‘If the truth is numerical, dry, factual, something that requires effort and study, then it is not truth for them, not something that can bewitch them.’
— Bertolt Brecht
‘Propaganda works best when those who are being manipulated are confident they are acting of their own free will.’
— Joseph Goebbels
Table of Contents
- Five Difficulties in Writing the Truth about the Coronavirus Crisis
- Deaths Registered Weekly in England and Wales, Provisional: Week Ending 17 April 2020
- Comparison of Weekly Death Occurrences in England and Wales: Up to Week Ending 17 April 2020
- User Guide to Mortality Statistics
- The Different Uses of Figures on Deaths from COVID-19 published by DHSC and the ONS
- Irrational Belief and Political Responsibility
1. Five Difficulties in Writing the Truth about the Coronavirus Crisis
In my most recent article on the coronavirus crisis, Giorgio Agamben and the Bio-politics of COVID-19, I ended by saying that I would continue to read, as others apparently are not, the official statistics on deaths attributed to COVID-19, in order to show that they do not justify the dictatorial regulations and intrusive surveillance measures being imposed on us by the UK Government.
This Tuesday, as on every Tuesday since 13 March this year, the Office for National Statistics (ONS) published its latest figures on deaths registered in England and Wales up to the week ending 17 April. Although 11 days behind due to the time it takes to collate the data from various sources, the ONS figures have found general acceptance as the most authoritative record of the extent and threat of COVID-19, and the official basis for the Government measures being taken to reduce both.
As happened last Tuesday and the Tuesday before that, these figures have been quoted by our newspapers, media outlets and on social media as irrefutable proof of the seriousness of the coronavirus pandemic, and therefore as further evidence that the raft of regulations empowering the police, the unscrutinised amendments to legislation, and the intrusions into our privacy and covert deals with tech companies the UK Government is pushing through during this de facto State of Emergency are ‘justified, proportionate and legal’.
What my analysis of these statistics will show is that, to the contrary, they are nothing of the kind — not by challenging their veracity, but by looking closely at the criteria by which the ONS, by their own account, has arrived at these figures, which are compiled from the Department of Health and Social Care, NHS England, Public Health Wales, and the Care Quality Commission. This article will follow how the Department of Health and Social Care has deliberately manipulated how a ‘COVID-19 death’ qualifies as such, and how the World Health Organisation has issued directives on how such a death is certified, both of which have resulted in the gross exaggeration of the numbers of deaths attributed to the so-called ‘coronavirus pandemic’.
In its rush to give credibility to the Government’s enacting of these emergency powers, which have removed our human rights and civil liberties and replaced our political system of parliamentary democracy with the executive powers of a police state utilising all the technology of the surveillance industry, our media has not scrutinised these criteria — or, rather, it has deliberately closed its eyes to them. At this moment in time, therefore, looking closely at how COVID-19 deaths are registered as such in the UK is one of the ways in which we can begin to speak what almost nobody is speaking about this crisis event: the truth.
As always, however, the truth isn’t easy to speak, and still less to write, particularly in an era when written analysis and reasoned argument have been supplanted by the 140-character memes of Twitter and the easily consumed graphs being published by papers like the Financial Times. In 1935, at a parallel moment in the rise of a dictatorship legally founded on a State of Emergency (the familiarly titled ‘Decree for the Protection of People and State’), the German writer, Bertolt Brecht, published an article titled Five Difficulties in Writing the Truth. These were: 1. The courage to write the truth in the face of threats and censorship; 2. The ability to find the truth among the disinformation and lies with which we are inundated by mass media; 3. The skill to turn the truth into a weapon against the propaganda of Governments and their allies; 4. The judgement to identify in whose hands the truth can become effective; and 5. The cunning to disseminate the truth among as many of these people as possible. 85 years is a long time, though, so I want to add a contemporary gloss to these difficulties:
- The courage to write the truth is, perhaps, for each of us to find within ourselves, but this is more often determined by the material disposition to do so that is dependent upon our independence from censorship by, for example, an employer. This is the case with those nurses and doctors who have been censored by the NHS from speaking about coronavirus on pain of losing their jobs.
- The ability to find the truth is determined not only by the education or training in how to first research and then understand the documents containing it, but also with the means and time to find them, both of which are often not available to those scraping a living under capitalism. In this, as in so many other ways, the educated middle classes from whom our intelligentsia is supposed to be drawn, but who instead spend their free time repeating and retweeting media propaganda without taking the trouble to verify its truth, have my complete contempt as the unthinking agents of the Government they unwittingly serve.
- When users of Twitter and Facebook posters can reach far more people than the most powerful propagandists of Brecht’s time, the ability to turn every bit of information into an ideological weapon is available to everyone. Unfortunately, with the size of their audience determined by the popularity of what they write rather than its truth, these weapons are being deployed overwhelmingly in the service of the Government, which has instructed users of social media not to disseminate anything that contradicts its narrative. Whether any of us has the skill to make our dissenting voices heard above the white noise of online propaganda and the censorship of online platforms is a question this crisis event will pose in the months and years to come.
- With radicals, socialists, anarchists and communists that have disagreed on every social and political issue in the UK for the past 20 years all suddenly united in their eagerness to blame, chastise and demand of the Government that it increase its measures to stop the spread of SARs-CoV-2 and impact of COVID-19 (even when few distinguish between the two), I admit that I lack the judgement to identify to whom I am writing, in whose hands the truth should best be placed, and what possible weapon can be made from it — not when there is such a small audience inclined to listen to the truth, let alone hands ready to wield it. More than the expected collusion of middle-class liberals with the Government they elected to office, the collaboration in spreading the lies of this Government by the so-called political Left in this country is, perhaps, the clearest sign of how ripe we are for fascism.
- Finally, while Brecht’s article, written from exile in Denmark, was first published in Paris, Basel and Prague in the communist journal Unsere Zeit, and later smuggled into Nazi Germany as a pamphlet under the title Practical Tips for First Aid, it received little response at the time, and I don’t expect a similar ruse to be any more effective 85 years later. But I will recall that, on the beam supporting the ceiling in Brecht’s study in Svendborg, he had written the words: ‘Truth is concrete’.
The Office for National Statistics is fairly transparent about the criteria through which they arrive at the figures they are publishing on the official deaths attributed to Coronavirus Disease 2019 (COVID-19), the symptoms developed in a small percentage of people who have contracted Severe Acute Respiratory Syndrome Corona Virus 2 (SARs-CoV-2). In fact, so open have they been about these criteria that it’s not impossible to suppose that the ONS is inviting a journalist or newspaper to expose just how open those criteria are to exaggerating the official number of deaths. If that’s the case, they may be waiting a long time. Although the ONS is the executive office of the UK Statistics Authority, a non-ministerial department, and therefore has a degree of independence from the UK Government, it reports directly to Parliament, and therefore according to criteria set by UK legislation. With Parliament adjourned for 4 weeks and Members placed under the same regulations on social distancing as the rest of us by the Government’s declaration of a de facto State of Emergency, it is unclear exactly who has laid down the criteria by which someone dying in the UK is designated a ‘COVID-19 death’: possibly the Department of Health and Social Care; possibly the World Health Organisation. But to understand as clearly as possible what those criteria are, I am going to quote extensively from — and comment in detail on — four pages from the Office for National Statistics website: the first recording deaths registered in England and Wales up to the week ending 17 April, 2020; the second comparing weekly deaths in England and Wales up to the same date; the third the website’s user guide to mortality statistics; and the fourth on the different uses of figures on deaths from COVID-19 published by the Department of Health and Social Care and the Office for National Statistics. Unfortunately, Brecht was right: the truth is concrete, and it takes a lot of hammering to release it from the lies in which it has been hidden.
The following indented passages are all quoted from the relevant webpages of the Office for National Statistics (abbreviated as ONS), with the section title and number given in bold for easy reference. All italics are mine. My commentary is flush with the left-hand margin. The contents of the ONS webpages overlap with each other, so there is some repetition of points, though these deserve repeating.
2. Main points
- ‘The provisional number of deaths registered in England and Wales in the week ending 17 April 2020 (Week 16) was 22,351; this represents an increase of 3,835 deaths registered compared with the previous week (Week 15) and 11,854 more than the five-year average; this is the highest weekly total recorded since comparable figures began in 1993.
Although limited to its remit of England and Wales and delayed by 10 days, the ONS record of overall deaths has become the accepted indicator of the severity of the coronavirus epidemic in the UK, from which newspapers such as the Financial Times have extrapolated that the actual number of deaths across the UK is more than double the ONS figures. Accompanied by simplistic charts showing sharply rising mortality rates, it is these figures that have confirmed the warnings about the threat of COVID-19 and the proportionality of the Government’s response.
However, if we look at the accompanying table published by the ONS (below), we can see that, in week 16 alone, 5,157 of the recorded deaths in England and Wales were among those aged 90 years and older. Of the total deaths in week 16 leading to an increase of 11,854 over the average number of deaths over the last five years, 13,441 were over 80. With the average life expectancy in the UK 81.4 years old, is this really evidence of a deadly epidemic, or of elderly and sick people dying in a more concentrated period than usual? Neither the ONS, the NHS, the DHSC or the CQC has provided information about the presence of co-morbidities (pre-existing illnesses) that one would expect to find in so elderly a demographic of supposedly ‘COVID-19 deaths’.
- ‘Of the deaths registered in Week 16, 8,758 mentioned “novel coronavirus (COVID-19)”, which is 39.2% of all deaths; this compares with 6,213 (33.6% of all deaths) in Week 15.’
Interestingly, this means that, even accepting the accuracy of 8,758 deaths being attributed to COVID-19 in the week ending 17 April, at least 3,096 of the deaths in excess of the five-year average for this week were due to other causes. 1,776 of these are listed as ‘deaths where the underlying cause was respiratory disease’, but as the chart clarifies: ‘if a death had an underlying respiratory cause and a mention of COVID-19, then it would appear in both counts.’ In other words, these 1,776 deaths are not in addition to the 8,757 in which COVID-19 ‘was mentioned on the death certificate’, but overlap with the latter. How many the chart does not say; but between 1,320 and 3,096 deaths in excess of the five-year average for week 16 did not have COVID-19 even mentioned on the death certificate. So what caused this increase? The logical answer is that the lockdown measures imposed on the UK, in which life-saving operations have been cancelled; in which staff from already under-staffed hospitals have been quarantined for testing positive for SARs-CoV-2, even if they display no or mild symptoms; in which vulnerable people of all ages have been either isolated in their homes away from their families and support networks for weeks on end, or forced to live in overcrowded homes, sometimes within violent households; in which people have been forced to watch the businesses and homes they have spent a lifetime building and paying for fall into bankruptcy and receivership; in which, offered nothing more than a future of infinitely extended social distancing, people have taken their own life. What of these deaths, which comprise maybe a quarter of the deaths in excess of the average for this week, and more than a third of the deaths attributed to COVID-19? Do these constitute mere collateral damage — as the US Army calls the civilian dead in its never-ending War on Terror — in our own war against the illusory threat of COVID-19?
- ‘Of deaths involving COVID-19 registered up to Week 16, 77.4% (14,796 deaths) occurred in hospital with the remainder occurring in care homes, private homes and hospices.
I will return to this in more detail in Part 3 of this article, but many of the 3,835 additional death certificates that mention COVID-19 from the previous week is due to the 32.6 per cent of deaths that have occurred outside of hospital, and in particular in care homes, which have grabbed the press headlines and Twitter feeds recently. We’ll come back to how and why these have been included in the Government’s official death toll of COVID-19 deaths.
- ‘The number of overall deaths in care homes for Week 16 was 7,316; this is 2,389 higher than Week 15, almost double the number in Week 14 and almost triple the number in Week 13.’
Specifically, of the 11,854 additional overall deaths for the week ending 17 April over the five-year average for week 16 of the year, 7,316 of them, or 62 per cent, occurred in care homes. This, and not a sudden increase in deaths from COVID-19 across England and Wales, is the reason for the rise in overall deaths to the highest since records began in 1993. And these deaths, as we might expect in care homes, are among the very old, with 4,444 deaths in this week among those aged 85-89, and 5,157 deaths among those aged 90 and older.
3. Deaths registered by week
‘The number of deaths mentioning “Influenza and Pneumonia” on the death certificate (without COVID-19) decreased from 2,003 in Week 15 to 1,931 in Week 16. There were 3,220 deaths in Week 16 that mentioned both “Influenza and Pneumonia” and COVID-19 on the death certificate.’
To recap, of the overall deaths in England and Wales in week 16 of this year, 1,776 were listed as ‘deaths where the underlying cause was respiratory disease’; 8,758 were deaths ‘where COVID-19 was mentioned on the death certificate’, and 3,220 mentioned both COVID-19 and influenza and pneumonia. It is worth asking, therefore, why, given the similarity of the symptoms of Coronavirus Disease 2019 to other respiratory diseases such as influenza and pneumonia, and the sudden increase in deaths among those over 85 in care homes, the number of deaths mentioning influenza and pneumonia on the death certificate has decreased from week 15. This suggests a choice being made by the doctors or coroners filling out the death certificate, or the recorders of these deaths compiling these statistics, to identify COVID-19 as the cause of death over other respiratory diseases. In other words, the decrease in respiratory diseases as a cause of death in a week when overall deaths are rising is a product of the taxonomy of COVID-19 deaths.
‘In Week 16, 47.8% of all deaths mentioned “Influenza and Pneumonia”, COVID-19, or both. In comparison, for the five-year average, 19.4% of deaths mentioned “Influenza and Pneumonia”. “Influenza and Pneumonia” has been included for comparison, as a well-understood cause of death involving respiratory infection that is likely to have somewhat similar risk factors to COVID-19.’
It is for this reason, I suspect, that the ONS has included these comparative figures for death certificates mentioning influenza and pneumonia: not only because of the similarity and familiarity of their symptomatology to COVID-19, but also because the identification of the presence of SARs-CoV-2 in the deceased under the current testing guidelines, which has never been conducted in the UK during previous epidemics of seasonal influenza, has established a causal connection that might not exist between potentially life-threatening symptoms such as pneumonia and testing positive for COVID-19, when numerous other, unidentified co-morbidities might be as or more responsible for the death of the deceased.
According to Dr. John Lee, a recently retired professor of pathology and a former NHS consultant pathologist, it is not the practice in the UK to test patients who have been admitted to hospital with a respiratory infection for a particular influenza virus, nor to list their deaths as caused by respiratory disease. Instead, the cause of death is typically recorded as pneumonia, or attributed, where one is present, to a contributing and far more serious disease, such as cancer, or leukemia, or diabetes, or other chronic diseases affecting the heart, lungs, kidneys or liver. That is until now. On 5 March a statutory instrument was made into law by the Secretary of State for Health and Social Care, Matt Hancock, that added COVID-19 to the list of notifiable diseases, and SARs-CoV-2 to the list of notifiable causative agents. This change in law was made by adding both to the Health Protection (Notification) Regulations 2010, and means that General Practitioners are required as a statutory duty to report all suspected cases of COVID-19 to Public Health England. Notifiable diseases include such extinct and rare conditions as botulism, smallpox, yellow fever and leprosy, and rare causative agents such as anthrax, cholera, plague and rabies, most of which most doctors will never see in their lives. The same day this change in law was made the first death attributed to COVID-19 was officially recorded by Public Health England. As a result of this pivotal change in medical taxonomy, COVID-19 is now the official cause of 39.2 per cent of all deaths in England and Wales in the week ending 17 April, even when 60 per cent of the deceased were over 80, even when 62 per cent were in care homes. Did none of these people die of something other than COVID-19, something far more serious, that would have made them equally susceptible to seasonal influenza — which is not a notifiable disease — any other year?
4. Deaths registered by age group
‘In Week 16 (week ending 17 April 2020), there were no deaths registered involving the coronavirus (COVID-19) in the youngest age group (that is, those aged 1 year or under). The highest number (3,413) of COVID-19 deaths were among those aged 85 years and over, however, the highest proportion of deaths involving COVID-19 out of all causes was among those aged 65 to 74 years (42.7%).’
In fact, if we look at the far more detailed tables published by the ONS (below), we can see that, of the 1,768 people under the age of 60 who died in England and Wales in the week ending 17 April, 481 of them, or 27 per cent, had COVID-19 ‘mentioned’ on their death certificate as a possible or contributing cause, or as a symptomatology similar to the deceased, or because they tested positive for SARs-CoV-2 at the time of death.
6. Deaths registered in the year-to-date, Week 1 to 16
‘Looking at the year-to-date (using the most up-to-date data we have available), the number of deaths is currently higher than the five-year average. The current number of deaths is 207,301, which is 22,085 more than the five-year average. Of the deaths registered by 17 April 2020, 19,112 mentioned the coronavirus (COVID-19) on the death certificate; this is 9.2% of all deaths.’
Averages, though, are not an accurate measure of what has gone before, even within the last five years. By week 16 of 2014, for example, following the influenza epidemic of that winter that was associated with 28,330 deaths in England alone, there was a total of 191,261 deaths in England and Wales, 16,040 less than in 2020. And in week 16 of 2018, after the 26,408 deaths associated with the influenza virus that season, there was a total of 198,943 deaths, just 8,358 less than in 2020 (below). In the week ending 17 April of this year alone there were 5,157 deaths of people aged 90 years and over in England and Wales, 3,413 of them attributed to COVID-19. Yet it’s on the basis of this increase of an average of 522 deaths per week this year out of a population of 56 million people in England and Wales that the Government has imposed the lockdown of the entire UK, the suspension of our civil liberties, and the removal of our legislature.
Given that 46,223 of the 217,311 deaths that have occurred so far this year in England and Wales — 21 per cent of all the deceased — have been people 90 years and older — some of whom, given the likely effect of co-morbidities on their state of health, might have died at some time during the year whether the coronavirus had spread to the UK or not — is it not reasonable to expect a reduction in deaths for the rest of the year once the coronavirus epidemic has tailed off, as it currently is doing, with the peak day for deaths on 10 April? It is even possible that, by the end of 2020, the total number of deaths might be lower than in 2018, during which few of us were even aware of an influenza ‘epidemic’ in the UK, let alone placed under prohibitions on our movement, actions, rights, liberties, privacy and political system by the UK Government? Are these not questions we should be asking — ourselves as well as our Government — before accepting these prohibitions without question?
2. Main points
- ‘A total of 19,112 deaths involving COVID-19 were registered in England and Wales between 28 December 2019 and 17 April 2020 (year to date).
- ‘Including deaths that occurred up to 17 April but were registered up to 25 April, of those we have processed so far, the number involving COVID-19 was 21,284 for England and 1,016 for Wales.
In fact, both these figures are contradicted by the ONS table above recording a total 19,093 deaths up to week 16 of 2020 ‘where COVID-19 was mentioned on the death certificate’, and the 22,351 total deaths; but in my experience figures from different sources rarely match exactly, and the difference is only 19 in the former count and 51 in the latter. This does at least clarify the difference between deaths registered before 17 April and those that occurred up to 17 April but were registered afterwards, in this case up to 25 April. More important is the new addition of deaths occurring in care homes, described here as ‘COVID-19 related’:
- ‘This week we have included Care Quality Commission (CQC) data on notifications of COVID-19 related deaths explicitly stated as occurring in care home settings; from 10 April to 17 April, these total 1,968 deaths, which closely matches the 1,999 COVID-19 related deaths in care home settings that were registered in England over the same time period.’
These 1,968 ‘COVID-19 related deaths’ in care homes in the week ending 17 April constitute 27 per cent of the 7,316 total deaths in care homes over the same week that we looked at above; and 22 per cent of the 8,758 total deaths over the same week in which COVID-19 was ‘mentioned on the death certificate’. It’s important, therefore, in assessing the contribution of COVID-19 in raising overall deaths to ‘the highest weekly total recorded’, to understand how deaths in care homes qualify as ‘COVID-19 related’.
Difference between ONS, DHSC, NHS England and PHW figures
‘The difference between the NHS England and PHW figures and the ONS figures by date of death is because of the wider coverage of the ONS figures, including deaths outside of hospital and those where COVID-19 was reported on the death certificate but there was no positive test. Looking at the year to date, 22.6% of deaths in England and Wales registered by 17 April involving COVID-19 occurred outside hospital (4,316 deaths).’
First of all, there is nothing new about how the ONS is recording deaths that occur outside of hospitals in which COVID-19 is mentioned or reported on the death certificate but there was no positive test for SARs-CoV-2. I continue to insist on this distinction, since COVID-19 is the disease, which manifests itself in mild or severe symptoms such as headache, sore throat, coughing, loss of taste or smell, shortness of breath and fever, while the so-called ‘COVID-19 test’ is for the coronavirus-2 that can cause it. A swab testing positive for the latter does not mean a person has the former, as the elision of the two in everything I’ve read about testing and the numbers of cases encourages us to believe. Symptoms are the physical manifestation of the disease, which run from cold-like to life-threatening; infection means merely that someone has a virus that in 80 per cent or more of people will not develop into symptoms, or into only very mild symptoms requiring no more remedies than those for a common cold. This is important to remember always, but especially in assessing the identification of COVID-19 as a contributing or determining factor in deaths in care homes in which ‘there was no positive test’ for SARs-CoV-2.
Deaths in care homes
‘The CQC is the independent regulator of health and social care in England. The data provided by the CQC are counts of deaths each day of care home residents who died in care homes, by date of notification. The data are from 10 April when CQC introduced a new way to understand whether COVID-19 was involved in the death. A death involving COVID-19 is based on the statement from the care home provider to the CQC: the assessment of whether COVID-19 was involved may or may not correspond to a medical diagnosis or test result or be reflected in the death certification.’
This bears repeating almost verbatim, so astonishing is it as criteria for establishing the cause of death during an epidemic that has justified the lockdown of the whole of the UK. In order to be added to the official tally of COVID-19 deaths, from 10 April the Care Quality Commission (CQC) can state that any death in care homes ‘involved’ COVID-19 without a medical diagnosis of the cause of death having been made, without a test for SARs-CoV-2 having been made, and without COVID-19 even being mentioned on the death certificate. One wonders on what basis such an involvement was inferred and by whom. Did the care home provider, which includes a range of private agencies such as Allied Healthcare and Bupa Home Healthcare, establish the involvement of COVID-19 in their client’s death by observing symptoms that are so similar to pneumonia and other respiratory diseases that the ONS has included the deaths from the latter as a comparison? Who conducted such an observation, and, if they were qualified to identify these symptoms, why did this observation not result in a medical diagnosis or even the mention of COVID-19 as a possible or contributing cause on the death certificate?
It beggars belief — even within the context of the diagnostic sloppiness with which the COVID-19 epidemic has been, and continues to be, recorded and reported — that deaths in care homes do not require any form of standard medical procedure in order to establish a medical diagnosis, in order to infer the meaningless statement that COVID-19 was ‘involved’ in the death of the deceased. Is it any wonder that, exactly a week later — and who can doubt that this ‘new way to understand’ COVID-19 was timed to increase these statistics exactly on 27 April? — 1,968 ‘COVID-related deaths’ were added to the official count?
‘An important difference between the two sources is that the ONS reports deaths where COVID-19 was mentioned on the death certificate, while CQC notifications rely on the statement of the care home provider that COVID-19 was suspected or confirmed.’
A clarification on definitions. According to the Oxford Dictionary of Epidemiology, the mortality rate is an ‘estimate of the portion of a population that dies during a specified period’, while the case fatality rate (CFR) is ‘the proportion of cases of a specified condition that are fatal within a specified time.’ Given the severity of the Government’s response to COVID-19, what must we ask of a death count, published daily by the Department of Health and Social Care and disseminated without question by our media, that relies on ‘mentions’ on death certificates and the ‘suspicions’ of private health companies to verify the impact of the coronavirus, and from this to extrapolate not even speculative, but purely fanciful, statistics about case fatality rates based on the unsubstantiated numbers of deaths actually caused by COVID-19 and the inadequate numbers of tests of SARs-CoV-2? This isn’t the result of the degree of inaccuracy inherent in any attempt to assess and report on the degree of risk from a new virus as it is spreading; this is deliberate fearmongering in order to manufacture consensus to a response that is without medical justification, wildly disproportionate to the actual impact of the virus, and legal only because the Government, on the basis of these fanciful criteria, has declared a de facto State of Emergency.
‘The ONS and DHSC COVID-19 death numbers have different criteria. The DHSC count deaths where a person has been tested positive for COVID-19, and for England this is in hospitals only. The ONS counts deaths where COVID-19 (including suspected cases) was mentioned on the death certificate, regardless of location.’
This is important in establishing that, in England, where the vast majority of the deaths attributed to COVID-19 are occurring in the UK, tests for SARs-CoV-2 are only carried out in hospitals. Even though this test in itself, as I have explained, does not mean that someone has symptoms of COVID-19, let alone died as a result of the disease, it does clarify that people who die outside of hospital, including those in care homes, do not have to have a positive test for the virus in order to be included in the ONS figures, which only requires that COVID-19 was ‘suspected’ as a possible or contributing cause of death.
Coronavirus (COVID-19) deaths
‘Coronavirus (COVID-19) deaths are those deaths registered in England and Wales in the stated week where COVID-19 was mentioned on the death certificate as ‘deaths involving COVID-19’. A doctor can certify the involvement of COVID-19 based on symptoms and clinical findings — a positive test result is not required.’
Again, in the glossary to these statistical tables and the webpages that accompany them, the ONS clarifies that, when a doctor fills out a death certificate, a positive test for SARs-CoV-2 is not required for COVID-19 to be mentioned as being ‘involved’ in the death, and therefore, as a newly-categorised ‘notifiable disease’, to find its way into the official count of ‘COVID-19 deaths’.
6. Measuring the data
‘Because of the coronavirus (COVID-19) pandemic, our regular weekly deaths release now provides a separate breakdown of the numbers of deaths involving COVID-19: that is, where COVID-19 or suspected COVID-19 was mentioned anywhere on the death certificate, including in combination with other health conditions. If a death certificate mentions COVID-19, it will not always be the main cause of death but may be a contributory factor.’
And finally, even within these criteria of ‘mentions’ and ‘suspicions’ of ‘involvement’ — which sounds like the report of a police constable trying to blame a crime on a group of youths the local station has been looking for a reason to arrest — the ONS makes it clear that COVID-19 was present at the scene of the crime ‘in combination with other health conditions’ that may have had a far more severe and determining role on the death of the deceased. Even when COVID-19 may have contributed to someone’s death— most obviously by weakening their immune system like any other influenza virus and therefore making them more susceptible to, for example, the pneumonia that kills them — it does not have to be the main cause of death to be recorded on the official list of COVID-19 deaths. And, importantly for measuring the impact of COVID-19, it will appear on this list without any pre-existing illnesses, even those that were the main cause of death, being mentioned as a contributing, let alone primary, cause of death.
All of which brings us to how death certificates are filled out in the UK, and how they are turned into the mortality statistics by which the Government’s official response to COVID-19 are justified.
2. Information collected at death registration
‘Mortality statistics are based on information recorded when deaths are certified and registered. Most deaths are certified by a medical practitioner, using the Medical Certificate of Cause of Death (MCCD). This certificate is taken to a registrar by an informant — usually a near relative of the deceased.’
As we have seen, however, where the ONS requires the mention of COVID-19 on the death certificate to number the deceased among its record of COVID-19 deaths, deaths occurring outside of hospital do not require the mention of COVID-19 on the death certificate for them to be qualified as such by the Care Quality Commission, but only the statement by the care home provider that they ‘suspect’ COVID-19 was ‘involved’. Both organisations, however, require a Medical Certificate of Cause of Death. So how do these certificates record the cause of death?
6. Certification of cause of death
‘When a death occurs, the attending doctor completes a Medical Certificate of Cause of Death (MCCD) [above]. This is normally taken to the local registrar of births and deaths in the district in which the death occurred.
‘The certifying doctor must have seen the deceased during the last two weeks of life to complete a MCCD. This is normally delivered to the registrar by the informant (often a relative of the deceased), within five days of the date of death, as required by law. The majority of deaths are registered in this way. A specimen of the draft death entry completed by the registrar at the time of registration is reproduced [below].’
To clarify, the Medical Certificate of Cause of Death (MCCD) is filled out by the medical practitioner, who must have seen the deceased at least two weeks before their death. The completed certificate is taken to the local registrar, who uses it to complete an entry form for registering deaths online
9. Cause of Death Coding
9.1 Coding the underlying cause of death
‘The death certificate 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.
The MCCD lists three causes of death under Part I. a) ‘Disease or condition directly leading to death’; b) ‘Other disease or condition, if any, leading to (a)’; and c) ‘Other disease or condition, if any, leading to (b)’. In addition to these causal diseases, under Part II the MCCD lists: ‘Other significant conditions contributing to the death, but not related to the disease or condition causing it.’ As laymen and not medical practitioners, it’s important for us to understand that the disease or condition directly leading to death, ‘does not mean the mode of dying, such as heart failure, asphyxia, asthenia, etc: it means the disease, injury or complication which caused death’.
‘The selection of the underlying cause of death is based on ICD rules and is made from the condition or conditions reported by the certifier, as recorded on the certificate. The underlying cause of death is defined by WHO as:
- ‘the disease or injury that initiated the train of events directly leading to death.’
Finally, the certificate specifies that ‘the condition thought to be the “Underlying Cause of Death” should appear in the lower completed line of Part I.’ That is, where ‘respiratory disease’ was listed as the ‘underlying cause of death’ for the 28,404 people who had this written on their death certificate in England and Wales up to 17 April this year, it would have appeared on the third line of Part I of the cause of death. However, there are exceptions to this rule.
Selection and modification rules
‘The selection of the underlying cause of death is generally made from the condition or conditions entered in the lowest completed line of Part I of the Medical Certificate of Cause of Death (MCCD). If the death certificate has not been completed correctly — for example, if there is more than one cause on a single line with no indication of sequence, or the conditions entered are not an acceptable causal sequence — it becomes necessary to apply one or more of the selection rules in the ICD-10.’
ICD-10 is the tenth edition of the International Classification of Diseases. Approved by the World Health Organisation (WHO), this was introduced in England and Wales in 2001, and was updated in 2010.
‘Even where the certificate has been completed properly, there are particular conditions, combinations or circumstances when modification rules have to be applied to select the correct underlying cause of death. On some death certificates, for example, when two or more causes are listed and then linked together, these may point to another cause. In other cases, the underlying cause of death can be selected from Part II of the MCCD.’
‘In summary, the purpose behind the selection and modification rules is to derive the most useful information from the death certificate and to do it uniformly so that:
- ‘data will be comparable between places and times;
- ‘each death certificate produces one, and only one, underlying cause of death.’
These are the guidelines that have led to COVID-19 being identified not as the medical condition leading directly to death, which in most patients testing positive for SARs-CoV-2 is acute respiratory distress syndrome; or as the condition leading to this respiratory distress, which in most cases is pneumonia; or even as a condition contributing to death but not related to the disease or condition that caused it, such as diseases affecting the heart, lungs, kidneys or liver; but as the underlying cause of death. If this were any other seasonal influenza, COVID-19 would not be mentioned on the death certificate, but as a newly categorised ‘notifiable disease’ it now must be included, and the deceased therefore listed in the official record of COVID-19 deaths.
9.3 Final cause of death
‘In summary, further details on the causes of death can be obtained in one or other of the following ways.
‘Deaths certified by doctors may have their cause amended as a result of a post-mortem, or of tests initiated before death. The certifier sends this additional information directly to the cause coding team at ONS, where it is only used for statistical purposes and does not appear in the public record.’
However, even when COVID-19 doesn’t appear on the death certificate as an underlying, contributing, tributary or direct cause, a positive test for SARs-CoV-2, conducted pre- or post-mortem, whether or not the deceased showed any symptoms of COVID-19 while alive, is enough for their death to be recorded in the ONS figures, and therefore to make their way onto the Department of Health and Social Care’s website publicising the official number of COVID-19 deaths. Given that the World Health Organisation has identified hospitals and other health care facilities as the source of infections for 30 per cent of patients admitted to intensive care units even in high income countries like the UK, and that anyone admitted to an NHS hospital therefore has a high likelihood of contracting SARs-CoV-2 during this crisis, this further demonstrates the inaccuracy of these statistics in assessing the true impact of COVID-19.
10. ONS short list of cause of death
‘The Office for National Statistics (ONS) short list for cause of death is based on a standard tabulation list developed by ONS, in consultation with the Department of Health.’
Each underlying cause of death has an ICD-10 code. For instance, J00-J99 are the codes for diseases of the respiratory system. These include J09, influenza due to certain identified influenza virus; J10-J11, influenza; J12-J18, pneumonia, J40-J44, bronchitis, emphysema and other chronic obstructive pulmonary disease; and J45-J46, asthma. However, a new addition to the ICD-10 codes used on the ONO statistical charts is U07.1 and U07.2. Since these are not included on the ONS shortlist of cause of death codes, it’s not clear whether they are being used to code an underlying cause of death, as the other ICD-10 codes are, or whether they are code for a contributing, tributary or direct cause; but these are the codes used on a Medical Certificate of Cause of Death for ‘deaths where COVID-19 was mentioned on the death certificate’.
According to the World Health Organisation (WHO), who published these codes on their webpage titled ‘Emergency use ICD codes for COVID-19 disease outbreak’:
- ‘An emergency ICD-10 code of “U07.1 COVID-19, virus identified” is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing.
- ‘An emergency ICD-10 code of “U07.2 COVID-19, virus not identified” is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available.
- ‘Both U07.1 and U07.2 may be used for mortality coding as cause of death.’
The WHO then directs the reader to the ‘International guidelines for certification and classification (coding) of COVID-19 as cause of death’, which it describes as ‘very technical’, and whose ‘inexorable richness of medical language’ is aimed at ‘physicians’. Presumably this is meant to discourage laymen such as myself from reading these guidelines. This article is already long and technical enough, so I may return to them another day; but the guidelines specify that if COVID-19 is the ‘suspected’ or ‘probable’ or ‘assumed’ cause of death, it should be entered on the lowest line of Part 1 of the death certificate as the underlying cause, while co-morbidities such as diabetes or artery or pulmonary disease should be reported in Part 2 as a contributing cause.
I’ll draw this already overlong discussion on death certificates to a close with these lines from the WHO guidelines on coding for COVID-19:
‘Given the intense public health requirements for data, COVID-19 is not considered as due to, or as an obvious consequence of, anything else in analogy to the coding rules applied for influenza. Further to this, there is no provision in the classification to link COVID-19 to other causes. Always apply these instructions, whether they can be considered medically correct or not.’
This may be the last time I can analyse this data. On 28 April Public Health England, the executive agency of the DHSC, decided to add every death in the UK to occur in a care home or otherwise outside a hospital since 2 March 2020 to its newly reconfigured website publishing the official count of COVID-19 deaths. At a single stroke this decision — which supersedes the ‘new way to understand whether COVID-19 was involved in the death’ announced on 10 April, and whose flawed criteria we looked at above — added a further 4,240 deaths, raising the total UK deaths to over 26,000, surpassing the count in France and even Spain, and closing in on Italy. The same day the Department of Health and Social Care announced that all such deaths will from now on be recorded as COVID-19 deaths. According to what the DHSC calls its ‘official statement on the changes in reporting’, which is published on the ONS webpage on ‘Different uses of figures on deaths from COVID-19 published by DHSC and ONS’:
‘From 29 April 2020, DHSC are publishing as their daily announced figures on deaths from COVID-19 for the UK a new series that uses improved data for England produced by Public Health England (PHE). These figures provide a count of all deaths where a positive test for COVID-19 has been confirmed, wherever that death has taken place.’
So let’s look at what these latest changes to the registration of COVID-19 deaths are, and how they resulted in an additional 4,240 deaths being added to the official total.
‘The new data series produced by PHE is created by combining reports of deaths from three different sources in England. The three sources are:
- ‘deaths occurring in hospitals, notified to NHS England by NHS trusts using the COVID-19 Patient Notification System (CPNS) (previously the source of daily COVID-19 deaths in England);
- ‘deaths notified to PHE Health Protection Teams during outbreak management (primarily in non-hospital settings) in people with a confirmed COVID-19 test and recorded in an electronic reporting system;
- ‘all people with a laboratory confirmed COVID-19 test are reported to PHE through the Second Generation Surveillance System (a centralised repository of laboratory results from Public Health and NHS laboratories). This list is submitted on a daily basis to the Demographic Batch Service (DBS) to check NHS patient records for reports of individuals who died in the previous 24 hours. These reports include deaths in any setting.’
This requirement of a ‘confirmed COVID-19 test’ marks a significant revision to the criteria for recording care homes deaths attributed to COVID-19, so perhaps the Office for National Statistics is not as independent of political intervention as I (or they) hoped. But in a separate page titled ‘Publication of statistics on deaths involving COVID-19 in care homes in England: transparency statement’, published ‘jointly’ by the Office for National Statistics and the Care Quality Commission and also updated on 28 April, it has a very different definition of what constitutes a COVID-19 death, one completely at odds with, and contradicting, the technical definitions in the DHSC statement:
‘The information notified to CQC includes the date of death, place of death, and (from 10 April) whether the death was a result of confirmed or suspected coronavirus (COVID-19). The inclusion of a death in the published figures as being the result of COVID-19 is based on the statement of the care home provider, which may or may not correspond to a medical diagnosis or test result, or be reflected in the death certification.’
So, which is it? Does the sudden addition of thousands of deaths outside of hospitals require a positive test for SARs-CoV-2 or not? Both definitions have been published simultaneously, both by the Office for National Statistics: one the ‘official statement’ by the Department of Health and Social Care, the other a ‘joint statement of transparency’ by the Office for National Statistics and the Care Quality Commission. Given the instructions from the World Health Organisation to identify COVID-19 as the suspected, probable or assumed underlying cause of death whether this is medically correct or not, I’m guessing it’s the latter. And this abandonment of medical diagnosis is not limited to deaths outside hospitals. The same day, 28 April, NHS England announced that it is now reporting patient deaths where there has been no positive test result for SARs-CoV-2, but where COVID-19 is documented as a ‘direct or underlying cause of death’ on either part 1 or part 2 of the death certificate.
In a way it doesn’t matter, because it now appears that the media boast that the UK will end up being the European country worst affected by the coronavirus will come true. On 27 April, the day before these so-called ‘changes in reporting’ were made — which are in practice changes to the technical definition of what a COVID-10 death is — the Department of Health and Social Care’s official death toll from COVID-19 was 338, the lowest since 29 March, and had been falling since its official peak of 980 on 10 April. Now these new official COVID-19 deaths outside of hospital — verified without the deceased even being tested for SARs-CoV-2, let alone COVID-19 being established as the actual cause of death — have been retrospectively added to the official count of daily deaths. This means the new peak of 1,172 deaths has been brought forward to 21 April (below), 10 days ago and 15 since the Government lockdown was extended by 3 weeks. It hardly seems likely that, when the lockdown is officially reviewed on 7 May, the Government that has deliberately increased the official figures for COVID-19 deaths won’t extend the prohibitions further, and possibly increase them. Flawed, inaccurate and undoubtedly exaggerated as they were as a measure of the threat and impact of this new coronavirus, the official figures recording COVID-19 deaths in the UK have now become completely meaningless. We have now passed from the realm of systemic distortion into the realm of make-believe. I want to end this article, therefore, by looking at what belief is and how it is made.
6. Irrational Belief and Political Responsibility
It’s difficult to argue with irrational beliefs. I’ve always thought the attempts of the evolutionary biologist, Richard Dawkins, to convince Christians and other believers of the wrongness of their religious beliefs and the rightness of his scientific knowledge has always left him looking rather foolish. 5.7 billion people worldwide believe in a god not because they think the existence of a divine being or beings is a better explanation of the origins of the universe and the evolution of man than the theories of Einstein and Darwin, as Dawkins earnestly tries to argue, but because they were born or drawn into the ideologies of Christianity, Islam, Hinduism, Buddhism, Sikhism, Judaism and all the other religions with which our Governments control 84 percent of the world’s population. Not only with these ideologies, of course, for capitalism is the most powerful ideology on this planet, and has been for some time. And science itself, as the Italian philosopher Giorgio Agamben has written in his recent commentary on our reaction to the coronavirus, has become the religion of our time. There is little difference between the 46 per cent of US citizens who take prescription drugs on a regular basis and the 29 per cent who regularly attend church or synagogue, and neither group are made up of pharmacologists or theologists. They pop pills and pray to their God because they believe it will make their lives better; because they have been told to by the salesmen of religion and science; because they need to believe in something bigger than themselves, whether capitalised Science or Religion; because they were born into a family, community, culture or country that did the same; perhaps, above all, because they’re afraid of dying; and for a dozen other reasons why we think and act in irrational ways. So although I might politely suggest to a friend that living day-to-day anaesthetised on prescription drugs might not be the best way to get through life, or that treating the world like the waiting-room for a future eternity blinds you to both the joys and duties of this life, I’m not going to argue the point with them rationally. Belief is not knowledge: it is historically determined, culturally contingent, emotively held, irrationally defended, and ideologically maintained by the vast reach and power over our lives of the myriad Christian churches, Islamic denominations, Hindu sects, Buddhist schools, Jewish movements, and the institutional, financial, judicial, military and government backing they have.
What I will argue with, however, is what is done in the name of these beliefs, with the approval or agreement of these beliefs, on the justification or basis of these beliefs, with the consensus — by default or actively — attained by appealing to these beliefs. A believer is welcome to their history, culture, emotions and beliefs, no matter how irrational these are; but when those beliefs are used to govern societies, appoint leaders, legitimise social hierarchies, create inequality, sell commodities, start wars, accommodate dictators, justify genocide, enact racism, oppress women, shame difference, silence dissenters, abuse and kill those under their power, and all the other crimes of which religious institutions are guilty today — let alone in their blood-spattered past — then the irrationality of religion becomes not just a matter of personal belief but of political responsibility. ‘Believers’, as religions like to call their subordinates, are responsible for the words and deeds of the institutions to which they belong and to which they give financial backing, cultural legitimacy and political power.
Last month the Economist magazine published an article asking ‘How deadly is the new coronavirus?’ The ground for posing this question was that, given the low level of testing for SARs-CoV-2 across the world — and particularly in the UK where, 4 months into an epidemic apparently warranting the lockdown of the state, about 1 in 50 of the population has been tested — the official case fatality rate of 3.6 per cent sanctioned by the World Health Organisation and repeated as a uniform percentage by Governments around the world is nothing more than speculation and will be shown to be far lower as testing for SARs-CoV-2 increases and the case fatality rate of COVID-19 inevitably drops. I couldn’t read the whole article as it was behind a firewall and I have no wish to subscribe to the Economist; yet this week, during a brief foray onto Twitter, I saw the article posted by someone who was clearly interested in the argument. The response, by members of the Twitterati — only a few of whom I’d imagine have a subscription and therefore could actually read the article — was several hundred comments, with nearly all of the ones I skimmed denouncing the article with varying degrees of fury, contempt, threats, sanctimony, sarcasm and all the other modes with which rational speech is drowned out and censored online. It reminded me of a TV programme I saw years ago in which Richard Dawkins tried to convince Ted Haggard, the evangelical pastor of the New Life Church in Colorado Springs, USA, that creationism is irrational. The pastor was, of course, a crook, but if the two of them were debating at the Oxford Union I would have to concede that the born-again evangelist and entrepreneur wiped the floor with the former Professor for Public Understanding of Science at Oxford University. Today I couldn’t locate the Twitter post, which presumably has been removed by the tweeter under the weight of public approbation.
Which brings me to our collective response to the coronavirus crisis. As a writer with an audience of maybe a thousand readers for a popular article, mostly writing about the housing crisis but also about other social and political issues, I have to be very sure about my research and the conclusions I draw from it. Over the five years in which I’ve published over 200 articles, case studies, presentations and reports on the ASH website, not once has someone challenged me on either the accuracy of the data I’ve researched or the logic of my arguments. Instead, as happens to anyone who challenges the orthodoxies of mainstream media lies and social media hysteria, I’ve been subjected to plenty of abuse, smear campaigns and online threats, but no-one has ever challenged my conclusions with anything more than a vague suggestion that I am motivated by personal vendettas, political extremism or various psychological defects; and the same reaction has characterised the response to the six articles I have published about the coronavirus crisis, particularly from those who haven’t read them but have recommended, for instance, reporting me to the police for ‘endangering lives’.
Since these responses are based on nothing more than beliefs that have been largely placed there by the media, that allay the believer’s fears, that feed their rising anxiety, that mirror the image they have of themselves, that accord with their cultural and religious backgrounds, that serve their class interests, that offer the comfort of a collectively held emotion, even when that emotion is panic, that allow them to indulge their fascination with death, that enable them to disguise that fascination with the most saccharine expressions of empathy with the deceased — that are, in other words, ideologically determined — these beliefs must be held with all the greater conviction. Anything that might shake that conviction, through rational argument rather than irrational belief, through analysis of empirical data rather than repetition of dogma, through logical deduction rather than emotional assumption, must not only be avoided but — as Christianity, Islam and Hinduism has done throughout their bloodstained histories — attacked, suppressed, destroyed, ridiculed, silenced, their authors denounced, censored, threatened and imprisoned. We are, as it were, entering into a new medievalism, in which, via the most advanced technologies of surveillance and control that are welcomed into the space where we think our souls should be — or, more accurately, that penetrate and monitor our biological and political existences through our willing consumption of information technology — the media terrifies us into obedience to our rulers with threats to our society, threats to our wealth, threats to our future, threats to our safety, threats to our health, threats to our very lives. If science is the religion of our time, the media are our churches, their high priests the CEOs of the information technology companies with an oligopoly over our souls: Microsoft, Apple, Amazon, Google, Facebook. It’s at their altars that we pray, to their sermons that we listen, in their churches that we commune, by their precepts that we abide.
Individuals can be excused their inability to understand the data I’ve analysed in this article, their manipulation by the propaganda of our media, and perhaps even their refusal to question what is happening because of their fears and anxieties; but they cannot be excused their collective responsibility for the assumption of dictatorial powers by our Government, for the granting of greater powers of arrest and detention to our police and security forces, and for the further intrusion of technologies of surveillance and control into our collective and individual lives. Ignorance, stupidity, anxiety, fear, are not an excuse for what is being done on the back of them. Watching what is happening in this country has made me realise that the universal excuse of the German people of the 1930s that they didn’t know what was happening before it was too late doesn’t describe how dictatorships arise from democratic societies. They can only do so with the consensus of the majority of the population. But that agreement does not have to be active. It can be agreement through default, agreement through silence, agreement through a refusal to question, agreement through obedience to regulations. However, under a propaganda campaign universally implemented by the full spectrum of our media, increasing numbers of the UK population have already progressed to agreement through the blind repetition of Government propaganda, agreement through the policing of dissent, agreement through the denunciation of disobedience, agreement through collaboration with the State.
It is not yet too late to halt the creeping totalitarianism to which all of us, in different degrees, are giving our consent, whether passively or actively. But the time to do so is rapidly running out, and the most right-wing and authoritarian Government in modern British history, run by a bunch of crooks the like of which not even the Conservative Party has placed into power before, is not dragging its feet in building consensus to ever more dictatorial limitations to our freedoms. Instead of sitting passively at home, justifying the latest prohibition on the grounds that it may save lives, and waiting for permission to return to the ‘new normal’ being prepared for us, we should be asking ourselves the following questions:
- Do we have the courage to read, write, speak, publish, share and act on the truth about COVID-19?
- Do we have the ability to recognise the truth beneath the media lies concealing it?
- How do we turn the truth into a weapon?
- Whose hands will wield the truth if not our own?
- How do we spread this truth among as many people as possible, so that they too can arm themselves against our rapidly expanding consensus to this indefinite State of Emergency as the political paradigm of our future Government?
Just as urgently, we must start acting on the answers we are prepared to give.
Architects for Social Housing
Architects for Social Housing is a Community Interest Company (no. 10383452). Although we occasionally receive minimal fees for our design work, the majority of what we do is unpaid and we have no source of public funding. If you would like to support our work financially, please make a donation through PayPal: