You asked
If someone dies from a non-Covid-19 related cause e.g. Car crash, heart attack, cancer but has received a positive test result within 28 days prior to the death occurring, will that death then be included in the coronavirus daily figures?
We said
Thank you for your enquiry.
Our data is derived from the death certificate, using information received at the point of death registration. This is different to the data used by PHE which records all deaths with a positive test within 28 days.
ONS data as described here are different from the figures on COVID-19 deaths published on the government's COVID-19 dashboard which shows 'deaths within 28 days of a positive test'. You can read a blog by Professor John Newton of Public Health England about the complexities of counting COVID-19 deaths and the different methods used.
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 details are printed out as the official 'death certificate' for the next of kin. The same information is sent electronically from the registration office to ONS for us to produce statistics about causes of death. For some deaths, such as when the death was due to an accident or violence, there is a coroner's inquest to establish the facts and the coroner then decides the cause of death and sends their findings to the local registrar.
The doctor or coroner certifying a death can record more than one health condition or event on the form. The medical certificate of cause of death has two parts, Part 1 contains the sequence of health conditions or events leading directly to death, while Part 2 can contain other health conditions that contributed to the death but were not part of the direct sequence. For statistical purposes one of the health conditions on the certificate is chosen as the 'underlying cause of death'. The underlying cause of death is defined as the health condition or event that started the train of events leading to death and is worked out according to rules from the World Health Organisation (WHO). COVID-19 is the underlying cause of death in around 92% of deaths where it was mentioned on the death certificate.
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.
In case this is of interest, please see the following information we hold on COVID-19 deaths:
Figure 2 of our Deaths registered weekly bulletin shows the number of deaths due to COVID-19 and the number of deaths involving COVID-19 with "due to" referring only to deaths where COVID-19 was recorded as the underlying cause of death and "involving" referring to deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not.
Please see the "download data" option at the bottom of Figure 2.
Here are the latest summed totals for COVID-19 up to week ending 19 February 2021:
- Deaths involving COVID-19 (underlying or secondary cause): 128,077
- Deaths due to COVID-19 (underlying cause): 115,574
We have also been producing Pre-existing conditions of people whose death was recorded with an underlying cause of COVID-19, deaths registered in 2020, this dataset can be found in section 7 of the Monthly mortality analysis bulletin. This dataset provides a greater insight into the leading pre-existing cause of death groups, for deaths occurring in England and Wales in 2020 that were due to COVID-19. This will be updated quarterly. COVID-19 deaths involving pre-existing conditions is split by broad age groups between 1 to 64 years and 65 years and over.
If you would like to discuss these statistics further, please contact health.data@ons.gov.uk.