Talk Evidence covid-19 update - covid ethics, waste and a minimum RCT size
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What is the current status of COVID-19 mortality in the UK?
Welcome back to Talk Evidence, your weekly look at the evidence around coronavirus. Last week we focused very much on the ONS death data in the UK and we'll be getting a little update on that, but this week we are going to be looking a bit more broadly at ethics and generally at waste and research. As always, I'm joined by our two favourite EBM nerds, Helen MacDonald, Resting GP and UK Research Editor for the BMJ. Hello, Helen.
Hi, Duncan.
And Carl Hennigan, GP, Professor at Oxford and Editor-in-Chief of BMJ EBM. Hi, Carl.
How do ethical considerations influence COVID-19 guidelines?
Hi, Duncan.
As always, Carl, you've had another busy week and we saw you are talking to national media on Newsnight with David Spiegelhalter, who was our guest last week, talking a little bit about that ONS data. Now, David last week suggested that he thought there was going to be another peak because of the way that data is collected. Did we see some of that?
Yeah, no, it's very interesting. The Office for National Statistics, ONS, each week on a Tuesday updates their data set. And I have to say they're doing an amazing job in improving the granularity of their data, putting more evidence in. In what we call week 15, up to 10th of April, there were 18,516 deaths registered compared with a five-year average of 10,520. So that's an excess of 7,996 deaths, 75% more than what we'd expect at this time. In week 14, we had 6,000 excess deaths. So it's ticked up again. And there are lots of very important caveats in the data. For instance, of the 7,996 excess deaths, 6,213, 78% mentioned COVID, but 22% did not mention COVID on the death certificates. A couple of important issues as well is that greater than 70% of all the deaths occurred in over 75s.
So this is disproportionately affecting elderly populations in a devastating way. But there's one really important issue I think within the coding that was very interesting for me was One of the aspects about SARS is it's the clues in the name, it's sudden acute respiratory syndrome.
What recent research updates are available on viral particle shedding?
So one of the things that I considered within SARS was that you were preparing for a viral pneumonia problem that required all the ventilators because you get this sudden acute respiratory problem that requires ventilation and oxygen. But the interesting issue is, if you look at all respiratory disease deaths, and they're coded ICD codes between J0099, you don't need to know that. But in week 15, there were only 1,810 deaths with that code on their death certificate. And that's actually a decrease of 14% compared with the previous week.
What is the impact of wasted efforts in COVID-19 research?
So that suggests that the majority of deaths that have been occurring are not predominantly respiratory and are caused by other conditions, because particularly on a death certificate, if it was pneumonia, you would have that on there. In a flu outbreak, when you get excess deaths, about one third of all deaths have pneumonia on their certificate.
So these raise important questions, I suppose, about the natural history of COVID, and we'll be wanting to pick that up in another episode, I think. One question that David, or three things that David thought might be suggesting some of the excess deaths there that didn't have a direct COVID-related line on the death certificate were, because there were, we'd had a mild winter, and there were a lot of frail elderly people, we might have expected to die from flu or whatever else in that period, who didn't. The fact that there might be, you know, reluctance to diagnose COVID, if that wasn't absolutely the obvious cause of death. And then finally, because there are these people who might not be going into hospital, even though they needed to.
Did any of that become more clear?
Well, I think the proportion of people who have recorded went up from last week to 80%. So I think it's clearer that the coding is getting better. And actually, what you might see is a tendency to over-attribute now because COVID is everywhere. So the potential in hospitals is if you think a patient's had it, you're likely to put it on the death certificate. What will happen in the lighter days when we come back is we can't tell this now.
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Chapters
8 chapters
1
What is the current status of COVID-19 mortality in the UK?
0:07–0:50
2
How do ethical considerations influence COVID-19 guidelines?
0:50–2:49
3
What recent research updates are available on viral particle shedding?
2:49–3:29
4
What is the impact of wasted efforts in COVID-19 research?
3:29–5:34
5
How is ethical decision-making evolving during the pandemic?
5:34–7:04
6
What challenges do healthcare professionals face in resource-poor settings?
7:04–9:38
7
How can we improve the quality and coordination of COVID-19 research?
9:38–12:36
8
What lessons can we learn from the COVID-19 pandemic for future research?
12:36–47:13
Speakers
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