Concerning excess deaths

The news that nine percent more deaths were recorded in 2022 than in 2019 (the last year before the pandemic) has naturally given rise to a fair amount of debate. It may well be that we have to wait for the results of in depth studies before we see a more definitive indication of the causes of excess mortalities. In the meantime, various theories have been put forward as to why the second half of 2022 in particular saw more deaths than would otherwise be expected.

During the course of the pandemic, concerns were raised that patients were delaying approaching their doctors or finding it difficult to receive an accurate diagnosis when consultations were managed at a distance. It was therefore recognised that the potential for untreated conditions to require greater intervention, once diagnosed, than would otherwise be the case could lead to excess deaths. For example, a recent BBC report, highlighted a reduction in the number of new prescriptions for blood pressure medication or statins during the covid period.

The ongoing effect of having had covid has also been put forward as another potential reason for people dying earlier than expected. One study reported in the BMJ [1] concluded that “Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population.” This includes an increased risk of cardiovascular disease following covid infection.

This theory is bolstered by another BMJ report [2] which highlighted the fact that whilst an analysis of the ‘underlying cause of death’ for conditions such as heart disease and stroke have not shown an increase, this changes dramatically when looking at the wider causes of death mentioned on death certificates. In particular, death certificates mentioning cardiovascular disease and diabetes have been seen to be substantially in excess of the norm since April 2022.

The ongoing pressures on the health service have also been put forward as a potential reason for some excess deaths. From delays in seeing a GP and starting treatment to pressures on the ambulance and emergency services; it is inevitable that pressures on the health service have the potential to affect patient outcomes.

This is one reason why there is an increasing emphasis on the part played by pharmacists and other health practitioners in delivering healthcare solutions. The more that healthcare professionals across the board can contribute to delivering patient outcomes, the greater the potential for improved acute patient outcomes. Of course, that spreading of the burden is only effective if it can be done without over-stressing other elements of the healthcare service. In part that means finding ways to work smarter rather than harder, to optimise patient consultation times without adversely affecting patient care.

Strategies such as digitising patient records can help here, enabling patient notes to be shared across healthcare professionals as required. Not only does this reduce delays in referrals, it also avoids needless time spent in requiring the patient to repeat their history to each successive healthcare professional. 

The problem of excess deaths isn’t confined to the UK. Speaking to Sky, NHS England chief strategy officer Chris Hopson highlighted that countries such as Germany, Spain and Italy are also experiencing higher mortality rates than normal. That’s why further research is required to identify the underlying factors and put mitigation strategies in place. Pending that research, the more that can be done to spread the excess healthcare workload, the better.