Today, the Scientific Advisory Group for Emergencies (SAGE) released a paper estimating the impacts of the coronavirus (COVID-19) on England’s mortality and morbidity. This was a collaboration between the Office for National Statistics (ONS), the Department of Health and Social Care (DHSC), the Government Actuary’s Department (GAD) and the Home Office. It was discussed by SAGE on 23 July 2020.

This work is significant because it presents a broad collection of quantified estimates of the coronavirus pandemic’s direct and indirect effects on the health of the population in a developing situation where little evidence is available. These estimates enable SAGE to understand the impacts of scenarios more fully, and to consider the evidence available to inform government decisions to tackle the coronavirus accordingly.

The report considers the impact of the coronavirus, and the government’s interventions to tackle it, in four categories:

  • those who contract COVID-19
  • outcomes for contracting COVID-19 worsened because of a lack of NHS critical care capacity
  • changes to health and social care made to respond to the coronavirus pandemic
  • factors affecting the wider population, both from social distancing measures and economic impacts

This is an updated and improved version of a report by the same four departments, discussed by SAGE on 8 April and released on 12 June. It differs from the previous paper in several ways, most importantly by including estimates of the quality-adjusted life years (QALYs) lost in each of these categories, through deaths and also for those who do not die but may experience health impacts. Both papers are based on scenarios agreed by SAGE, rather than forecasts, and so do not represent predictions of the future trend. The estimates presented in the main body of the paper are for England only, but illustrations of how UK-level estimates would look are included in an annex.

The ONS published a blog on 12 June to coincide with SAGE’s release of the first paper. This outlined the large amount of work to understand the coronavirus’s impacts, which has been conducted and published since delivering the first excess deaths paper to SAGE in April. Since submitting the second paper to SAGE, results have been published for the relationship between COVID-19 and socioeconomic deprivation, and the coronavirus's economic impacts, both of which are relevant themes to this cross-departmental piece of work.

Development of analysis for COVID-19’s impacts on excess deaths and morbidity is planned to continue, with updates to present newer scenarios with the same methodology. As more data become available and our understanding of COVID-19 improves, so too can these estimates.

The main points of the paper for SAGE are summarised below, and the whole paper can be found in SAGE’s Meeting 48, 23 July meeting papers.

Main points from “Direct and Indirect Impacts of COVID-19 on Excess Deaths and Morbidity”

  • This paper estimates the number of excess deaths in England from COVID-19, changes to the healthcare system, and lockdown measures; health impacts are measured using Quality-Adjusted Life Years (QALYs).
  • These estimates are based on a scenario of weekly COVID-19 deaths continuing at approximately the same level as observed in mid-July, and the impacts of a two-month lockdown; they are not a forecast.
  • Direct COVID-19 deaths account for the majority of all excess deaths; approximately 65,000 excess deaths are estimated as a result of contracting COVID-19 between March 2020 and March 2021.
  • There are no deaths of COVID-19 patients estimated to be the result of receiving lower quality care because of NHS critical care capacity being breached; this is because it is judged that critical care capacity has not been breached to date.
  • Approximately 16,000 excess deaths are estimated because of changes in emergency care and social care within a year from March 2020 – the majority of these are deaths in care homes; changes to elective care, primary, and community care are not expected to result in deaths in the short term in this scenario.
  • Between March 2020 and March 2021, the wider impacts of social distancing measures are estimated to reduce mortality, resulting in 7,000 fewer deaths than expected; the main cause of this change is less air pollution early in the outbreak, though the results of that improvement to air quality are expected to actually occur over the longer term.
  • Over the whole period presented from March 2020 to more than five years from now, there are approximately 25,000 excess deaths resulting from social distancing and economic impacts in the chosen scenario.
  • The negative health impacts of social distancing amount to a loss of 88,000 QALYs up to March 2021, so mortality improves over this period but health worsens – the main causes of this are increases in: depression; musculoskeletal disorders, resulting from more people working from home without suitable equipment; and domestic abuse.
  • Socio-economic effects are estimated to have the greatest impact on quality of life of all categories investigated, over the short and long term combined; from March 2020 to more than five years from now, the impacts of lockdown and a resulting recession are estimated to reduce England’s health by over 970,000 QALYs – the health impacts of contracting COVID-19 are still unclear in the long term, but between March 2020 and March 2021, these represent 570,000 lost QALYs.
  • While these negative health impacts of lockdown exceed the impacts of COVID-19 directly, they are much smaller than the negative impacts estimated for a scenario in which these measures are not in place; without these mitigations, the impact of direct COVID-19 deaths alone on both mortality and morbidity would be much higher – an estimated 439,000 excess deaths resulting from COVID-19, and 3,000,000 QALYs lost.