Abstract
BackgroundThe SARS-CoV-2 pandemic has passed its first peak in Europe.AimTo describe the mortality in England and its association with SARS-CoV-2 status and other demographic and risk factors.Design and settingCross-sectional analyses of people with known SARS-CoV-2 status in the Oxford RCGP Research and Surveillance Centre (RSC) sentinel network.MethodPseudonymised, coded clinical data were uploaded from volunteer general practice members of this nationally representative network (n = 4 413 734). All-cause mortality was compared with national rates for 2019, using a relative survival model, reporting relative hazard ratios (RHR), and 95% confidence intervals (CI). A multivariable adjusted odds ratios (OR) analysis was conducted for those with known SARS-CoV-2 status (n = 56 628, 1.3%) including multiple imputation and inverse probability analysis, and a complete cases sensitivity analysis.ResultsMortality peaked in week 16. People living in households of ≥9 had a fivefold increase in relative mortality (RHR = 5.1, 95% CI = 4.87 to 5.31, P<0.0001). The ORs of mortality were 8.9 (95% CI = 6.7 to 11.8, P<0.0001) and 9.7 (95% CI = 7.1 to 13.2, P<0.0001) for virologically and clinically diagnosed cases respectively, using people with negative tests as reference. The adjusted mortality for the virologically confirmed group was 18.1% (95% CI = 17.6 to 18.7). Male sex, population density, black ethnicity (compared to white), and people with long-term conditions, including learning disability (OR = 1.96, 95% CI = 1.22 to 3.18, P = 0.0056) had higher odds of mortality.ConclusionThe first SARS-CoV-2 peak in England has been associated with excess mortality. Planning for subsequent peaks needs to better manage risk in males, those of black ethnicity, older people, people with learning disabilities, and people who live in multi-occupancy dwellings.
Highlights
The severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic has passed its first peak in many countries in Europe, where the speed of implementing lockdown has predicted mortality.[1]
The first SARS-CoV-2 peak in England has been associated with excess mortality
Planning for subsequent peaks needs to better manage risk in males, those of black ethnicity, older people, people with learning disabilities, and people who live in multi-occupancy dwellings
Summary
The severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic has passed its first peak in many countries in Europe, where the speed of implementing lockdown has predicted mortality.[1] The UK has had one of the highest SARS-CoV-2 associated mortality rates in Europe with >42 000 deaths. The European mortality project (EUROMOMO) lists England as the only country with an ‘Extremely High Excess’, and substantially greater than that of the devolved nations Scotland, Wales, and Northern Ireland.[2] The reasons for this difference, despite a unified public health response, are unclear.[3] There has been concern about excess mortality in care homes,[4] and that it may be indicative of widening social inequality.[5] England is among the most densely populated countries in the world with 430 people per square kilometre — the highest in Europe — and London is the fifth most densely populated city globally.[6]. CoV-2 pandemic has passed its first peak in Europe
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