Thousands more people than usual are dying ... but it’s not from Covid
While focus remains firmly fixed on Covid-19, a second health crisis is quietly emerging in Britain. Since the beginning of July, there have been thousands of excess deaths that were not caused by coronavirus.
According to health experts, this is highly unusual for the summer. Although excess deaths are expected during the winter months, when cold weather and seasonal infections combine to place pressure on the NHS, summer generally sees a lull.
This year is a worrying outlier.
According to the Office for National Statistics (ONS), since July 2 there have been 9,619 excess deaths in England and Wales, of which 48 per cent (4,635) were not caused by Covid-19.
So if all these extra people are not dying from coronavirus, what is killing them?
Data from Public Health England (PHE) shows that during that period there were 2,103 extra death registrations with ischemic heart disease, 1,552 with heart failure, as well as an extra 760 deaths with cerebrovascular diseases such as stroke and aneurysm and 3,915 with other circulatory diseases.
Acute and chronic respiratory infections were also up with 3,416 more mentions on death certificates than expected since the start of July, while there have been 1,234 extra urinary system disease deaths, 324 with cirrhosis and liver disease and 1,905 with diabetes.
Alarmingly, many of these conditions saw the biggest drops in diagnosis in 2020, as the NHS struggled to cope with the pandemic.
A report released last week by the Government detailing the direct and indirect health impacts of the pandemic reported that there were an estimated 23 million fewer GP consultations – both in-person and online, in 2020 compared with 2019.
Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) fell by 51 per cent, atrial fibrillation 26 per cent, heart failure 20 per cent, diabetes 19 per cent, coronary heart disease, 17 per cent and stroke and transient ischemic attack by 16 per cent.
Struggling to access the NHS
Since the start of the pandemic, charities and health bodies have warned that people were struggling to access care as the NHS switched to fighting the pandemic.
Now, 18 months of delayed treatments may be starting to take their toll.
Dr Charlotte Summers, an intensive care consultant from Addenbrookes Hospital, Cambridge, told a Royal Society of Medicine (RSM) event this week that patients were arriving at A&E with serious conditions that had worsened during the pandemic.
“There is an increase in non-Covid emergencies that are arriving at the front doors of hospitals from all the delays the pandemic has created already. Things like people presenting later with tumours, and therefore having bowel perforations and aneurysms and lots of other things that were delayed,” she said.
“We've got a massive elective backlog....and we’re potentially likely to have flu at increased levels this year because immunity to influenza will have waned.
'It feels like winter already'
“Last winter, there was almost no RSV (Respiratory syncytial virus), and paediatric intensive care was pretty much empty and could help us out. Now they are absolutely teeming as are our emergency departments with adults and children with RSV infection.
“It feels like winter is already here, rather than it is coming. It’s worse this year than I think I remember at any point in the last 20 years.”
Data from NHS England suggest that there are around five million people currently waiting to begin treatment, and the Health Secretary Sajid Javid has warned that the figure could rise to 13 million.
Elective operations fell by 3.5 million between March 2020 and February 2021 as the NHS prioritised Covid-19 care, and there was an increased staff absence due to illness, and the need to self-isolate.
Treatment delays, poorer health outcomes
Between October and December 2020, approximately a quarter of all surgical activity in Britain was lost, with one in five operating theatres shut, and one in eight anesthetic staff absent from their normal duties.
Emergency admissions also fell by 1.6 million as people failed to seek help for fear of burdening the NHS, or concerns they might catch Covid-19.
A government report, put together by the Department of Health and Social Care and the ONS, found that while admissions recovered over the year, elective admissions by mid July were still lower than the pre-pandemic level for all cancers apart from colorectal.
The authors warned that: “Although it is not possible to quantify the full impact of the delays in presentation, consultation and diagnosis stages at this point, the literature shows that these treatment delays are likely to lead to poorer health outcomes for patients.”
Lockdowns suppressed Covid, but may lead to other problems
The country is also suffering because of a lack of immunity. While lockdowns, social distancing, isolation and masks kept Covid-19 down, it also prevented other diseases from circulating.
In the 52 weeks to the week ending July 11, 2021, there was a decrease in the number of reported infectious illnesses across diseases such as mumps (-72 per cent), rubella (-84 per cent) or yellow fever (-100 per cent) compared to the pre-pandemic five year average.
Last year, the influenza-like illness rate peaked at 3.8 per 100,000, compared to a peak of 59 per 100,000 in 2017/2018.
While this undoubtedly saved lives, we are beginning to experience a rise in infectious diseases that could hit us harder than ever this winter as we have less protection than normal.
The danger is that these added pressures on the NHS will force the Government into locking down the country again this winter, mandating masks and work from home rules.
If it does, we could end up in a perpetuating state of low-immunity in winter that it will be difficult to escape from. The Covid-19 response may have inadvertently created an ongoing health crisis from which there is no way back.