October 3, 2020
While the United Kingdom has suffered perhaps the worst death toll in Europe during the Covid19 pandemic, only the larger half of above-average deaths have been linked to the SARS CoV-2 virus. The rest are disputed excess deaths likely caused by unknown infections with the same rampant pathogen or, to many minds, by the lockdown itself.
Among these, Kit Knightly at the Off-Guardian blog noticed, at the end of July, a trend in the mortality data. Among hard-hit nations, the vast bulk of victims were over 65, but England was different, seeing an "Unprecedented spike in deaths of 15-44 year-olds." Knightly found these, by age, "unlikely to be due to Covid19" and claimed - falsely as we'll see - "no (other) countries anywhere show increased mortality in people under 45." This "unprecedented spike," he says, "seems to be unique around the world. Why?" He offers no guess, except to doubt that it was caused by the virus, and suggesting the actual cause might be what I call "lockdown, somehow."
The unusual level of deaths referred to is real, and we'll look at it in a little detail below. In fact I can add the issue has become a bit more pronounced since his article. Knightly takes 15-44 as too young to include many covid deaths, but this is sloppy thinking. As I'll show, it doesn't seem there that many, really. And also, 15-44 is broad, including some overlap with semi-old groups where fatal conditions apply more than one might think. Some quick basic references to start getting a view what rates apply around age 44, the upper end of the range in question:
compared to 18-29year-olds:
* 40-49 years had 3x higher hospitalizations, 10x higher deaths.
* 50-64 years had 4x higher hospitalizations, 30x higher deaths
* ages 35-44: 1,780 deaths, 1.722% of total
* ages 45-54: 4,976 deaths, 4.815% of total
* ages 18-39 had a 0.06 "hazard index"
* age 40-49 was 0.3
* 50-59 was 1.0, etc.
By June 14 (citing old numbers since revised down): of a total 44,869 deaths: 40,023 were 65+, 4,359 were 45-64, and 487 were under 44. That small portion will be spread out over all the ages, but we should get why they'll mainly be clustered at the older end, with probably over half of them aged 35-44, and maybe even with over half of them in their 40s (and also predominantly male).
I'm still no expert, but when I looked into it early to assess my own risk, it seemed ages up to 30 had negligible deaths, with a slight increase in risk accumulating between ages 30 and 44, a slight but marked increase, it seemed, right at 45 (the line I'm just past). Of course it's down more to conditions, and I'm on the wrong side of that line too (maybe related to my anti-virus bias?) I don't recall now just where I had seen that and why it seemed so year-specific when most sources I see now just give ranges. But it had seemed to me the biggest single age difference was between 44 and 45, with the difference being smaller between 46 and each year up to around 55, where it gets increasingly worse every step from there up - I didn't pay as much attention past my zone, which we're dealing with here.
If 45 is such a cut-off, a group spanning up to 44 might seem safely in the low fatalities zone. But in reality and on a big scale, there can't really that much uniform difference between the two ages. If 45 tends to be the start of high risk, 44 1/2, 44, maybe even 43 1/2 should see some early risk-bloomers. It would mean a sharper increase right around that age, over the slight increases seen from age 30-40. Reasonably, that means of the 487, likely 1/3 to 1/2 of this small number were aged 40-44. That would be 162 to 243 deaths = 0.36% to 0.54% of the total killed in the UK's first wave. There are already the scattered few in their 30s and early 40s this adds to. The total might be significant, if still paling in comparison to the masses of fatalities in higher age brackets.
This pattern was noticed in combined mortality - covid and supposedly non-covid deaths. But the latter can in fact include any proportion of undiagnosed virus-related deaths, depending on the details (as well as vice-versa, also depending). My opinion remains a solid majority of those disputed excess deaths in the UK, and even some of those below average, were killed by SARS CoV2, following on confirmed, unconfirmed, and totally unknown infections. It kills almost always with the help of existing conditions, which it turs into co-morbidities, during or after active infection, by direct suffocation or exacerbated damage, causing death often decades ahead of schedule. The relative few deaths in England and elsewhere under age 45 would be primarily among the 30-44 age sub-group, centered old (mostly 40-44). As far as I know, that exactly the age break down for all the elevated 15-44 deaths.
I'll try to look out for, and will suggest someone should make available, relevant fatality breakdowns (esp. for the UK/England) for that overly-broad age bracket 15-45. But for now ...
The stats cited above for UK deaths - again this is with the first wave up to late May/June, while the issue in question was only noticed in late July, in part because it was becoming more evident by then. If they were more covid deaths, they would follow the same age patterns, and that's just what's in dispute here; they seem to be too young. That pattern does exist and, as I'll show, it's gotten even clearer since then. England's "non-covid" deaths aren't just unusually young on average, they're getting younger all the time. And yet, the bulk of those above average (and even some of those below it) probably are more-yet victims of the same deadly virus.
Europe's Younger Death's Assessed
I checked deeper into the data Knightly cited (see below - the European Mortality Monitoring Project (EUROMOMO) - 20 European nations signed on to pool mortality data from 2016 on to help track public health threats like this one - there are signs of the same thing happening in other countries, most notably in Spain. Actual levels barely avoid reaching excess, but they do so after rising from the early low, sometimes for a couple weeks in a row, and at the right times to caused buy the virus.
See here for the data cited: https://www.euromomo.eu/graphs-and-maps. For reference, the involved countries/locales are: Austria, Belgium, Denmark, Estonia, Finland, France, Germany (actually 2 entries: Belrin, Hesse - the rest of the country?), Greece, Hungary, Ireland, Italy, Luxembourg, Malta, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, and the UK as its four countries: England, N. Ireland, Scotland, Wales.
The Z-score they use for measurements will be explained somewhere ... the provided baseline uses historical weekly death tolls and some seasonal and yearly variables like heat waves into an algorithm that should decently predict the number of deaths to expect - basically - if this pandemic hadn't happened. (or so I gather on a skim of the site)
While the scale of it has no clear precedent among the examined examples, the issue of elevated younger deaths is not unique to England. How it compares to trends in, say Brazil, India, or Iran remains unclear, and even among the other EUROMOMO states, we can see it's not entirely unique or unprecedented. In case after case, with varying clarity, we can see rises in deaths here corresponding to those among older classes and with known surges of coronavirus infections/deaths.
And as I'll show, the rises in younger deaths are followed by larger surges among older folks aged 45-64 and more so with those 65+, just like covid death waves might move. The pattern was terrible in the pandemic's first wave prior to general lockdown and related control efforts, but greatly muted in the second waves of summer and fall. It's as if the older section were learning and avoiding the virus better while those aged 15-44 seem to keep getting it and then dying at about the same rate they always did. It's only natural then that the deaths are getting younger on average. And this would support a connection between all age groups - same virus, different learning curves.
Upon a bit of examination, several countries' data is clear that parts of 2020 have been quite deadly for Europeans aged 15-44. Those parts tend to match up with Covid19 1st and 2nd waves, and otherwise might reflect less obvious levels of the same thing in between. There will be other causes mixed in bringing the death higher or lower than the virus alone would, but to imagine anything else causing the bulk of them ... is something I'd need a little help with.
Knightly picked for consideration the five European countries "most affected by Covid19 so far," which he fairly considered to be Italy, Spain, Belgium France and the UK. For each one, he showed a graph of weekly mortality for those aged between 15 and 44, squished small to show several years. England definitely stands out, but at least Spain is visible even there as scoring significant excess at relevant times. Most of the others show different kinds of rises to and past the upper limit of normal, often after a quick rise from a level well below average, often corresponding to periods of strict lockdown (see France for example).
Increases in younger deaths can be seen among all EUROMOMO nations combined: definite excess in this group past the red upper 5 at w12-16, and close to it w31/32, with two spikes to the upper 2 at year's start and February (possibly related), and a bit past that line in week 22 following the April peak, and close again week 37, with the most recent weeks elevated and holding steady just below the 2. In all countries combined, deaths 15-44 are well over baseline in the second half of the year, after starting a bit low. England will be the biggest contributor to this, but not the only one.
Here I added the green box and other labels, including to explain the graph used throughout. The original chart also gives actual numbers of deaths, unlike most of them. Weekly deaths as high as 1,448 in week 15, to an expected baseline of about 1,170 - an additional 24% died across these 22 nations. It hits 14% over in weeks 31 and 32. )
Also note in the plotting above and those below a possibly misleading optical illusion: in most cases the actual number of deaths age 15-44 is unclear, and may seem large by the graphing. But usually this bracket dies off in fairly small numbers, with proportionally small variations that - by the nature of small numbers - look fairly dramatic and erratic. So it's not that hard to exceed normal or even excess, as soon as there's anything around to push them higher at all. If I read it right, the above plotting uses a baseline of around 1,150 to 1,200 deaths per week between all 20 involved nations. That 24% excess would only be an extra 288 deaths, across 20 nations and in a whole week.
So even England's massive spike looking similar to those for older folks still represents a fairly small portion of deaths. As noted above, only 487 Covid19 deaths under 44, plus whatever excess past that (another 300?) fill out that massive peak up to June. A few hundred people in their 40s plus a few hundred all younger ages combined, some confirmed and some not, in a hard-hit nation of 67.5 million - is that really so hard to swallow?
By-Country Analysis
Some other countries considered, just in text first, then visuals for some:
Spain: plotting shows excess for ages 15-44 at weeks 4-6, w12-14, solid excess at w5, 13 then average, then excess at w31 and 35, and all high near upper 2 in between.
Italy at upper 2 w8 9 12 14 16, and low since
France: w13, 15, then a steep fall w 16/17, average since, until a rise to near upper 2 at w32
Austria: a smooth rise peaking w11 near upper-z, notable lack of low usual low weeks - all high must add up.
Belgium: rises within normal at weeks 5, 12, 36
Belgium: rises within normal at weeks 5, 12, 36
Portugal: at upper 2 w27,29,31, with actual excess w29
Switzerland: a rise peaks at upper 2 w15, 23
Sweden scrapes it w10, 15, but otherwise near and often below baseline. This was part of their plan - it was the old Mr. Tegnell was willing to lose a bunch of.
Netherlands: odd pattern, possibly unrelated (more study in image): early spikes, moderate since, then near-excess again at weeks 33/34 and 36.
In my crude visual explorations below, I'll show the interrelated rises and falls between 3 age brackets (15-44, 45-64, and 65+), while exploring a new theme I noticed; the disputed death cause(s) seems to spread from the younger to older over time, with peaks tending to appear about a week later in each bracket up from 15-44 (with a week being the finest time unit available). In the first wave, each level also shows a higher peak of deaths and a longer post-peak high following it, and with little or no time delay. In subsequent waves over the summer and fall, the same effect appears but much more muted, sometimes invisible, and it takes longer for a spike of deaths to appear each level up. Those aged 45 and up and especially aged 65 up have by and large learned to avoid Covid19, and they do that now. They still die from it, but in lower number and after evading it longer than than they did before.
England, noted and visual: w13-16 high excess, pretty high since, esp. w30, 32. w13-17 at upper 5, peaking at z-score 6.45 week 15 - solid excess past the 2 w20, slight w23, 30, 32, 38. Legendary excess among the older groups during the first wave. As often happens, this instill a strong communal lesson - from purple forward, the time delay between a surge hitting different age groups is longer than any others I looked at - 2 and 3 weeks, to the 1 or 2 weeks or no offset with the rest. If English youngsters are especially infected and dangerous, could it be the older folks know this and avoid them a bit better than usual?
There's also a notable rise in all ages deaths in the first weeks of the year, spiking shortly after Christmas family visits would occur, with ages 65+ in excess, scraping the upper 5 in weeks 1 and 2. A similar trend in the US involved a holiday surge of mysterious "pneumonia" deaths in week 1, just as the first confirmed covid19 death (unknown at the time) occurred on January 4. Did England see the same kind of thing?
Wales - the closest thing to another England, most likely to develop or catch the same problem: similar rise offset between ages but shorter - mostly one week, and note above how 15-44 deaths start below average/baseline prior to the April peak, and remains solidly above after that. Wales displays the same pattern, but more muted. As noted above, all EUROMOMO nations combined also shows the same basic pattern. From week 20 forward it rises to entirely above baseline, scraping the upper 2 at week 22 and surpassing it at week 33, while deaths for older classes remain close to or below baseline levels of death.
Spain: less time delay - generational mixing is the norm? (orange, green). But in the purple min-rise - is the loosened lockdown, continued segregation of elders? And that was later loosened? I haven't followed, but if I had to guess...
Also I had noted before a surge of deaths in Spain in late 2019-2020, when they did have at least a couple of known covid cases. There on the left we can see a similar pattern between all age brackets. But just what caused that to level off and drop well before the bulk of covid cases would take some explaining. Maybe they had a bad flu before, that actually WAS its own thing.
Italy- looking milder than I'd think relative to the red line for upper-5 significant increase. Great display of magnified and delayed tolls at each bracket up, following a basic shared pattern in all three color-coded phases.
France - as with Spain, not so much for the time delay, and the deaths among younger people tends to come at the end of each surge, when it's more often at the start. But again rises in deaths occur in all 3 groups at a time of surging likely covid deaths, and to an increasingly similar scale (on the Z-scale) each time. See in France too how deadly lockdown was to 15-44 year-olds (weeks 16-19, most recent weeks)
Netherlands: almost backwards for age offset, but again all three ages brackets have surges of death around the same time, most likely from the same cause.
Blah Blah then End
People aged 15-44 - especially the younger half of the bracket - are on balance the most mobile and least cautious, the least burdened by a sense of personal danger, and thus the most likely to stumble into the SARS Cov-2 virus early on, and to be the main drivers of contagion everywhere. They don't die as often as older patients do, but they suffer some deaths along the way - especially among the older half, and primarily those aged 40-44, or anyone with the right conditions. It won't then move to an older group an leave them alone, but the graphs almost look that way. Some of them may have some a heart valve disorder, etc. and would die suddenly, while less of them die after a struggle (absent some such swift assassination, they can often win a struggle), so their deaths might spike earlier in a surge.
Older folks know the danger and are more careful, but when it's spreading widely enough, many wind up getting it eventually - around a week later on average, and much more fatally per capita. Many of these deaths are also swift, but it more often comes to a struggle, which they more often lose. It will be just as fatal to them now, but less are dying. This means one way or another, the virus is getting to less of them, and getting there later when it does.
The younger folks, by contrast, haven't learned they have anything to learn, and so they keep getting infected and thus dying at the same or even higher rates as they were before. Considering the lessons most of us have drawn, so many convinced this is a harmless flu except to people over 60 or 70 or at least over 50 - they WOULD get infected more widely, and find their fatal percentage much more effectively, apply it to a far greater number, and gradually or swiftly skew the average death age younger.
If we could only see just where in 15-44 it's centered, we could probably see even more clearly how my reading makes the most sense - ignorance is the #1 extra contributing factor to this issue.
England is heavy on semi-misinformed libertarian lockdown rejectionists and herd-immunity-enthusiasts, even among otherwise bright people. It does not surprise me that an unusual proportion of the 15-44 drivers there wind up dead, with both higher spikes and a higher prolonged elevation between. I'm not surprised to see it bleeding over into Wales. All things considered, this probably is due to the same virus killing so many others. More likely there are just far more people aged 15-44 than we realize, far more than normal, with unconfirmed infections. Many will have sought out infection deliberately. The unconfirmed fatality ratio we'd be looking at might then be about the usual. Maybe it higher than even this, because of more diabetes than usual, or whatever. But either way, it all makes sense to me.
Here's another thing I found to help understand: ONS 2019-2020 weekly all-cause mortality surveillance for England and the "devolved administrations" of Wales, Northern Ireland, and Scotland, in less detail and the latter with a 2-week time lag.
upper 2 (upper normal range) used here, and broader age groups: 0-15, 15-64, and 65+. Just one group sees excess past week 23, and it includes the segment in question, adding a bit of time-and-space detail to the picture.
We'll start at the last high week you could call part of the April peak - week 22, ending May 29 (example PDF link): "In week 22 2020 in England, statistically significant excess mortality by
week of death above the upper 2 z-score threshold was seen overall. Statistically significant excess mortality was seen by age group in the 15-64 and 65+ year-olds and sub nationally (all ages) in the North East, North West, Yorkshire & Humber, East & West Midlands, East of England, South East and South West regions." No excess deaths in Wales, Northern Ireland, but (as usual noted in a later report) there was in Scotland back in week 20, when almost everywhere was.
From there forward, statistically significant excess mortality was seen in ...
week 23: Excess seen sub nationally (all ages) in Yorkshire & Humber and East Midlands regions (not Scotland or anywhere outside England, from here on out).
week 24: no excess anywhere
week 25: only in East Midlands (all ages)
week 26: East Midlands (all ages)
week 27: no excess
week 28: ages 15-64, East Midlands
week 29: ages 15-64, East Midlands
week 31 no excess
week 32: ages 15-64, East Midlands (all ages)
week 33: ages 15-64, East Midlands and South West (all ages)
34: no excess
35: no excess -
36: "Statistically significant excess mortality was seen by age group in the 15-64 year-olds and sub nationally (all ages) in the North East, East Midlands and South West" - bit the actual death toll given is far lower than the other weeks - see notes below.
37: no upper-z excess
38: no upper-z excess - ??
39: sub-nationally (all ages) in the North East and East Midlands regions
"All ages" doesn't mean every age group was in excess. It means ... not sure. Ages aren't given for reginal overage? General excess, but only a tiny bit over in a few areas, under in others, with no one bracket standing out for excess?
Anyway, no age bracket stands out then except 15-64, apparently meaning nationwide, but clearly driven most by constant excess in East Midlands. It keeps doing that. Why? I offered my guess already, a couple of times. Sorry.
So England's excess deaths also centered in the East Midlands, besides being younger than usual. Nearly all of them will have some kind of condition, even a mild and totally unknown one, been smokers, or obese. I bet they also have a higher tendency for taking their health advice from alternative media. Maybe just the person who infected them did. For whatever reason, the excess deaths never stopped there, hovering above and just below that generously high upper 2 z-score level. weeks 28-33 and 36 is when more younger folks start dying even more, which would be some days to week(s) after increased infections during the second wave in September.
Ref: week 22 where I started, with deaths coming out 757 above my calculated multi-year average for that week. That's down from +1,578 in week 21, following a peak of 12,711 above average (well over double the usual deaths) in week 16 (and week 17 wasn't much better). Those all labeled as showing significant excess deaths in all or most areas and age groups. But at week 35 where it's 857 above my average, it's called not significant. Then the next week it says deaths are up all over, despite the lowest numbers yet? Week 36: "Statistically significant excess mortality was seen by age group in the 15-64 year-olds and sub nationally (all ages) in the North East, East Midlands and South West" coming to the furthest below average toll yet: 1,807 below my 3-year-average. (7,739 deaths vs. 3ya 9,546 - ONS uses 9,182 5ya for this week). The pattern plotting these weeks 35-37 is \/, while the description is opposite, and EUROMOMO data for England agrees, giving the weeks a /\ pattern, but kinf of tilted or flipped (and actual numbers unclear for better comparison). I'm still working on a big project involving all this that got hung up on that very confusion.
Update October 7:
Figure 3 shows "Non-COVID-19 deaths are generally below the five-year average for younger age groups from Week 12 (week ending 20 March 2020), particularly those aged 10 to 39 years."
notice the cut-off age. 40+ aren't so particular in being low, and they would grow in time. But they show weekly deaths by 10-year brackets, and on review, I may have overrated the 40s. At least by variation from the norm, the 30-39 bracket did almost as poorly, though compared to probably lower norms.
It seems plenty in their 30s die as well, and that's part of why 15-44 year-olds die so much.
Figure 2 in the later report shows the same over lockdown and into the summer, used here (remixed with notes) to compare the 4 age brackets where covid-age deaths can be still be seen as the ones in excess, a bit younger than you'd think, if not younger than usual.
The ethnic demographics of the UK will play a part in regional mortality differences; as a result of cultural differences, socio-economic factors, and age stratification.
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