UK coronavirus cases are exceeding April's 'peak' – so why are deaths still low?

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The UK may be in the midst of a second coronavirus wave, with the number of confirmed daily cases exceeding the so-called peak of the first outbreak.

A further 5,693 people tested positive for the infection on 27 September, a potential underestimate due to the “weekend effect”, when reporting is artificially low.

Nevertheless, this is higher than the 5,130 incidences confirmed on 8 April, the same day the government reported a record 1,073 people died with the infection.

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But while coronavirus cases are accelerating throughout much of the UK, deaths remain relatively low, with figures released on 27 September recording 17 people dying within 28 days of a positive test.

With local lockdowns seeming to be the “new normal”, many people are undoubtedly wondering why rising coronavirus cases are corresponding with relatively few fatalities.

Young woman standing on city street wearing protective face mask
Thousands of coronavirus cases are said to have been missed due to a lack of testing during the UK's first wave. (Posed by a model, Getty Images)

‘We were lucky if we detected one in 20 cases’

An analysis of official figures suggests the UK’s true coronavirus peak may have been more bleak than ministers made out.

According to The Guardian, 8 April’s actual death toll was 1,445.

Until 29 April, the fatality figures announced at the Downing Street press briefings only took into account people who died in hospital following a positive coronavirus test.

Thereafter, deaths in all settings – including those who showed symptoms but were not swabbed – have been included in the count.

The analysis suggests that during the height of the outbreak, more than 1,000 people died with the coronavirus every day in the UK for 22 consecutive days.

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As well as many deaths going unreported, insufficient testing meant thousands of coronavirus cases were likely being missed.

“Testing is a lot higher now,” Professor Michael Tildesley from the University of Warwick told Yahoo UK.

“6,000 confirmed cases today is very different from 6,000 confirmed cases in April.

“We’re not really at the same peak as we’re observing more cases now.”

Professor James Naismith from the Rosalind Franklin Institute agreed, telling Yahoo UK: “The cases aren’t comparable, we were probably having 100,000 to 200,000 cases a day in March, we just had no way to measure them.

“We’re [now at] a fraction of the cases [we were at during the start of the outbreak].

“We were lucky if we detected one in 20 cases before we had widespread testing.”

This has been echoed by health secretary Matt Hancock, who said on 24 September: “We estimate through surveys that over 100,000 people a day [in April] were catching the disease, but we only found around 6,000 of them and they tested positive”.

Anyone with the coronavirus’s tell-tale fever, cough, or loss of taste or smell is encouraged to get tested.

If they test positive, employees of NHS’s test and trace system get in touch, asking for the contact details of the individuals the patient has recently spent time with.

Both the patient and their contacts are then told to self-isolate for up to 14 days, “not leaving their home for any reason”.

The NHS Test and Trace app, which was launched in England and Wales on 24 September, scans a user’s local area for positive cases they may have crossed.

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The overall test and trace system has faced harsh criticism, with experts labelling it “a weak and inequitable defence” that “creates [a] false sense of security”.

Nevertheless, around 220,000 individual tests are being processed every day, with the government hoping to raise capacity to 500,000 by Halloween.

“We’re [now] testing more people in the community than just hospitals or care homes,” said Professor Tildesley.

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‘Cases always rise before deaths’

While deaths appear to be reassuringly low at present, experts fear fatalities will rise unless transmission is brought under control via local lockdowns and other restrictions.

“There’s a lag,” said Professor Tildesley. “Cases always rise before hospitalisations and deaths do.”

On 27 September, 266 people in the UK were admitted to hospital with the coronavirus, compared with 3,564 on 1 April.

While hospitalisations remain relatively low, there has been an uptick in cases among younger age groups, who are significantly less likely to develop complications or symptoms but may readily spread the infection.

“Young people may [go on to] infect elderly relatives,” said Professor Tildesley.

The Office for National Statistics revealed on 28 September that “positivity rates [in England] have increased over time amongst those aged under 35 years who had socially distanced direct contact with six or more people aged 18 to 69 years”.

“[An infection] always spreads first in young people as they’re out and more sociable,” said Professor Naismith. “Most young people don’t even know they’ve got it.”

Dr Michael Head from the University of Southampton told Yahoo UK a “move from younger population into vulnerable populations” has “been demonstrated in recent weeks in both France and Spain”.

If vulnerable individuals do catch the infection, advances in treatment could lead to better outcomes than previously.

At the start of the outbreak, those requiring hospitalisation were given supportive care – like ventilation – while their immune system worked to fight off the coronavirus naturally.

In June, scientists from the University of Oxford found the low-cost steroid dexamethasone reduced the risk of death by one-third in patients on ventilation.

A review of seven studies co-ordinated by the World Health Organization (WHO) later found that dexamethasone and fellow steroids hydrocortisone and methylprednisolone reduced the risk of death by around a fifth (20%).

dexamethasone drug syringe in blue gloved hands
Studies have suggested the steroid dexamethasone could cut the risk of death from coronavirus complications by up to a third. (Getty Images)

Off the back of the results, the WHO issued guidelines to include steroids in the treatment of critically ill patients.

The NHS said it would “take immediate action” to ensure those who could benefit from steroids receive them, “adding a further weapon in the armoury in the worldwide fight against COVID-19”.

“We know we have better drugs to treat patients in hospital,” said Professor Tildesley.

“Hospitalisations may go up but not deaths. Patients who are sick enough to go to hospital may have better outcomes.”

It has been suggested those who were vulnerable enough to become seriously ill with the coronavirus may have died during the first wave, a claim Professor Naismith disputes.

“There’s always new old people,” he said. “People replenish the supply of old people.

“People are [now] six months older, six months more vulnerable, more people have [been diagnosed with] diabetes [than at the start of the outbreak].”

Any suggestion of herd immunity reducing the death rate is also “just a hypothesis”, according to Professor Naismith.

Professor Tildesley agreed, adding: “We’re still a long, long away from herd immunity.”