Ref: FOI/2022/4528
You asked
Please supply deaths caused by Coronavirus (COVID-19), where COVID-19 is the only cause of death listed on the death certificate, broken down by age group and gender between Feb 2020 upto and including Dec 2021.
Please supply the number of autopsies carried out on those where COVID-19 was the only cause stated.
We said
Thank you for your email.
Pre-existing conditions in COVID-19 deaths
Health conditions are recorded on the death certificate only if the certifying doctor or coroner believed they made some contribution to the death, direct or indirect. The death certificate does not include all health conditions from which the deceased might have suffered if they were not considered relevant.
The death certificate (Annex A (PDF, 224KB)) used in England and Wales is compatible with that recommended by WHO. It is set out in two parts. Part I gives the condition or sequence of conditions leading directly to death, while Part II gives details of any associated conditions that contributed to the death but are not part of the causal sequence.
We recommend using our pre-existing conditions methodology to answer this question as it removes any conditions caused by the underlying cause of death.
We define pre-existing conditions as those mentioned in Part 2 of the medical certificate of cause of death. If COVID-19 is mentioned in Part 1 on lines above other conditions also mentioned in Part 1, the last condition mentioned in Part 1 is also considered a pre-existing condition. We don't know exactly how many people who died from COVID-19 had no pre-existing health conditions, only how many did not have a pre-existing condition mentioned on the death certificate. A contributor to the cause of death is expected to have increased the likelihood of death, but this does not mean that the death would have been avoided in its absence.
We use the term "due to COVID-19" when referring only to deaths with an underlying cause of death as COVID-19 and we use the term "involving COVID-19" when referring to deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not.
We would also recommend reading our recent blog on this subject: To say only 17,000 people have died from COVID-19 is highly misleading.
We hold analysis showing deaths due to COVID-19 with no pre-existing conditions by broad age-band in England and Wales in the following publication: Pre-existing conditions of people who died due to COVID-19, England and Wales. This is published quarterly in our Monthly Mortality Analysis publication.
COVID-19 deaths involving post-mortem
Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.
Doctors are required by law to certify the cause of death 'to the best of their knowledge and belief'. That means they use their medical expertise to decide the cause based on symptoms, physical examination, hospital records, laboratory tests, and all the other information available. If death is certified by a coroner, the Coroner's Court follows legal rules of evidence when deciding the causes of death. For deaths involving COVID-19, whether or not there was a positive test result is only one piece of information to be taken into account, alongside the patient's symptoms and other evidence. So, a death can be certified as involving COVID-19 without a positive test, based on any sound medical evidence, like observed symptoms or X-ray images of the lungs. In the absence of a test result, the doctor may sometimes certify the death as 'suspected' COVID-19. A positive test result does not make a death 'count' as involving COVID-19 if COVID-19 did not actually contribute to the death, for example if the person died in an accident.
A post-mortem would be requested if the death was sudden and the cause unknown, if there was no doctor in attendance, or if the death has been referred directly to the coroner by the police. Covid-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death and Covid-19 is not a reason on its own to refer a death to a coroner under the Coroners and Justice Act 2009.
Table 13 in our impact of registration delays on mortality statistics release shows that in 2020 1,615 of the 73,766 (2.2%) of deaths due to COVID-19 had a post-mortem.
The number of autopsy reports that had COVID-19 mentioned for 2021 is provisionally scheduled to be published in January 2023. The final release date will be announced on our Release Calendar.
As such, the information you have requested for 2021 is exempt under Section 22(1) of the Freedom of Information Act 2000, whereby information is exempt from release if there is a view to publish the information in the future. Furthermore, as a central government department and producer of official statistics, we need to have the freedom to be able to determine our own publication timetables. This is to allow us to deal with the necessary preparation, administration, and context of publications. It would be unreasonable to consider disclosure when to do so would undermine our functions.
This exemption is subject to a public interest test. We recognise the desirability of information being freely available and this is considered by ONS when publication schedules are set in accordance with the Code of Practice for Statistics. The need for timely data must be balanced against the practicalities of applying statistical skill and judgement to produce the high quality, assured data needed to inform decision-making. If this balance is incorrectly applied, then we run the risk of decisions being based on inaccurate data which is arguably not in the public interest. This will have an impact on public trust in official statistics in a time when accuracy of official statistics is more important to the public than ever before.
For further enquiries please contact the Data & Analysis for Social Care and Health (DASCH) Customer Services team at Health.Data@ons.gov.uk.