Recommendation 28

HM Government · verbatim extract Accepted in Part

The government partially accepts this recommendation. The Office for National Statistics (ONS) and NHS Digital, which together represent the UK on matters relating to the classification of diseases and deaths, have been closely involved in helping WHO formulate international standards on the reporting of COVID- 19 deaths. WHO issued international guidelines for certification and classification (coding) of COVID-19 as cause of death9 in April 2020 and subsequently updated these10 in the light of emerging knowledge and public health needs. ONS and NHS Digital will continue to engage actively with WHO to ensure robust international classifications and standards are in place and to support WHO’s readiness to respond to any future pandemics or other emerging health problems. ONS reports deaths involving or due to COVID-19 based on the contents of the death certificate. The numbers of deaths reported on the coronavirus data website11 follow a different methodology based on death within either 28 or 60 days of a laboratory- confirmed positive COVID-19 test, in the latter case with COVID-19 being mentioned on the death certificate. This approach was developed during the pandemic by PHE and other responsible organisations to permit rapid reporting of newly identified deaths without waiting for the process of death certification to be completed. It was not designed to produce definitive figures on deaths caused by COVID-19 in the long term, or to be internationally comparable. The Office for Statistics Regulation published a 9 International Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death – WHO (https://www.who.int/publications/m/item/international-guidelines-for-certification-and-classification- %28coding%29-of-covid-19-as-cause-of-death) 10 Updates 3 & 4 in relation to COVID-19 coding in ICD-10 – WHO (https://www.who.int/publications/m/item/updates-3-4-in-relation-to-covid-19-coding-in-icd-10) 11 COVID-19 Death Data – GOV.UK (https://coronavirus.data.gov.uk/details/deaths) blog, ‘The challenges of counting COVID deaths’ 12 in August 2020 on the differences between these ways of counting COVID-19 deaths. Methods for rapid reporting of deaths not based on death certificates necessarily differ between countries because of numerous differences in the organisation of health and social care systems, availability and quality of diagnostic facilities, data collection capabilities, and ability to use multiple reporting routes to overcome the limitations of individual sources. Comparison of all-cause mortality is considerably easier than comparison of disease-specific mortality, as the fact of death is often collected more quickly than diagnostic details, and all-cause mortality avoids confusion caused by national differences in clinical practice, diagnostic criteria and availability of laboratory testing. When comparing across countries there is therefore a strong case for total deaths from all causes as the most reliable measure of the impact of a pandemic. While ONS has published comparisons of all-cause excess mortality in European countries13 during the pandemic, not all countries produce sufficiently timely or reliable data for similar comparisons to be feasible on a global basis. The government will continue to work with WHO and other international stakeholders to support effective international reporting of COVID-19 deaths and those caused by other health conditions, including future pandemics, on the most appropriate basis for each situation, recognising that appropriate methodologies may vary as outlined above. ONS and other UK statistics providers have developed substantial expertise in monitoring the pandemic and estimating incidence, symptom prevalence and other measures in addition to deaths and this knowledge will also be made available to promote internationally comparable standards and methods. 12 The challenges of counting COVID deaths – OSR (https://osr.statisticsauthority.gov.uk/the-challenges-of-counting-covid-deaths/) 13 Comparisons of all-cause mortality between European countries and regions – ONS (https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/co mparisonsofallcausemortalitybetweeneuropeancountriesandregions/datauptoweekending3september 2021) Testing and contact tracing