A new study from Imperial College London looking at both the direct and indirect deaths caused by the pandemic puts England and Wales at the top of the ranks for per capita mortality, along with Spain.
The findings, published Wednesday in the journal Nature Medicine, studied the first wave of the COVID-19 pandemic in 21 industrialized countries, mainly in central and western Europe as well as Australia and New Zealand.
The researchers sought to capture mortality from COVID-19 as well as other deaths linked to the pandemic, like overburdened health services, violence or self-harm.
To measure the magnitude, they estimated “excess deaths” above the average of previous years, while adjusting for certain predictable factors and allowing for a range of uncertainty. Their findings are similar to a report issued by the U.K.’s Office for National Statistics last summer.
Spain, England and Wales all posted higher than average mortality that also stretched out over months, said study author Majid Ezzati, professor of global environmental health at Imperial College, speaking on a call to journalists. This puts their per capita death toll in front of other countries with high mortality such as Italy, Scotland and Belgium.
Co-author Jonathan Pearson-Stuttard, a Wellcome Trust clinical research fellow also at Imperial College, said that poor underlying health of the population — such as obesity and diabetes — played a part in the high mortality for England and Wales, which are counted as one country for the purposes of this survey. However, those factors didn’t explain the difference entirely, as some countries with similar poor health metrics didn’t experience the same rates of mortality.
Another finding emphasized by the researchers: A strong test and trace system is a key lever in shortening lockdown times and severity. According to the study, high performing countries likes Denmark and Austria — which had almost no excess deaths — were able to boost testing quickly thanks to their laboratory networks and public health infrastructure. By contrast, the U.K. and Spain had only limited testing capacity and contact tracing capabilities early in the pandemic.