to say whether they had underlying, undiagnosed co-morbidities which contributed to their death,” a spokesman said.
Increase in use of DNRs
The report authors also said there should be further investigation into the large numbers of people dying after the imposition of DNRs.
At London North West University, by December 2020 there had been 623 Covid deaths of which 555 (89 per cent) were subject to DNRs.
At King’s College Hospital NHS Foundation Trust, 85 per cent of Covid deaths had a DNR by November 2020. At Barts Health NHS Trust, it was lower at 32 per cent.
A recent report by Oxford and Durham Universities showed that in the first wave of Covid in the spring of 2020 there had been a 30 per cent increase in the use of DNRs, with a fifth of patients not consulted about the decision.
“This requires further investigation,” said Prof Carl Heneghan, Director of the CEBM at Oxford. “Were these orders already in place as may be the case with terminal disease or were they instigated during admission?
“These are vital questions requiring answering to determine the impact of the virus particularly in the most vulnerable and likely to die.”
‘We were in panic mode’
The UK Statistics watchdog has said that excess deaths give the closest indication, but researchers said it was impossible to separate deaths from Covid and those caused by the pandemic response.
“It’s very hard to understand who is dying of Covid and who is dying from the measures put in place to tackle the virus,” added Prof Henghan.
“For example, if you’re elderly and have dementia and are left alone, you’ll be dead in two to three days. We were in panic mode.
“When you look across the devolved nations there are real problems. There are subtle variations in how the deaths were recorded, and these different interpretations have left everyone seriously confused.”
Without a true death count, researchers say it is impossible to calculate the real fatality rate of Covid or compare Britain to other countries.