FOI Ref: ​FOI/2021/2848

You asked

Please could you tell me whether those England and Wales citizens who have been deemed to have died linked to Coronavirus, currently amounting to some 130,000, are also recorded as having died due to another cause, possibly the principal cause, of death such as road traffic accident or heart attack.

We said

Thank you for your enquiry into cause coding of COVID-19 deaths.

When a person dies, in most cases a doctor writes a medical certificate of cause of death (MCCD) which is then recorded in the death registration (at a local authority registration office). The details are printed out as the official 'death certificate' for the next of kin. The same information is sent electronically from the registration office to ONS for us to produce statistics about causes of death. For some deaths, such as when the death was due to an accident or violence, there is a coroner's inquest to establish the facts and the coroner then decides the cause of death and sends their findings to the local registrar.

The doctor or coroner certifying a death can record more than one health condition or event on the form. The medical certificate of cause of death has two parts, Part 1 contains the sequence of health conditions or events leading directly to death, while Part 2 can contain other health conditions that contributed to the death but were not part of the direct sequence. For statistical purposes one of the health conditions on the certificate is chosen as the 'underlying cause of death'. The underlying cause of death is defined as the health condition or event that started the train of events leading to death and is worked out according to rules from the World Health Organisation (WHO).

If someone dies in circumstances involving an accident, violence or suspicious circumstances, the case is referred to a coroner for investigation. A post-mortem examination is carried out and usually an inquest is held. The Coroner's Court hears all the evidence and follows legal rules of evidence when deciding the causes of death. It is extremely unlikely that a coroner would find that someone was involved in a traffic accident, or was the victim of violence, because of having COVID-19 or a positive COVID-19 test - so they would not mention COVID-19 on the death certificate. This applies to any death caused by an accident, violence, poisoning, or other external causes. Even if in an unusual case a death certificate mentioned both COVID-19 and a traffic accident (or other external causes), the World Health Organisation (WHO) rules for coding deaths mean that the traffic accident would be identified as the underlying cause of death in our data.

You can read in detail about the coding of causes of death and identifying the underlying cause in the ONS User guide to mortality statistics and the WHO International Classification of Diseases (ICD-10) instruction manual.

COVID-19 deaths by underlying cause and contributory cause are reported weekly in the Deaths Registered Weekly in England and Wales publication, which is updated every Tuesday.

When we say that a death 'involved' COVID-19, we mean that COVID-19 was mentioned anywhere on the death certificate, possibly along with other health conditions, not necessarily as the underlying cause of death. When we say that a death was 'due to' COVID-19, we mean that COVID-19 was the underlying cause of death, because it was either the only health condition mentioned on the death certificate, or it was the one that started the train of events leading to death. You can see how these different categories are used in the ONS Monthly mortality analysis.

2020 data is available in our recent publication Deaths due to COVID-19, registered in England and Wales: 2020

Deaths due to and involving COVID-19 registered in England and Wales in 2020

a)    Number of deaths due to COVID-19: 73,766

b)    Number of deaths involving COVID-19: 81,795

Summed total of deaths due to and involving COVID-19 registered in England and Wales 2021 (as of 27 August 2021)

COVID-19 (U07.1, U07.2, U09.9, U10.9)

Deaths involving COVID-19 (any mention on the death certificate): 61,497

of which, deaths due to COVID-19 (underlying cause): 53,659

If you would like any further information regarding these statistics, please contact