Death Rates in UK Compared to Covid-19 Deaths

What is the true rate of Covid-19 deaths in the UK?

Covid-19 accounts for an average of 11 of the 1,687 deaths in Britain every day, according to official statistics.

In comparison, 124 people died each day from flu and pneumonia in the week ending Sept. 4.

Heart disease – Britain’s biggest killer – accounted for 460 deaths every day last year, while cancer kills an average of 450 people per day.

Around 87,000 people die of dementia each year – about 240 a day. Lung disease accounts for 31,000 deaths, or 84 every day, while fatal accidents at home – often while doing DIY – lead to 16 deaths per day.

Every day 5 people die in road accidents across the UK, while infections (including C.difficile and stomach bugs) kill 5,691 a year, about 16 people a day.

Last year (2019), there were 5,691 deaths attributed to suicide, an average of 15 per day.

There were 2,958 stillbirths, 2,831 deaths in infants under one year, and 3,248 deaths in children under five in 2018.

Source: article in Daily Mail, 20 Sept. 2020

Covid-19 Interferon Beta Treatment

Preliminary results of a clinical trial suggest a new treatment for Covid-19 reduces the number of patients needing intensive care.

The treatment. Developed by Southampton-based biotech company Synairgen. Uses a protein called interferon beta which the body produces when it gets a viral infection. The protein is inhaled directly into the lungs of patients with coronavirus, using a nebuliser. The hope is that it will stimulate an immune response.

The double-blind trial involved 101 volunteers who had been admitted for treatment of Covid-19 infections at nine UK hospitals. Half were given the drug and half a placebo (an inactive substance).

Initial findings. Suggest that the treatment  cut the likelihood of a patient developed severe disease (e.g. requiring ventilation) by 79%. Patients were two to three times more likely to recover to the point that everyday activities were possible. Indications were that there were very significant reductions in breathlessness. The average time spent in hospital is reported to have been reduced to six days, down from an average of nine days.

Publication and peer review. Stock market rules required the company to report preliminary results, but they have not yet been published in a peer reviewed journal. As the full data has not been released, the BBC were unable to confirm the claims. While the trial was relatively small, the indication that the treatment benefits patients was strong.

Implications. If results are as reported, it will be an important new treatment for coronavirus infections.

• Many governments have indicated that they will work as fast as possible to get promising coronavirus treatments approved. This could include emergency approval.
• Another possibility is that more patients will be able to receive the treatment while being monitored to confirm it is safe and effective.
• If approved for use, the drug and the nebulisers used to deliver it would then need to be made in large quantities.
• Previous clinical trials by Synairgen show it can stimulate an immune response and the patients with asthma and chronic lung conditions can comfortably tolerate the treatment.
• The Synairgen team believes the drug could be even more effective at the early stages of infection.

Reported 20 July 2020. Have not found any further updates.

Source: Coronavirus: protein treatment trial 'a breakthrough' by Justin Rowatt, 20 July 2020. BBC website: https://www.bbc.co.uk/news/health-53467022.

Deaths From Other (Non-Covid-19) Causes

 Deaths from other causes

In a normal year, there is a predicted number of deaths (e.g. strokes, heart attacks, cancer and old age) plus excess winter deaths due to respiratory diseases (including flu), circulation diseases, and dementia and Alzheimers diseases. 

It is important to distinguish between these and Covid-19 deaths. In England and Wales, excess winter deaths were 34,300 in 2016-2017 and 23,200 in 2018-2019. Flu deaths worldwide range from 290,000 to 650,000 per year.

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Zinc

Zinc is an important part of our diet. It is found in meat, shellfish, dairy and some cereals. Most people get enough from a balanced diet.

Zinc is pivotal in would healing, keeping the protective skin barrier intact, and supporting the function of white blood cells.

Woman need about 7mg a day, men need about 9.5mg. Too much zinc can reduce copper absorption by the body, carrying a risk of anaemia and osteoporosis, so if you choose a supplement, stick to a maximum of 25mg per day.

It has been suggested that zinc can reduce the ability of some viruses to multiply, so there have been many studies looking at the effect of zinc lozenges on both preventing and treating the common cold. While results have been conflicting (partly due to uncertainty about the dose and type of lozenge) there is some evidence that they might speed recovery from colds.

It is still too early for reliable studies into its effect on the coronavirus, though it is possible that it might inhibit the action of some viruses.

Source: Health column in Good Housekeeping, June 2020.

Covid-19 Who is most at risk?

Who is most at risk?

Adults over the age of 60.

Age is one factor in whether someone dies from Covid-19. This is because past the age of 60, someone is more likely to have heart disease, cancers and other medical conditions such as diabetes, which mean the body is less able to fight off the infection. The proportion of Covid-19 deaths by age groups is:

• 90% are over 60. (52% are over 80 and 39.7% are between 60 and 79.)
• 7% are between 40 and 59, while 0.72% are between 20 and 39
• 0.077% are between 0 and 19.

Very few children become severely ill with the virus

Children of all ages may catch the disease but are likely to have milder symptoms and a lower chance of severe disease than adults. They are also less likely to pass on the infection. Australian researchers have identified a number of factors which may explain this.

• Children have strong undamaged cells in their blood vessels which prevent inflamation and clotting, and their blood clotting system is different.
• They have elevated levels of vitamin D.
• Their immune system is fast acting. They are more likely to be infected with other pathogens such as colds and and other germs picked up in the playground. This can build a strong natural immune system.
• They have often been recently vaccinated for other diseases, including MMR. This effectively 'trains' the immune system and keeps it 'firing on all cylinders'.
• They have fewer ACE2 receptors, which the virus uses to infect cells. ACE2 becomes more prevalent as they grow up.

However a coronavirus-related inflammatory syndrome occasionally occurs in children. Symptoms include high temperature, low blood pressure, a rash and difficulty breathing; some also had tummy pain, vomiting or diarrhoea, and inflammation of the heart and abnormal blood test results. Experts say these are signs the body becomes overwhelmed as it tries to fight of the infection.

People who are overweight or obese.

Obesity increases the risk of a number of diseases, (e.g. heart disease, cancer and type 2 diabetes). The more overweight, the more fat you carry, the less fit you are and the lower your lung capacity. So it's a bigger struggle to get oxygen into the blood and around the body, which impacts on the heart and blood flow. Being overweight, you also have a demand for more oxygen. This can be a serious problem during a respiratory infection like coronavirus; the obese body  becomes overwhelmed by the lack of oxygen. Overweight and obese people in intensive care are more likely to need assistance with breathing and support with kidney function.

An enzyme called ACE2, present in cells, is the main way for the virus to enter the body. Higher levels of this are thought to be found in adipose (fatty) tissue, which could explain the higher risk of catching the disease and a higher risk of being ill with it.

The ability of the body to fight off the virus (the immune response) is not as good in people who are obese, due the inflammation driven by immune cells called macrophages which invade our fat tissue; they interfere with how our cells respond to infection. This can lead to a 'cytokine storm' - a potentially life-threatening over-reaction of the body's immune system which causes inflammation and serious harm.

And there can be challenges in managing these patients in intensive care: (a) it is more difficult to intubate them (put onto a ventilator); (b) to scan them because of weight limits and (c) they may be more tricky to turn, or prone, in order to relieve their breathing.

Men

Men are slightly more likely to die, but in some countries this is may be due to higher smoking rates in men which compromise lung function. New research shows that men have higher levels of the ACE2 receptor on cell surfaces, which binds to the new virus, allowing it to enter and infect cells. Men have a higher level of ACE2 found in the heart, kidneys and tissues lining blood vessels, and especially high levels in the testes. 

Black, Asian and Minority Ethnic (BAME) populations 

UK data (May 2020) suggests that 35% of critically ill patients are from BAME backgrounds. The following factors appear to be important.

Many BAME populations come from lower socioeconomic backgrounds and work in public-facing occupations (healthcare, cleaners, restaurant workers, transport and delivery workers and other public services). They are likely to be in inter-generational households, with more of the aged still at home, and religious activities with large numbers of attendees. Between 15% and 30% live in overcrowded households in contrast to just 2% of white British households.

They have an increased risk of certain diseases (e.g. diabetes and heart disease).  People from BAME backgrounds have more of a specific type of fat tissue which is prone to macrophage invasion (see section on obesity and the ACE enzyme), have elevated rates of diabetes, and may therefore be more vulnerable to the virus.

Pregnant women

Pregnant women may be at higher risk for severe infection but data is not yet available. 
Those with a pre-existing condition (e.g. high blood pressure, diabetes, heart disease and lung disease) are more likely to die.

People with disabilities that limit activity.

People (over the age of 9) with a disability that limits activity account for nearly 60% of UK Covid-19 deaths, but form only 16% of the population. (Study reported 18 Sept. 2020.)

Certain blood groups may be more likely to have severe infections

Ethnic and national populations can have different proportions of blood groups. Worldwide the rarest blood type is AB, while Rh negative blood types are found in 0.3% of Asian populations and 15% of European populations. Proportions can also differ within a country. In the UK, the ratio is O = 48%   A = 38%   B = 10%   AB = 3%. In southern England: O = 44%   A = 45%   B =  8%    AB = 3%.

A study in China (March 2020) found that the normal population ratio was A = 31%   B = 24%   AB = 9%   O = 34%, while the ratio for those with the virus was A = 38%   B = 26%  AB = 10%  O = 25%.  Researchers concluded that "blood group A had a significantly higher risk for Covid-19 compared with non-A groups, whereas blood group O had a significantly lower risk." (Their findings were published before peer review, so need to be treated with caution.) In the US, another study found a similar pattern but only among rhesus positive patients. NB. Susceptibility to infection does not necessarily equal risk to getting seriously ill. Other studies on infection rates and severity of illness relating to blood groups are currently in progress in several countries.

Another study of patients in Italy and Spain with Covid-19 respiratory failure found two genetic variants associated with the severity of their disease. One cluster of six genes had included genes that regulate ACE2. The other variant was the ABO blood group system. However, an analysis of medical data from thousands of people in the Boston area of the US found no association.

Note: Some other viruses are blood-group dependent. People with type A blood seem to be more susceptible to hepatitis B and HIV, while people with type O are somewhat protected against catching SARS.

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