A Closer Look At Respiratory Death (part 4)

Lessons from an undisclosed NHS Trust

By now readers of this series should have realised that ascribing causality to death is more akin to a mirage than a tangible reality and that medical subtlety is being brushed aside in a bid to a stamp everything with a COVID sticker.

I’ve established an indicator for symptomatic and asymptomatic COVID death and it will be interesting to see how this pans out in time series analysis. Before we do that we need to establish that the weekly trend in all cause deaths in the NHS Trust under study is representative of the weekly trend in registered all cause deaths across England and Wales.

To do this I downloaded weekly registered all cause deaths from the ONS website and subtracted deaths for the two youngest age groups of age 0y and age 1 – 14y, this being a reasonable match for my definition of adult (>=18y). The weekly data series for all cause in-hospital deaths within the Trust and the ONS all cause series for registered deaths for the period 2017/w1 to 2021/w37 were then subject to Z-score transforms to enable direct comparison on the same graph.

The result is most satisfactory indeed, greatly exceeding my expectation! We may conclude that the sizeable Trust I have been studying since June 2021 is remarkably representative of the nations of England and Wales as a whole, at least in terms of the trend in all cause adult death…

With all cause matching beautifully we now need to repeat the process for COVID death. To do this I downloaded daily certified COVID death for England from the UK GOV coronavirus dashboard, summed these figures to weekly counts and ran a Z-score transform for this series together with the series COVID deaths within the NHS Trust under study…

Again we observe a striking match, with the most significant difference being an excess spate of COVID deaths within the Trust between 2020/w41 and 2020/w53 (slide #2). This may be a localised outbreak, a policy change, a protocol change, a run of excess false positives or something else entirely. The main result here is that the pattern of COVID in-hospital death within the Trust under study mirrors the wider world. With confidence tucked into our back pocket we can now proceed to roll the time series for symptomatic and asymptomatic COVID death within the Trust to see what can be seen…

This third slide of the day is utterly fascinating. During the spring outbreak of 2020 asymptomatic COVID death greatly exceeds symptomatic by a factor of around x3 at peak. During this time COVID was billed as an acute respiratory disease but it is clear that this was far from the case! It would have been more accurate to portray it as an asymptomatic respiratory disease (i.e. a disease of something else) but then again the behavioural insights team wouldn’t have been able to create all those highly emotive blue-filtered images of older people gasping for their last breath.

Come the second and third wave and it is a different matter. We now see equal numbers of symptomatic and asymptomatic adult COVID in-hospital deaths, with symptomatic death reaching an all time pandemic peak. This clearly wasn’t a good time for those with significant comorbidities running into the winter season, nor for teams keeping ICU beds turning over. Even so, what the ONS are claiming as causal COVID death – and the death certification process itself - must be brought into question: at very best COVID causal death figures are half what they claim.