Every week, more is written on COVID-19 than any individual could possibly read. Collectively, the COVID‑19 Actuaries Response Group read more about the outbreak than most, so we’ve decided each Friday to provide you with a curated list of the key papers and articles that we’ve looked at recently.

Modelling – reports

Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study (Davies et al, 2 June)

This paper, from the Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group, is a useful summary of some of the modelling that was carried out at the start of the outbreak. It sets out the key analyses and scenarios presented to decision makers over February-March 2020, based on information available at that time. The group modelled the impact of four key interventions (school closures, physical distancing, shielding of over-70s, and self-isolation of symptomatic cases), alongside phased lockdown-type restrictions, and found that

• Interventions without lockdown would not be sufficient to bring R₀ below 1;
• An unmitigated outbreak would have led to 350,000 deaths by December 2021;
• The most stringent lockdown scenario would have resulted in 50,000 deaths by December 2021.

Clinical and Medical News

Racial Disparities

There has been growing concern that those from BAME populations may be more vulnerable to COVID-19 in terms of both risk of developing the illness, and risk of mortality. The reasons for this are considered in this rapid data review published in April. The review finds that:

• There is evidence that morbidity and mortality within all ethnic groups is strongly patterned by socio-economic position;
• There is growing evidence that racism plays a role in the poorer physical and mental health of minority ethnic populations via direct personal experience of racist victimisation or discrimination and via the fear or expectation that racism may be encountered;
• There is clear evidence that ethnic minority people reside disproportionately in areas of high deprivation with poor environmental conditions, with concomitant negative impacts on health;
• There is growing evidence of differentially poor access to primary and secondary preventive and curative healthcare that could help to reduce inequalities in the major causes of morbidity and mortality;
• There is widespread consensus amongst geneticists and epidemiologists that genetic factors contribute only marginally to ethnic inequalities in health.

Surgical Outcomes in Patients with COVID-19

Whilst we know are starting to understand the impact of COVID-19 from a clinical perspective, little is known about the impact on those with COVID-19 who require medical procedures/input for something other than COVID-19.

Analysis of patients undergoing surgery finds that pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and is associated with higher mortality. Men aged 70 years and over who have emergency or major elective surgery are at particularly high risk of mortality, although minor elective surgery is also associated with higher-than-usual mortality.

Physical distancing, face masks, and eye protection

We’ve recently reviewed the effectiveness of facemask wearing for the general public, , and the UK government has now mandated facemasks on public transport with effect from 15 June, likely spurred on by this excellent analysis by Professor Trisha Greenhalgh.

The impact of all personal protection measures reviewed by the COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors on behalf of the World health Organisation  finds that:

• Current policies of at least 1 m physical distancing are associated with a large reduction in infection, and distances of 2 m might be more effective;
• Wearing face masks protects people (both health-care workers and the general public) against infection by these coronaviruses;
• Eye protection could confer additional benefit.

Diabetes and COVID-19

Diabetes, cardiovascular disease and hypertension are the commonest chronic long-term co-morbidities in people with severe COVID. Analysis seeking to understand the relationship between hyperglycaemia and other modifiable risk factors including obesity, and risk of COVID-19 related mortality in both community and hospital environments provides some insights into this.

The authors report that the total number of deaths per week among people with diabetes in England has more than doubled since 3 April 2020 compared with what would be expected in this period. In addition there was a clear relationship between COVID-19 related death and socio-economic deprivation among people with diabetes of either type; the level of hyperglycaemia was also associated with increased risk of mortality.

Accessing Treatment During Lockdown

The British Heart Foundation (BHF) have reported that half of people with existing cardiovascular disease have had difficulty accessing medical treatment during the pandemic. This includes access to medicine, and cancellation or postponement of planned tests, surgery or procedures. Patients also reported reluctance to put extra pressure on the NHS, and fears about contracting the virus in healthcare settings.

Hydroxychloroquine Controversies

A rare retraction has been issued by the authors of a paper that originally concluded that  hydroxychloroquine or chloroquine decreased in-hospital survival and increased frequency of ventricular arrhythmias (link). The authors state that  the veracity of the data and analyses conducted by Surgisphere Corporation and its founder and our co-author, Sapan Desai, could no longer be relied upon. The supply of flawed, and possibly fabricated data for analysis is at the heart of this controversy.

Data

ONS – Analysis of death registrations not involving coronavirus (COVID-19), England & Wales: 28 December 2019 to 1 May 2020 

It has been clear for some weeks that the simple count of COVID-19 deaths in England & Wales has been significantly lower than the overall excess mortality – what has been less clear is whether these deaths have been related to COVID-19 (and not recorded as such) or deaths not directly related to COVID-19 deaths.

ONS have analysed the causes of excess mortality up to 1 May 2020, and found the largest increases to be from dementia and Alzheimer disease, as well as ‘symptoms signs and ill-defined conditions’ (typically frailty / old age). Their conclusion, based on the information available, is that undiagnosed COVID-19 could help explain the rise in non-COVID-19 excess deaths, although they do note that a full analysis of non-COVID-19 excess deaths will not be available for several months.

Comparing mortality data

We, and other commentators, have noted that it is very difficult to compare COVID-19 mortality figures – the ONS analysis above illustrates how hard it is to compare within a country, as it seems likely that the ‘official’ COVID-19 figures may need to be increased.

Cross-country comparison is also very problematic, and could lead to inaccurate conclusions. For example, it was widely reported that Spain recently recorded no daily COVID-19 deaths on a couple of occasions, but this is based on a change in reporting such that they only add additional deaths if they occur and are reported in the 24 hours before the daily bulletin . Whilst the numbers of COVID‑19 deaths in Spain are lower than in the UK, it is not possible to compare the figures directly.

And finally …

What’s in a name?

The pandemic seems to be influencing the choice of names by new parents. Names such as Cora, Corina and Viola have fallen from favour, whilst ‘secure’ names are more popular. These include Florence, Hero, Hope and Joy for instance

However do spare a thought for the twins Covid and Corona!

5 June 2020