Covid Scotland: What death statistics reveal about the pandemic so far

There has also been recurring debates on social media about just how serious the disease really is compared to other common respiratory viruses - especially influenza. 

Here, the Herald takes a look at the latest statistics and what they tell us about coronavirus.

WHERE HAVE COVID DEATHS OCCURRED?

National Records of Scotland have produced data which provides a breakdown of Covid deaths for every "intermediate zone" in Scotland - a subset of each council area typically made up of no fewer than 3000 to 7000 residents. 

This provides a granular account of how Covid deaths have been distributed across neighbourhoods. 

It reveals that the community of Liberton West & Braidhills within Edinburgh has been the worst hit, per head of population, of any neighbourhood in Scotland. 

Between March 1 2020 and September 30 2021, the area lost 51 of its residents to the disease - a mortality rate of more than 1,400 per 100,000 (equivalent to nearly three in every 200 people living there). 

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The next worst hit - Burnbank South and Chantinghall in South Lanarkshire - has seen one in every 100 residents die after becoming infected with Covid. 

The following graphic illustrates the worst and least hit neighbourhoods for every council area in Scotland (excluding those with zero deaths).

For example, very rural mainland councils such as Moray and the Highlands had a large number of intermediate zones with no Covid deaths at all.

Island local authorities have also been excluded due to the very small numbers of Covid deaths and residents per zone. 

It is important to note, however, that these figures are "crude" rates of death. 

That means the deaths are counted per 100,000, but they are not adjusted to take into account varying demographics between neighbourhoods - such as age, or deprivation levels. 

For example, an area which has a comparatively high elderly population would be expected to have higher death rates from Covid because older people are more vulnerable to serious complications if they contract the virus. 

On the other hand, communities with lots of people in their 80s and 90s also tend to be more affluent than the Scottish average, since longevity is closely linked to lower deprivation. 

Age-standardised NRS figures show that deaths from all causes - not just Covid - were twice as high among people living in the 20% most deprived parts of Scotland (known as 'Quintile 1') compared to those living in the 20% least deprived neighbourhoods ('Quintile 5'), between March 1 2020 and September 30 2021.

For all causes, the age-standarised death rate was 1.9 times higher in the most deprived areas compared to the least deprived: 1678.8 versus 888.3 per 100,000. 

For Covid, however, the mortality rate was even more skewed towards the least well-off: 221.4 versus 91.4 per 100,000, or 2.4 times higher. 

When Covid deaths rates are illustrated on an age-standardised basis, by local authorities as a whole, it is clear that the urban Central Belt has been worst hit - particularly in the west of Scotland.

According to the NRS data, Glasgow City has had the highest Covid mortality at 214.2 deaths per 100,000 (age-standarised and where Covid was considered as a cause of death).

This is followed by West Dunbartonshire and North Lanarkshire. 

The City of Edinburgh - despite being home to the worst-hit neighbourhood - ranks 18th out of 32 council areas, while the most remote and rural regions of Shetland, Moray, Highland, Orkney and the Western Isles have each recorded around a tenth of the deaths compared to Glasgow. 

WHICH JOBS ARE ASSOCIATED WITH HIGHER COVID DEATHS? 

Throughout the pandemic, there has been a focus on the risk of infection for those working on the frontline - especially in hospitals or in care homes. 

It can appear counterintuitive therefore that the Covid death rate among healthcare workers is actually lower than, for example, secretaries and admin staff. 

According to NRS, between March 1 2020 and September 30 2021 there were 37 Covid deaths (where the disease was either an underlying or contributory cause) among healthcare workers, and 70 among social care workers.

Age-standardised per 100,000 people aged 20 to 64 in each occupational group, the death rate from Covid was 13.1 for healthcare workers and 36.2 for social care workers. 

That compares to 15.2 for secretarial-related occupations, and 20.7 for those in "admin occupations". 

The highest number of deaths - 99 - were reported among people in "elementary admin/service" occupations, but the highest death rate - 69.1 per 100,000 - occurred among those in factory jobs, classed as "process, plant and machine operatives". 

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The trends in occupational deaths have to be considered in a wider context, however. 

It does not mean that working as a filing clerk is more dangerous during a viral pandemic than working in a hospital. 

Firstly, the statistics only tell us the deceased's occupation - it does not necessarily mean they became infected in the workplace. 

Nonetheless, people in jobs which can be done from home have consistently been among those at lowest risk during the pandemic. 

Care home workers cannot do their jobs from home, but neither can factory workers. 

However, social care workers were more likely than factory workers to be provided with PPE and to be prioritised for vaccinaton from December 2020 onwards. 

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Deprivaton is also likely to be a factor, as people who are more affluent are also less likely to smoke or have underlying conditions - such as asthma, obesity, heart disease, or diabetes - which increase the risk of fatal Covid complications.

For example, teachers - who returned to classrooms towards the end of 2020 and for most of 2021 - have had the lowest Covid death rate of any occupation, at 6.9 per 100,000, despite having a comparatively high rate of workplace contacts. 

BUT HUNDREDS OF PEOPLE DIE FROM FLU EVERY YEAR TOO?

A frequent comment during the pandemic from people opposed to lockdowns or who believe restrictions are an overreaction to the danger posed by Covid is that influenza already claims many lives every year without similar measures being imposed. 

However, figures released this week by NRS shows that the death toll from influenza in Scotland from 2000 onwards has been substantially lower than mortality from Covid. 

Source: National Records of Scotland/Scottish Government

Between 2000 and 2021, there were a total of 1,307 influenza deaths in Scotland where the virus was listed as an underlying cause of death. 

Even counting them by the number of times influenza was mentioned on a death certificate, the total is still only 1,617. 

In comparison, Covid - where the infection has been confirmed prior to death - has claimed upwards of 9000 lives since March 2020. 

Source: Public Health Scotland

Since the beginning of the pandemic, influenza has largely disappeared from circulation, as demonstrated by the above graph from Public Health Scotland of positive laboratory tests for the virus. 

PRE-EXISTING CONDITIONS

Another recurring theme throughout the pandemic is the idea that Covid is a disease that only kills the elderly or those with underlying health conditions. 

Data from NRS shows that, of the 11,179 deaths where Covid was mentioned on the death certificate between March 1 2020 and September 30 2021, 88% (9,829) were in people aged 65 and over. 

However, this includes 599 individuals who had no pre-existing health conditions.

Furthermore, among males under-65 who died with Covid, 16% had no known health problems, and 12% of females had been otherwise healthy.  

Across the board, however, diabetes was the most common underlying condition in Covid deaths, affecting 26% of patients who died with the virus. 

EXCESS DEATHS

Finally, how has the pandemic affected the deaths from other causes? 

Overall, during 2020 and 2021 - up to October 10 - there were 474 more deaths from cancer compared to the pre-pandemic average (the four-year period from 2015 to 2019).

This may reflect delayed diagnoses making treatments less effective, or interruptions to some services such as chemotherapy or surgery as a precaution earlier on in the pandemic while coronavirus rates were high. 

There have also been 580 excess deaths from strokes and heart disease over the same period, which may reflect lower A&E attendance with cardiac symptoms during 2020.

However, Covid infections are also known to cause blood clots meaning that some of these deaths may actually be linked to the virus, but patients - especially earlier in 2020 - were not automatically tested.  

In contrast, deaths from dementia and Alzheimer's disease increased by an excess of 278 during 2020 but then reversed and have been 267 below average in 2021. 

There have also been 3,130 fewer deaths from non-Covid respiratory diseases, such as pneumonia, partly reflecting the way social distancing and hygiene measures have curtailed the spread of viruses.