Definition of "deaths involving COVID-19"

FOI Ref: ​FOI/2021/2887

You asked

Please explain the phrase "deaths involving COVID-19”, i.e. was this the primary cause of death or could the patient have tested positive/been showing symptoms yet died from cancer or a vehicle accident.

We said

​Thank you for your request.

When we say that a death 'involved' COVID-19, we mean that COVID-19 was mentioned anywhere on the death certificate, possibly along with other health conditions, not necessarily as the underlying cause of death. When we say that a death was 'due to' COVID-19, we mean that COVID-19 was the underlying cause of death, because it was either the only health condition mentioned on the death certificate, or it was the one that started the train of events leading to death.

Our data is derived from the death registration process. When a person dies, in most cases a doctor writes a medical certificate of cause of death (MCCD) which is then recorded in the death registration (at a local authority registration office). The same information is sent electronically from the registration office to ONS for us to produce statistics about causes of death.

The death certificate (PDF, 225KB) used in England and Wales for deaths over 28 days of age is similar to that recommended by the World Health Organization (WHO). The cause of death information is set out in two parts. Part 1 gives the condition or sequence of conditions leading directly to death, while Part 2 gives the details of any associated conditions that contributed to the death but are not part of the causal sequence.

If someone dies in circumstances involving an accident, violence or suspicious circumstances, the case is referred to a coroner for investigation. A post-mortem examination is carried out and usually an inquest is held. The Coroner's Court hears all the evidence and follows legal rules of evidence when deciding the causes of death. It is extremely unlikely that a coroner would find that someone was involved in a traffic accident, or was the victim of violence, because of having COVID-19 or a positive COVID-19 test -- so they would not mention COVID-19 on the death certificate. This applies to any death caused by an accident, violence, poisoning, or other external causes. Even if in an unusual case a death certificate mentioned both COVID-19 and a traffic accident (or other external causes), the World Health Organisation (WHO) rules for coding deaths mean that the traffic accident would be identified as the underlying cause of death in our data.

You can read in detail about the coding of causes of death and identifying the underlying cause in the ONS User guide to mortality statistics and the WHO International Classification of Diseases (ICD-10) instruction manual.

Using the Deaths due to COVID-19, registered in England and Wales 2020 publication, you will find deaths due to and involving COVID-19 in England and Wales.

Using Deaths registered weekly in England and Wales 2021, there are 54,237 registered deaths where COVID-19 was the underlying cause as of 3 September (latest available data).

There are 62,156 deaths where COVID-19 was a contributory cause (involving COVID-19). This publication is updated every Tuesday.