At face value, the figure is contradicted by other evidence and ignores or misunderstands comorbidity and causes of death. Data shows that by the end of September 2020, COVID-19 was the underlying cause of death for 808 deaths (89.6%) of the 902 COVID-19-related deaths registered.
A Facebook post shared 100 times in less than a day claims that there have been “113 covid deaths in all of Northern Ireland since the start of the ‘pandemic’”.
Comments under the Facebook post add more context to the discussion, such as Freedom of Information requests being submitted to health trusts and statistical agencies requesting data on deaths that were solely attributed to COVID-19 and had no other underlying health conditions. Many more Facebook posts are sharing the “113 deaths solely due to COVID-19” statistic and attracting comments that question the seriousness of the pandemic and the subsequent lockdowns.
Between March and September 2020, the Northern Ireland Statistics and Research Agency (NISRA) analysed death certificates from March to November 2020 and found that 114 COVID-19-related deaths (8.1%) had no pre-existing conditions. However, that does not mean that COVID-19 was not a causality in the other deaths. After coding and analysing each death certificate, NISRA found that COVID-19 was listed as the underlying cause of death for 808 deaths (89.6%) of the wider group of 902 COVID-19-related deaths (where COVID-19 was mentioned anywhere on the death certificate) registered by the end of September 2020.
To claim that just over a hundred people have died from COVID-19 in Northern Ireland ignores and/or misunderstands comorbidity and causes of death. It is important to ask: What is comorbidity? How are COVID-19 deaths measured? How can we understand these statistics better?
What is comorbidity?
Comorbidity is defined by the English Department of Health as the co-occurrence of two or more long term conditions in a person. The Office of National Statistics lists the leading causes of death in England and Wales, in an online spreadsheet.
Counting COVID-19 deaths in Northern Ireland
FactCheckNI has previously published an explainer article outlining the three different sets of figures that are published with varied timeliness regarding numbers of deaths attributed to COVID-19: daily, weekly, and quarterly.
- Daily. Northern Ireland’s Department of Health (DoH) publishes a daily figure for deaths reported in the 24 hours up to 10am the previous day. Deaths are attributed as “COVID-19 deaths” in the DoH’s figures if the person had a positive test for COVID-19 within the previous 28 days. This measure is now broadly consistent across the UK and allows regional comparisons to be made. The Deaths Summary pane of the DoH dashboard shows that exactly 2,000 COVID-19 deaths had been reported by 10am on 15 February 2021.
- Weekly. NISRA publishes weekly figures, based on COVID-19 being mentioned on death certificates (with or without a positive test). Unlike the DoH figures, NISRA’s weekly statistics include deaths of people who did not have a positive test at the time of death. NISRA’s figures will include people whose certifying doctor notes COVID-19 symptoms, but died of a different primary cause once further analysis is conducted. From the start of the pandemic until 5 February 2021, NISRA’s weekly figures show that there were 2,574 deaths registered mentioning COVID-19 on the death certificate.
- Quarterly. The Registrar General Quarterly Report is published by NISRA, in line with other UK statistical agencies, and categorises deaths by cause. The primary cause of death is precisely coded against the ICD-10 international model. These are the most accurate, but the slowest to produce, of these three sets of figures for COVID-19 deaths. During the first nine months of 2020, NISRA’s quarterly figures explain that there were 808 deaths where COVID-19 was the underlying cause (information accurate on 18 November 2020).
The “113 covid deaths in all of Northern Ireland” figure in the Facebook claim is contradicted by all these statistics.
Causes of death
On 23 December 2020, NISRA published a statistical bulletin, Covid-19 related deaths and pre-existing conditions in Northern Ireland: March to November 2020.
There are two parts to a Medical Certificate of Cause of Death (MCCD), more commonly referred to as ‘death certificate’:
- Part 1 gives the conditions leading directly to death. This could be either a single condition, or a sequence of conditions split over multiple lines in the MCCD. In principle, the lowest line of Part 1 should be the underlying cause of death; and
- Part 2 contains conditions that contributed to the death but are not directly causal.
The chart below plots monthly figures for COVID-19-related deaths, deaths where COVID-19 was mentioned in Part 1 of the death certificate, and deaths where COVID-19 was the underlying cause of death (figures for October and November not yet published).
The chart suggests that most deaths where COVID-19 is mentioned on the death certificate correlate with COVID-19 being determined as the underlying cause of death. Analysis on deaths up to the end of September found that COVID-19 was the underlying cause of death for 808 deaths (89.6%) of the 902 COVID-19-related deaths registered.
In the majority of cases where COVID-19 is noted as the underlying cause of death, death certificates note that patients had other pre-existing health conditions, with dementia and Alzheimer’s disease appearing in just over a third of deaths. Note that information on the severity of pre-existing conditions is commonly not reported by the certifying medic.
Between March and November 2020, NISRA’s analysis of death certificates found that 114 COVID-19-related deaths (8.1%) had no pre-existing conditions.
NISRA’s response to a Freedom of Information request was published on social media. The “number of deaths in which COVID-19 alone has been mentioned on the death certificate” was “113 (6.2%) out of the 1,831 COVID-19 related deaths up to 31st December 2020”.
In all cases where COVID-19 was listed as the underlying cause of death, regardless of pre-existing conditions, the certifying medical practitioner believed that COVID-19 caused their death.
An example from summer 2020 in the US
At the end of the summer, a statistic circulated in the US stating that only 6% of deaths listed COVID-19 as the sole cause. The 6% figure is still true today according to the latest figures from the Centers for Disease Control and Prevention (CDC) which also explain that for deaths with conditions or causes in addition to COVID-19, on average, there were 2.9 additional conditions or causes per death.
HIV virologist Ryan McNamara (University of North Carolina at Chapel Hill School of Medicine) interpreted those raw figures and explained comorbidity in a series of tweets that were reported by The Miami Herald. He used HIV as an illustration.
“After years of virus spread, and in the absence of treatment, a patient infected with HIV will develop AIDS. During this state of HIV progression, white blood cells called T-cells are depleted. This can allow co-infecting pathogens to spread unchecked or tumor cells to grow and metastasize. Hence pneumonia and AIDS-associated cancers are leading causes of death in HIV+ patients.
“For SARS-CoV-2, the assault it elicits on the lungs can greatly exacerbate other pre-existing conditions. So things like cardiac arrest, renal failure, liver failure, sepsis, lung scarring, etc. can all occur post-infection with SARS-CoV-2, leading to death.
Only considering the deaths of patients with COVID-19 but no other underlying health conditions ignores or misunderstands comorbidity and causes of death.
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