Coronavirus: Death rate from Covid in England is nearly twice as high as Scotland

The gap has been steadily increasing. Just over a week ago the difference in death rates was nine to four per 100,000 respectively, although this also indicates that the death rate is rising faster north of the Border.

So far, Scotland has recorded 615 deaths in people who tested positive for Covid-19, against 11,005 to date in England.

Both figures are based on the daily counts provided by Health Protection Scotland or Public Health England, however, which are believed to significantly underestimate deaths in the community or care homes where people are less likely to be tested.

READ MORE: 'Early' lockdown measures mean Scotland's death rate should be lower than rest of UK

Death certificates, which list suspected as well as confirmed Covid deaths, are considered to be more accurate. Using this measure, the Office for National Statistics estimated yesterday that total virus deaths in England, up to April 3, had actually been 15 per cent higher.

When National Records of Scotland performed the same analysis, for death certificates up to April 5, it found 61% more Covid deaths than had been officially recorded.

The reason for the large discrepancy between the two nations is unclear. It could be partly skewed by the smaller sample size in Scotland, but there have also been reports of doctors recording Covid deaths as something else - for example, pneumonia, dementia or old age. It is possible this is happening more frequently in England than Scotland.

It comes amid a debate about whether Ireland has achieved much lower death rates than the UK because it introduced tough social distancing measures earlier.

Mortality from Covid-19 in the Republic of Ireland is currently seven per 100,000.

The UK and Ireland started out with the same number of intensive care beds per head, but Ireland closed its schools and universities and banned mass gatherings on March 12, within 24 hours of its first virus death and when there were just 27 confirmed cases. Pubs closed across the country from March 15.

By the time pubs, clubs, restaurants and leisure facilities were ordered to close in the UK, on March 20, there were 177 deaths and nearly 4000 confirmed cases.

Professor Luke O'Neill, an immunologist at Trinity College Dublin, said Irish scientists were "shocked" by the UK's approach, which he blames for the country's higher death rates.

He said: "The only explanation at the moment has to be shutting things down quickly.

"The UK delayed, and that could be disastrous."

READ MORE: Covid hospital admissions slowing in Scotland and half of ICU beds are empty

However, not everyone agrees.

Critics have pointed out that the UK was also disadvantaged by London, which crams in nine million people and is a major international travel hub. Heathrow is one of the world's busiest airports.

Population density is also a likely factor, which could partly explain why Scotland's death rate is so much lower than England's: England has four times as many people per square kilometre as Scotland, or the Republic of Ireland.

Linda Bauld, a professor of public health at Edinburgh University, said the pattern was clear in a previous coronavirus epidemic - SARS.

She said: "In terms of the transmission and the negative outcomes from SARS in south-east Asia, it was much worse in cities like Seoul and Singapore than in other regions.

"Population density is a big issue, because it's an infectious disease.

"Ireland has a lot of international travel too but not on the same scale, so it's highly likely that community transmission started later there than in the UK.

"So there's two things. One is community transmission, meaning that lockdown measures came into effect in Scotland and Ireland at an earlier point, at a time when infection rates weren't as bad as they were in England. So we will have benefitted from that more here than, for example, London.

"Secondly, population density - there are fewer people in concentrated areas in Scotland or Ireland than England.

"Another thing that might be the case - and I'm only going by what we've seen in the intensive care audits - is this ethnicity issue and whether that's playing a role.

"London, and the Midlands, have very ethnically diverse populations. That's not the case in Ireland to anywhere near the same extent - or in Scotland."

In England and Wales, 34% of critically ill Covid patients are black, Asian or minority ethnic, despite accounting for just 14% of the general population.

In Scotland questions have also been raised about the impact of poverty after the Greater Glasgow and Clyde region recorded a death rate 40% higher than Lothian, despite similar age profiles.

READ MORE: Poverty, lockdown, or missed Covid cases - what is really driving Scotland's mystery surge in deaths?

Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said evidence from China showed the virus spread more readily in families than public transport.

He said: "Clearly there is a population density argument but it's quite complicated. I'm not sure it's as simple a comparison as population density and death rates.

"Clearly the virus has done very well in London, and much better in Glasgow than in Grampian, where half the population don't live in Aberdeen.

"But the data we have at the moment is so broad brush as to be crude. Are infections spread equally across Glasgow, in housing schemes and more affluent areas? We don't know.

"Was it pubs, schools, transport? I think we have to wait and have a good look at the data after the virus has died down to see just how transmission took place."

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