Moving coffins to a temporary morgue in Birmingham, Britain, in April. The city saw a surge in deaths that was well above the average of recent years. Photo / Andrew Testa, The New York Times
Prime Minister Boris Johnson has linked Britain's high toll to record-keeping variances among nations. But a government report shows deaths really have been higher than in neighbouring countries.
England has had the greatest rate of excess deaths of any country in Europe during the coronavirus pandemic, with a surge that lasted longer and spread to more places than those in hard-hit nations like Italy and Spain, according to a government report released Thursday.
The findings, in a report by Britain's Office of National Statistics, painted a grim picture of how Britain — and England in particular — weathered the first wave of the pandemic. They came as Prime Minister Boris Johnson spotlighted the struggles of other countries in controlling new infections by moving to put more of them under a travel quarantine.
Critics said Johnson was trying to deflect attention from his own dilatory initial response to the pandemic, which they said had left the country as vulnerable to a resurgence as its neighbours.
When Britain's death toll from the virus first surpassed those of other European countries in May, Johnson argued that country-to-country comparisons were invidious because governments collect and analyze data differently.
But the statistics office said it avoided those pitfalls by examining mortality rates across Europe from all causes — not just those attributed to Covid-19, the disease caused by the virus — from January to June, and then comparing them to average figures from 2015 to 2019.
That takes into account Covid-19 deaths that were not labelled as such, and deaths indirectly related to the pandemic, like those from a lack of access to hospitals during lockdowns. Demographers believe tracking excess mortality is the most accurate gauge of deaths during the pandemic.
There are some major holes in the data, not least a lack of statistics from Germany, Western Europe's most populous country and one that has performed better than most in keeping down infections and fatalities.
The report also does not provide raw numbers of excess deaths for each country, but rather a relative measure of the rate of deaths above the historical average, adjusted for factors like age differences.
The statistics office has separately estimated that the United Kingdom suffered 55,763 excess deaths from March 14, when the virus began circulating in the country, through July 17. A New York Times analysis puts excess deaths in Britain at 62,600 over the same period, by far the most in Europe and a 31 per cent increase in mortality for that time of year.
The British report confirms the harrowing images of overwhelmed hospitals in Italy and Spain in March and April. At their peak, deaths in parts of Spain and Italy surged much more than anywhere in Britain, spiking to 9 1/2 times the usual rate in mid-March in Bergamo, in northern Italy, an early epicentre.
In England, where the local increases were not as steep, the biggest jump was to 4 1/2 times normal in mid-April in Brent, a borough of London. Birmingham had the highest peak for a major British city, at 3 1/2 times the average of recent years.
But the death rate for Britain as a whole was elevated longer than in Spain or Italy, and the increase spread to every corner of the country.
"Excess mortality was geographically widespread throughout the UK during the pandemic, whereas it was more geographically localised in most countries of Western Europe," said Edward Morgan, an expert in health analysis and life events at the Office for National Statistics.
For most European countries, the death rate spiralled in late March and early April. During the last week of March, the worst across Europe with 33,000 excess deaths, Spain alone registered over 12,500 more fatalities than would be expected when compared with data from 2016 to 2019, and Italy over 6,500 more, according a second study, by the French national statistics agency, INSEE.
All told, Italy has reported 35,129 Covid-19 deaths and Spain has reported 28,441, but the Times analysis puts excess deaths at more than 44,000 in each of those countries.
The British report focused primarily on England rather than the entire United Kingdom because, it said, the governments of Scotland, Wales and Northern Ireland administer their own health policies, often with different results. England, the largest part of Britain, has recorded much sharper increases in death rates during the pandemic than the others.
Public health experts have attributed Britain's high toll in part to the timing of Johnson's lockdown, which came a week after those in Italy and Spain. The government abandoned a program of mass testing and contact tracing in early March, depriving it of data on how fast the virus had circulated in the population.
Johnson's messaging may have played an inadvertent role. Worried about the National Health Service being overrun, as hospitals in Italy had been, the prime minister urged people to "Stay at home" and "Protect the NHS."
The British public took that to heart and hospitals coped well with the flood of patients, one of the pandemic's few bright spots. But experts said that some sick people who should have gone to the hospital stayed home — and at least some of them died of cancer, heart disease or other illnesses.
"'Protect the NHS' became interpreted as 'Stay away from the NHS,'" said Devi Sridhar, chair of the global public health program at the University of Edinburgh.
That could help explain one of the intriguing disparities in the report, she said. It showed that in London, which was hard hit by the virus, there was little difference in the excess death rate for people over age 65 and those under 65.
In Madrid and Barcelona, by contrast, there was a huge disparity between those over 65 and the rest of the population, which is consistent with a disease that is more lethal to the elderly. Manchester and Birmingham also showed an age disparity, though somewhat less pronounced.
Sridhar argued that England should adopt a policy of driving new infections down to zero, similar to that of the government in Scotland. With such a policy in place, she said, it would make sense for the government to screen incoming travelers and impose strict quarantines where necessary.
"Otherwise," she said, "given the high level of cases in the community, it might be seen as preempting blame for a second wave to Europe."
Last weekend, British officials added Spain to a list of countries from which travelers have to isolate themselves for 14 days. Now they are monitoring France, Belgium and Croatia, where there have been fresh outbreaks. Johnson said he was determined to stop a second wave of infections imported by British vacationers.
The rapidly changing policy has played havoc with the holiday plans of thousands and drawn criticism from the Spanish government and flagging tourism businesses.
"We think it's a big diversion from the government's failure to handle this in a more sensible way," said Steven Freudmann, the chairman of the Institute of Travel and Tourism, an industry lobbying group. "The risk actually is greater staying at home than it is going to many of these countries."
Written by: Mark Landler
Photographs by: Mary Turner and Andrew Testa
© 2020 THE NEW YORK TIMES
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