Excess Deaths by Cause, England 2020/w1 – 2022/w46 (part 3)

Statistical analysis of a dataset obtained under FOI by Joel Smalley. In this article I present excess deaths for ICD-10 chapter X (J00 – J99): diseases of the respiratory system.

Please see part 1 of this series for background detail.

We now come the third most frequent cause of death, this being diseases of the respiratory system. This ICD-10 chapter covers everything from J00X Acute nasopharyngitis [common cold] to J99.8 Respiratory disorders in other diseases classified elsewhere. In plain English we’re talking asthma, COPD, emphysema, influenza, pneumonia, laryngitis, tonsillitis, bronchitis and, of course, my favourite coding: J67.2 Bird fancier’s lung.

More Deaths To Come

When viewing these slides please do bear in mind that delays in processing (largely due to involvement of the coroner) mean counts as far back as January 2022 are likely to be underreported, especially for the younger age groups. Because of the volume of slides I need to present and limits to email delivery I will keep commenting to a minimum.

Keep an eye out for the mysterious death spike of 2020/w15 (w/e 10 April) and a tailing-off of excess during 2022 for the younger age groups. Under ‘normal’ circumstances excess respiratory death should show as a series of waves flipping from positive excess to negative excess to positive excess. Keep your eyes peeled for any persistent trends or offsets, whether this is characterised by a persistent positive or negative excess. Please do remember that vaccine harm will be one of many factors.

One last thing… if you are expecting a surge in respiratory death due to COVID then think again! These respiratory deaths are strictly non-COVID, for COVID-related deaths were counted under ICD-10 Chapter XXII: Codes for special purposes.

Let’s tuck straight in…

Respiratory Diseases By Age Band

The first thing that struck me with this slide is the persistent negative offset, the mean of which fetches up at -1.2 deaths per week. The spike just prior to the pandemic is interesting given anecdotal evidence that 2019/20 was a harsh flu season. Also interesting are the 2021/22 and 2022/23 season dips, which suggest influenza viruses may well have gone into hiding as some bods suggest.

My eyeballs suggest a random walk, and a Wald-Wolfowitz runs test indicates this is so (p=0.537). Nothing to see here, folks (as far as I can tell).

I’ve once again derived the mean for the reference period of 2020/w16 to 2022/w33 (red dashed line) and added in the three sigma boundaries (grey dashed lines). You can now see that the 2021 whopper spike pushes well past the upper three sigma boundary, so we may conclude that something was very likely going on to cause a sudden burst of young respiratory death during 2021/w36 (w/e 10 Sep). Again, what fascinates me are the dips during peak flu season, which indicates observed deaths were below baseline for this time of year. Unfortunately, this could also arise from coding fun and games at the MUSE end of certification.

The pattern of fewer respiratory deaths than is ‘normal’ for flu season begins to deepen to an extraordinary extent, with the overall series mean fetching up at -22.7 deaths per week for the 60 - 69y group. The question on my lips right now is why are we seeing persistent negative offsets for respiratory deaths for the 40 – 49y, 50 - 59y and 60 - 69y age groups for the period 2020 – 2022?

Yes indeed, that there first sudden hike in (non-COVID) respiratory deaths also took place during 2020/w15 (w/e 10 April). Thus, we have cancer, cardiac and respiratory diseases all mysteriously peaking in the same week. This defies explanation!

We arrive at an extraordinary period grand mean of -90.3 deaths per week for those aged 90 years and more compared to the previous 5-year base period of 2015 – 2019. Either the baseline period was unusually loaded with respiratory death or the most vulnerable members of society have gained magical powers during flu season. Then there’s the sudden death spike for 2020/w15 (w/e 10 April)… WHO killed cock robin?

And so we arrive at the final catch-all slide, which will be dominated by the dynamics for the older age groups. The overall series grand mean is -276.7 deaths per week. That’s a lot of missing deaths that has been sustained for nigh on three years, so I am beginning to suspect the usual ONS coding fun and games, especially given the software was tweaked during January 2020 in time for the pandemic party.

From COVID To CONVID

OK then, so those two dirty great holes in excess death coinciding with the traditional seasonal peak for all things respiratory has generated a decent wedge of critical commentary, and rightly so. Sure we can wave our hands and talk about viral dominance but it isn’t influenza that does all the killing per se, it is pneumonia and bacterial pneumonia at that.

There’s also a rumour going round that UK medics stopped prescribing antibiotics for respiratory cases back in 2020 and the winter of 2020/21 because they switched to new-fangled antivirals as per guidance. I’m aware that some UK hospitals got involved in the RECOVERY and REMAP experimental drug trials but it would be darn handy if some courageous bod could come forward to confirm or deny these rumours. If true then we’re talking iatrogenic death.

All this prompted to cancel my appointment with the beautician and lump all chapter XXII (Codes for special purposes) deaths in with respiratory to see what that final slide for all ages looks like with a make-over. Have a look for yourself:

There’s our familiar 2020/w15 (w/e 10 April) multi-synchronous across the chapters and age groups mega death spike (that also happens to coincide with those two trials I mentioned), and there is the winter of antibiotic discontent spike. After that we have plain sailing and a picture that makes sense for the 2022/23 season.

It sure looks to me like a whole heap of genuine respiratory death has been re-branded as COVID, and this is a situation where a certifying physician’s idea of causality would have been over-ridden by the MUSE software coding rules. I would suggest that a thorough audit of the paper trail is in order.

As for those twin peaks we can no longer trust that these have arisen solely from COVID alone given the mounting evidence of poor patient management.

Onwards and upwards.

Kettle On!