England, Wales and Scotland are among nations with the highest numbers of excess deaths as a result of the first wave of the COVID-19 pandemic, a new study has found.


The research, led by Imperial College London, analysed weekly death data from 19 European countries, Australia, and New Zealand, between mid-February and end of May.

The results, published in the journal Nature Medicine, showed England and Wales and Spain experienced the largest increase in mortality, with nearly 100 excess deaths per 100,000 people.

According to the researchers, this is an increase of 37 per cent for England and Wales and 38 per cent for Spain, when compared to how many deaths would have been expected without the pandemic.

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In Scotland, the excess death deaths rate was 84 per 100,000 people during the first wave, which is a 28 per cent increase from average expected deaths.

Study co-author Dr Jonathan Pearson-Stuttard, from the Imperial College London’s School of Public Health, said a number of factors may have influenced why England, Wales and Scotland had higher number of deaths than some of the other nations.

He said that a combination of the general population health, the resilience of the public health and social care system, and the policy response to the pandemic, may have contributed to “what looks like the highest excess deaths across the 21 countries”.

We cannot dismantle the health system through austerity and then expect it to serve people when the need is at its highest
Professor Majid Ezzati, Imperial College London

The first wave of the COVID-19 pandemic has identified "just how frail and vulnerable our society and our economy is to our public’s ill health", said Dr Pearson-Stuttard.

“So, everything that has been [an] issue – whether that’s obesity, whether that’s relative inequalities and so forth – each of those are risk factors for the worse COVID outcomes, as individuals or communities or whole nations.

“On many of those aspects, our public health has lagged behind other countries for some years, and the COVID-19 pandemic has brought that to the fore.”

Disruptions to healthcare services and the social and economic impacts of the pandemic also led to increased deaths during the pandemic, said the researchers.

Argument for New Zealand-style Zero-COVID strategy strong, experts say © Getty Images
Some experts have called for governments around the world to adopt a “zero-COVID” strategy like in New Zealand © Getty Images

“Epidemiologists and statisticians have been saying, ever since the start of the current pandemic, that the best way to assess the effects of the new virus on mortality is to look at excess deaths," said Professor Kevin McConway, an Emeritus Professor of Applied Statistics at The Open University. "Just looking at the numbers of deaths attributed to COVID-19 is problematic. What counts as a COVID-19 death is defined differently in different countries.

"Looking at excess deaths isn’t new – it’s been used for many years to look at effects of influenza outbreaks, or extreme weather events, for example.

"Because this new analysis only goes up to the end of May, and because it can’t provide a lot of detail in comparing policy choices so far, I don’t think it can provide much clear guidance on policies that should be used in the situation in which we currently find ourselves – in the UK or in any of these countries," said Prof McConway.

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The authors of the study estimate that an additional 206,000 deaths had occurred as a result of the pandemic in the 21 countries included in the analysis.

The countries were Australia, Austria, Belgium, Bulgaria, Czechia, Denmark, England and Wales, Finland, France, Hungary, Italy, Netherlands, New Zealand, Norway, Poland, Portugal, Scotland, Slovakia, Spain, Sweden and Switzerland.

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But they found very little difference in the death rate between men and women – 105,800 deaths were in men and 100,000 in women, despite COVID-19 having a more severe effect on men.

Professor Majid Ezzati, the paper’s senior author, said one of the reasons for the lack of difference could be down to missed COVID-19 diagnoses in care homes.

“In some countries, the number of women who are in care homes is larger," said Prof Ezzati. "Testing may have been quite restricted and limited there and it may just be the case that some infections were missed.”

He also said that women, on average, tend to live to older ages compared to men, and that other medical causes may have been a contributing factor.

In addition, the researchers said that nations with the highest excess deaths were those who have had a lower investment in their health systems and health protection.

For instance, they said, Austria, which had very low numbers of deaths from all causes, has nearly three times the number of hospital beds per head of population than the UK.

“Long-term investment in the national health system is what allows a country to both respond to a pandemic, and to continue to provide the day to day routine care that people need," said Prof Ezzati.


“We cannot dismantle the health system through austerity and then expect it to serve people when the need is at its highest, especially in poor and marginalised communities.”

What is the R value?

The reproduction number – often called the R value or R number – is a measure of a disease’s ability to spread. It tells us how many people a single infected person will pass on the disease to.

The R number for COVID-19 that’s being quoted in the media and government briefings is what’s known as the ‘effective’ reproduction number. This value can go up and down.

We can reduce R by making it harder for the disease to spread, by implementing measures such as social distancing, closing restaurants and non-essential shops, and encouraging people to stay at home.

Every disease also has what’s called a ‘basic’ reproduction number, R0, which is the fixed value of R if no measures are put in place. For example, measles is highly contagious, with a R0 as high as 18, while COVID-19 has a R0 of around three.

So if COVID-19 was allowed to spread through the population, an infected person would, on average, give the disease to three other people.

But if all these people are practising physical distancing, then the virus can’t spread so easily and the effective R value goes down.

The crucial thing is to keep R below 1. If we can do this, then the number of new cases dwindles and the outbreak will eventually come to a halt.

Conversely, if R rises above 1, then we run the risk of rapidly escalating case numbers that would require stronger measures to keep the virus under control.

Because of this, R is used by governments to assess how we are doing in our efforts to stop the spread of COVID-19, and to adjust our actions, if needed.

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Amy ArthurEditorial Assistant, BBC Science Focus

Amy is the Editorial Assistant at BBC Science Focus. Her BA degree specialised in science publishing and she has been working as a journalist since graduating in 2018. In 2020, Amy was named Editorial Assistant of the Year by the British Society of Magazine Editors. She looks after all things books, culture and media. Her interests range from natural history and wildlife, to women in STEM and accessibility tech.