Covid-19 deaths, hospitalisations, vaccinations and classifications

FOI Reference: FOI/2021/3184

You asked

I am aware that you publish data in multiple forms however according to my research it is not possible to split the data out by the correct criteria. I am happy for you to send me data in raw format as an ExCel format which I am able to filter to get the cut of data that I would like.

For this information I would like to see data from the first recorded date of COVID-19 in the UK until the date of request 9th November 2021. I consider the date of first recorded cast according to records January 29th, 2020.

1. How is a death categorised as COVID-19 related? Is this an automated system or is there individual cause of death decided by a doctor and/ or coroner?

2. Does someone who dies due to an unrelated cause (an example such as a road traffic accident) get reassigned to a different cause of death even if they tested positive for COVID-19 in the past 28 days or is it automatically considered COVID-19 related?

3. What is the survival rate of COVID-19 in the UK? I would consider this to be the % of deaths in relation to number of COVID-19 cases.

4. What is the number of hospitalisations in total that have been recorded as a % of COVID cases recorded?

5. How many adverse effects to the COVID-19 vaccine have been reported (in total for all brands of vaccine)?

6. How many deaths due to Influenza were recorded in 2019?

For the following data I would like to know the information since August 1st 2021 to date of request 9th November 2021.

1) How many people who have had

no vaccinations/ dose of vaccination/ doses vaccinations

Have tested positive for covid? How does this translate to be a % of the total of positive COVID-19 cases?

2) What is the % of frontline NHS staff vaccinated with 2 doses?

3) What % of nurses have been vaccinated and what % of doctors have been vaccinated?

We said

Thank you for your request.

COVID-19 death categorisation

When a person dies, in most cases a doctor writes a medical certificate of cause of death (MCCD) which is then recorded in the death registration (at a local authority registration office). The details are printed out as the official 'death certificate' for the next of kin. The same information is sent electronically from the registration office to ONS for us to produce statistics about causes of death. For some deaths, such as when the death was due to an accident or violence, there is a coroner's inquest to establish the facts and the coroner then decides the cause of death and sends their findings to the local registrar.

The doctor or coroner certifying a death can record more than one health condition or event on the form. The medical certificate of cause of death has two parts, Part 1 contains the sequence of health conditions or events leading directly to death, while Part 2 can contain other health conditions that contributed to the death but were not part of the direct sequence.

For statistical purposes one of the health conditions on the certificate is chosen as the 'underlying cause of death'. The underlying cause of death is defined as the health condition or event that started the train of events leading to death and is worked out according to rules from the World Health Organisation (WHO).

You can read in detail about the coding of causes of death and identifying the underlying cause in the ONS User guide to mortality statistics and the WHO International Classification of Diseases (ICD-10) instruction manual.

COVID-19 deaths and external cause deaths

If someone dies in circumstances involving an accident, violence or suspicious circumstances, the case is referred to a coroner for investigation. A post-mortem examination is carried out and usually an inquest is held. The Coroner's Court hears all the evidence and follows legal rules of evidence when deciding the causes of death. It is extremely unlikely that a coroner would find that someone was involved in a traffic accident, or was the victim of violence, because of having COVID-19 or a positive COVID-19 test -- so they would not mention COVID-19 on the death certificate. This applies to any death caused by an accident, violence, poisoning, or other external causes.

Even if in an unusual case a death certificate mentioned both COVID-19 and a traffic accident (or other external causes), the World Health Organisation (WHO) rules for coding deaths mean that the traffic accident would be identified as the underlying cause of death in our data.

With regards to the COVID-19 "within 28 days of a COVID-19 test" methodology for reporting COVID-19 deaths, ONS and UK Health Security Agency (formerly PHE) COVID-19 deaths data are produced in different ways and have different purposes:

•       The daily COVID deaths counts reported on the government's COVID-19 dashboard (produced by UKHSA) shows deaths within 28 days of a first positive laboratory-confirmed test

•       ONS weekly death registrations data for England and Wales, relate to the week that ended 11 days prior and are based on the cause of death reported on the death certificate, thereby not restricted to only deaths that showed a positive test.

More information can be found in a blog by Professor John Newton of Public Health England about the complexities of counting COVID-19 deaths and the different methods used.

COVID-19 UK Survival Rate

Whilst we hold the raw datasets that could potentially be used to estimate survival rates, we do not hold the requested information. This would involve linking the Test and Trace data to the death registration data and would require extensive quality assurance analysis, as the Test and Trace data only cover a subset of people infected with SARS-CoV-2. We are currently exploring this, but at the time of this request, we do not yet have completed the analysis. Under the Freedom of Information Act 2000, Public Authorities are not obligated to create information to respond to requests. This information is therefore not held for FOI purposes.

UK Health Security Agency are better placed to answer your enquiry. They publish a weekly surveillance report which looks at the impact on hospitalisations, infection, vaccine effectiveness and mortality. They can be contacted on InformationRights@UKHSA.gov.uk

COVID-19 Hospitalisations

Whilst we hold information on hospitalisations, we do not hold any analysis on this data. In order to provide this information, we would need to create complex analysis. Under the Freedom of Information Act 2000, Public Authorities are not obligated to create information to respond to requests. We therefore do not hold this information for FOI purposes.

UK Health Security Agency (UKHSA) would be better placed to answer your enquiry. They publish a weekly surveillance report which looks at the impact on hospitalisations, infection, vaccine effectiveness and mortality. They can be contacted on InformationRights@UKHSA.gov.uk

Adverse reactions to COVID-19 vaccination

We do not hold this information. Adverse reactions are reported using the Yellow Card Scheme. Please contact Medicines and Healthcare Regulatory Agency for further information.  They can be contacted on info@mhra.gov.uk

Deaths in the UK due to Influenza in 2019

We are responsible for the production of Mortality data for England and Wales, this is driven by information collected from the death certificate at death registration. National Records Scotland (NRS) and Northern Ireland Statistics and Research Agency (NISRA) are responsible for statistics pertaining to Scotland and Northern Ireland. They can be contacted at foi@nrscotland.gov.uk and info@nisra.gov.uk respectively.

All the conditions mentioned on the death certificate are coded using the International Classification of Diseases, Tenth Revision (ICD-10) the coded mortality data available up to end of December 2020 is coded to version 2014 of the ICD10 framework. Influenza is coded under the ICD-10 code J09 -- J11

Using our NOMIS interactive webservice we have populated the following table:

Please also see the following instructions on how to use this service in case this is helpful:

• Select the geography (England and Wales, regional or by local authority).
• Select dates - 2013 to 2020 or tick all.
• Select Age - All ages or 5-year age bands.
• Select Gender - Total or Male/Female
• Select rates - All deaths, rates or percentage of population for example.
• Select cause of death (ICD10 code search is available). Influenza J09-J11
• Select format (Excel or CSV for example)

If you have any questions regarding the mortality information provided in this response, please contact Health.Data@ons.gov.uk

Vaccination information:

The COVID-19 Infection Survey is a household survey that estimates the number of people testing positive for infection and for antibodies in the UK. Our statistics refer to the number of current COVID-19 infections within the population living in private residential households. We exclude those in hospitals, care homes and/or other communal establishments. In communal establishments, rates of COVID-19 infection are likely to be different.

The information you have requested regarding infections by vaccination status is available from the UKHSA (UK Health Security Agency, previously Public Health England) COVID-19 surveillance reports which can be found here. The relevant figure is on page 29. Please pay attention to the note accompanying the figure. In the context of very high vaccine coverage in the population, even with a highly effective vaccine, it is expected that a large proportion of cases, hospitalisations and deaths would occur in vaccinated individuals, simply because a larger proportion of the population are vaccinated than unvaccinated and no vaccine is 100% effective. For more information, you can contact UKHSA via email at informationrights@ukhsa.gov.uk.

You may also be interested in the Office for National Statistics COVID-19 infection survey technical article on positivity after vaccination and accompanying dataset, which includes the number of people who test positive after one and two dose vaccination from 1 December 2020 to 31 May 2021. Alongside this, you may also be interested in our technical article on the impact of vaccination on testing positive and accompanying dataset, which includes the risk ratios of testing positive by vaccine exposure from 1 December 2020 to 14 August 2021.

You can find the numbers of NHS trust workers and frontline NHS workers who have been vaccinated by first, second and booster dose in the weekly announced vaccinations datasets. These data are taken from the National Immunisation Management System alongside the NHS electronic staff records.

Further information and an overview of data about the coronavirus (COVID-19) pandemic from the Office for National Statistic (ONS) and other sources can be found in our Coronavirus (COVID-19) latest insights tool.