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  • Writer's pictureRichard Cree

Hit By a Bus

Updated: Oct 13, 2020

1st October 2020

UK COVID Deaths - Daily 59 / Total 42,202

James Cook Hospital – Total COVID deaths – 260

All COVID cases within South Tees Hospitals Trust – 26

James Cook Critical Care COVID cases – 6 (1 ventilated)

The sad news today for the people of Middlesbrough and Hartlepool is that they are to join their neighbours from Tyneside and Wearside in a local lockdown. Coronavirus case numbers have continued to rise and so, from Saturday, separate households will no longer be able to meet anywhere indoors. Other restrictions include a ban on spectating at amateur sporting events, advice to avoid care home visits and to restrict journeys to all but essential travel.

In the hospital, the number of cases remains relatively static. There have been a few more admissions to the wards and we have admitted another patient onto the COVID ICU for CPAP. However, within the North of England Critical Care Network there are now over 40 patients requiring Intensive Care. Twenty-three of these are requiring mechanical ventilation. Most of them are to be found in the north of the region in the Newcastle and surrounding hospitals whilst numbers are rising more slowly on Teesside.

I seem to be coming across more and more people who are doubting the need for the various measures that have been put in place. Most have their own views on what is and what isn’t necessary but there are a growing number of people who appear to be basing their opinions on misinformation that is circulating through social media. Everyone is aware of the various conspiracy theories that are out there: the virus was made in a laboratory or it doesn’t exist at all, 5G masts are to blame, coronavirus testing is really detecting the ‘flu, Bill Gates will be controlling you after you are vaccinated, David Icke really is the messiah, etc. etc. etc.

Of course, there is no proof for these theories and so in order for them to be plausible, the evidence from the scientific establishment has to be discredited. Only by sowing doubt and distrust can these beliefs gain momentum. One important example of this is a lack of trust in the system used to record COVID-19 deaths in the UK. This is what I like to call the ‘they didn’t really die of COVID, they were hit by a bus’ theory.

As a result I thought I would discuss how COVID-19 deaths are recorded in a bit more detail. After all, an understanding of what has really happened over the past few months is critical to planning for the forthcoming winter. It turns out that counting the number of people who have died from COVID-19 is more complicated than it might initially appear.

Many people will die from COVID-19 shortly after they are diagnosed but there are some who will die much later after a protracted illness. Intensive Care patients who die after weeks of mechanical ventilation are a good example. Coronavirus can also contribute to a death without it being the main cause. For example, an elderly person may die of a bacterial pneumonia which they would have not developed without first contracting COVID-19 a few weeks before.

The WHO states that: “A COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma).” So we’re back to being hit by a bus again. But what’s clear from this definition is that accurately defining a death as a COVID-19 death requires a clinical assessment.

Back in March, the Government began reporting all deaths that occurred following a positive coronavirus test. This was the figure reported daily by the media. However, there were problems with this system; inevitably some patients had died as a result of other conditions and there were some patients who died from COVID-19 without having a positive test. The inevitable over- and under-reporting meant that this figure was always going to be an approximation.

So, how do you accurately record a COVID-19 death? Such deaths must be identified as such on death certificates which are issued by a registered medical practitioner. Data on the numbers of these certified deaths have been reported each week by the Office for National Statistics (ONS) since 31 March. Unfortunately, there is an inevitable delay in reporting and publishing deaths based on death certificates and so it was impossible to produce an up to date daily figure.

So you had a daily figure that was an approximation and a weekly figure that was more accurate. However, by the end of July, the daily figure that the media were reporting was becoming increasingly inaccurate. This was because the chance of any patient with a positive test dying from some other condition was increasing as time went on.

The other problem was that each country in the UK was doing something different. Scotland, had only been counting deaths within 28 days of a positive test so that their figures did not correlate with the figures from England and Wales.

So Public Health England (PHE) conducted a detailed review of COVID-19 deaths to try to establish a more universal, reliable figure. They looked at all 41,598 deaths that had occurred in England in anyone who had tested positive for COVID-19 up until 3 August. They reviewed death certificates and found that 91% of all deaths reported by PHE in the daily figure had COVID-19 on the death certificate. This wasn’t bad at all for a daily ‘approximate’ figure but for the reasons listed above, the accuracy of this figure would only get worse.

Looking further, they found that 88% of all deaths due to COVID-19 occurred within 28 days of a positive test. If you extended this period to 60 days and counted those who died after 60 days who had COVID-19 on the death certificate then you captured 96% of all COVID deaths.

This was why, on 12th August, all of the UK started using the 28 day figure and the 60 day figures to report daily deaths. It is the 28 day figure that the media uses and you will be familiar with. This is also the one I use at the top of each post to avoid confusion.

By this stage the 28 day figure was 5377 less than the old daily figure. The seeming ‘fall’ in the number of deaths doubtless fanned many a conspiracy theorist’s flames but this correction was necessary to prevent an escalating, inaccurate figure. The current daily 28 figure stands at 42,202 people.

But what of that weekly figure from the ONS? This is by far the most reliable one that we have. It includes all deaths where death certificates list COVID-19 as the direct cause of death or that COVID-19 contributed to the death (like in the elderly pneumonia example I referred to earlier). Unlike the PHE daily figures it also includes anyone who the doctor filling in the death certificate strongly suspected had COVID-19 as well as just those who tested positive. This is in line with the WHO guidance.

The most recent ONS figure (up to 18th September) stands at a sobering 57,113 deaths across the UK.

Of course, if you are a conspiracy theorist then you won’t trust the death certificate process at all. Maybe the Illuminati are forcing me to issue false death certificates? If I don’t do as they wish then doubtless Lord Lucan will feed me and my family to the Loch Ness Monster. Along with Shergar and Elvis.

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Oct 07, 2020

i think that thiz blug is suparb wold recomendd


Richard Cree
Richard Cree
Oct 05, 2020

Hi Elaine Thanks. I agree entirely. The real extent of the damage being done by the spread of misinformation on social media is becoming all too clear. All we can continue to do is to accurately report what is really happening in our hospitals. Cheers, Richard


Oct 05, 2020

Hi Dr Cree

A quick introduction, I’m Dr Elaine Edmunds, a former consultant psychiatrist and college tutor. I’ve been following your blog as you give a well observed account of the reality of Covid 19 for the NHS.

I spend a lot of time challenging Covid deniers. Your blog is a good resource.

Unfortunately this isn’t helped by the intemperate and what I would consider unprofessional language of some medical experts who get media attention... this “ hit by a bus “ statement from Professor Carl Heneghan for starters which has been taken up by conspiracy theorists along with other speculations.

Its important for doctors to stick within their level of expertise when dealing with the press.. and to…


Oct 02, 2020

@emmagaulter @cheryl.mckenna - you want some facts?...I can speak from a position of experiencing both seasonal 'flu and Covid-19. Whilst having flu 2 years ago, I didn't suffer a collapsed lung, pneumonia, haemofiltration (for failing kidneys), being ventilated in a coma for 5 weeks, a tracheostomy, a PEG (stomach feeding tube), foot neuropathy (resulting in me having to learn to walk again), disphonia (vocal cord and tongue palsy), breathlessness, massive fatigue and losing 25 kgs in weight. Tell that to anyone that says COVID-19 is just like 'flu. I owe my life to the dedicated medics like Rich, nursing staff and therapists. Take care everyone.


Oct 02, 2020

@emmagaulter, that's a great idea. I am often hearing "more people die from flu", and whilst I have the usual debates of why it actually is worse, it would be good to hear some facts. The gazette have just published this blog post, and the comments are still astounding (most of them probably haven't even bothered to read it).

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