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Deaths outside hospital

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It is worrying that there appears to be a sharp increase in deaths in the community that are not known to be due to covid-19. (The Office of National Statistics just reported an increase of over 5000 deaths in the week to 3rd April compared to the previous week.) So far, we don’t have good data on the possible reasons for this but there are a number of possibilities. The first is simply that many of these are in fact caused by covid-19 that wasn’t diagnosed. Testing remains extremely limited outside of hospitals so we probably won’t ever know how many people had the virus during this period.

There are probably multiple reasons for other deaths. These include people not feeling able to attend their GP surgeries, call an ambulance or attend A&E as they may have done in the past. Therefore, some serious conditions may present too late for effective treatment. Concern has been expressed by doctors working in children’s emergency care that they are not currently seeing the usual range of childhood emergencies.

Another possibility is that some people with serious conditions, like cancer or chronic kidney disease, are either unable or unwilling to attend hospital on the usual regular basis, so their treatment regimes may lapse. Managing conditions like unstable diabetes will be much harder remotely than with face to face attention. Or there may be people who would have been referred to specialists for assessment of potentially serious conditions, where there is now a delay in offering appointments or indeed clinics may simply have been cancelled.

Some people confined to their homes are likely to be drinking and smoking more, or eating less healthily, and this may also contribute to health problems, including accidents, around the home.

Finally, there is already much known about the psychological effects of quarantine, especially when this is prolonged beyond a couple of weeks. Most of the mental health consequences will have a longer timescale and probably haven’t contributed to the excess mortality currently being seen. There don’t seem to be any data that so far suggest there is a wave of suicides. I think we might have seen more anecdotal cases in the news media if this was so. It is however quite possible that we will see an increase in suicides and self-harm over time, the longer the lockdown goes on. People with existing serious mental health issues may find the current circumstances particularly difficult, as they may have limited social networks or difficulty in accessing their usual sources of support.

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