Boris Johnson’s most memorable phrase, before his illness was “I want to level with you”. At that stage, telling us that people would die in British hospitals was still newsworthy. Six weeks on and telling us how many are dying in our hospitals is newsworthy only that it helps us see that curve flattening.

But the bigger curve – the curve that describes total deaths in the UK from COVID-19 is not being shown to us. Instead we get a lesser version of the great curve “total reported deaths” and deaths reported from COVID-19.

A friend of mine nearly died from a heart attack two weeks ago, the heart attack is thought to have been brought on by COVID-19 though – had he perished, the cause of death would have been “cardiac arrest”.

We now know that many specialists in non-respiratory disciplines have been on COVID-19 wards , meaning that patients with worsening symptoms have missed emergency help, operations and treatments have been postponed and this will have pushed up death rates. These death rates are – with reference to death certificates – not COVID-19 deaths, though COVID-19 was the major contributory factor.

A death is a death

When an actuary is compiling a mortality table, he/she looks for outliers – excess deaths. The latest number of excess deaths in Britain this year is 46,000. In a year when mortality was below average in the first quarter, it is clear that these excess deaths relate to the period from the end of February when the impact of COVID-19 took place.

The Institute and Faculty of Actuaries, who have professional standards akin to those in the medical profession are responsible for working out the 46,000 number and if you follow the links to the CMI page, you can see the working

The Continuous Mortality Investigation (CMI) has published its analysis of today’s ONS release.

Key points:
– death rates 2.5 times the same week last year
– total excess deaths 1.5 times COVID-19 deaths
– They estimate there have been 45,000 excess deaths in the UK! pic.twitter.com/XDvHYsPVQR

— COVID-19 Actuaries Response Group (@COVID19actuary) April 28, 2020

What is truly frightening is that this shows England against our European peers in a very bad place indeed.

I was hesitating to post this chart, so depressing is it.
The lines here represent excess deaths.
No other major European state has excess deaths so far above “normal” levels for the time of yr.
In other countries excess mortality is falling. In England it’s still rising #COVID19 pic.twitter.com/tZO37qZczd

— Ed Conway (@EdConwaySky) April 28, 2020

I have followed commentary on this second chart and I understand the comparison isn’t entirely fair. This data is from EuroMoMo.  EuroMoMo does not purport to compare countries to each other. It analyses each country separately showing whether its mortality is unusual based on its own history. (see end of blog for difference between Z scores and excess mortality)

Nonetheless, it is clear that things are very bad in the UK, worse than others shown.

The current spike may not be the only one this year. It is likely we’ll get another after control measures are relaxed.

I’ve no doubt that historians will look back on 2020 (& 2021?) in the way we look back at the Spanish Flu. A global tragedy, even if some countries manage ok.

— stuart mcdonald (@ActuaryByDay) April 28, 2020

If the Government wishes to level with us, it must admit that we are in a very dark place and accept the consequence of that is continued lockdown for a time to come. This current “tie and tease” which gives us lockdown with the teasing expectation of release is a dangerous game, as the numbers show.

To somehow suppose that those excess deaths in care homes aren’t really deaths is both heartless (Ros Altmann’s point) and untrue – Stuart MacDonald’s point. A death is a death.

Yes, did similar calculation last week. Within hospital half of deaths were age 80 plus. Outside hospital three quarter of deaths were age 80 plus.

My regular reminder that many of those aged 80 plus had many years ahead of them though.https://t.co/Y0Rtd12JZO

— stuart mcdonald (@ActuaryByDay) April 28, 2020

Can we stand this much reality?

There is a sub-question in the title of this blog. That question is whether it might be best for the Government to level with us. Is transparency the best policy when it risks other consequences, such as a loss of confidence in Government itself?

This is not as disruptive a thought as it seems. Even if this Government has made strategic mistakes, vacillating between suppression and mitigation, failing to order PPE and being over lenient in the lockdown (all of which may be true), if we lose faith in those who are calling the shots, we risk something much worse.

What seems clear to me is that we are not all in this together and that the vast majority of us my readers have seen very little genuine hardship. The impact of COVID-19 is being felt most within the captivity of care homes, among the BAME and in certain geographical areas, especially parts of London. In this Boris Johnson (and my friend) are outliers.

But to suppose that Middle Britain has escaped the worst of COVID-19 is to suppose that we are on the downward curve for good. This seems increasingly unlikely.

Why we should remain calm.

My natural reaction when I find I’m being fed a line is to get angry and this is what I did last night, listening to the Government 5 ‘Clock Daily Briefing. We were told that the 26,000 figure was the “reality” when it clearly isn’t and the Government’s argument that they will have to wait a couple of weeks for the excess death data is clearly tosh (they just need to read the CMI’s work).

But as I ranted at my mothers (who at 87 knows a thing or two more than me about morbidity and mortality) , I realised that I was telling her something it did her no good to hear. She reproved me and told me the information I was giving her made her sad but would not change her behaviour. I asked her why it made her sad and she said she wanted to have confidence in what the Government told her to do.

My mother was right and I was wrong and I suspect that this Government has no alternative at this point but “not” to level with us. Because if it loses us, it loses the dressing room and it may well lose the game set and match.

So we must stay calm, smile while we are fed the B/S and accept that sometimes sunlight is not the best disinfectant.

Footnote – Euromomo’s Z Scores v Excess deaths

The Euromomo chart plots each country against its own normality, this isn’t quite the same thing as plotting each country against its excess deaths. This is explained here (again with thanks to Stuart McDonald

They explain their approach to z-scores here. Going outside +/- 4 is a “substantial” deviation.https://t.co/1DbsjqSDL2

— stuart mcdonald (@ActuaryByDay) April 28, 2020