How deaths from COVID-19 are recorded by ONS

You asked

Please provide the following:

1. Please provide the total number of all deaths where COVID-19 was registered as the cause of death, rather than a "COVID-19 linked death", from the 12th of August 2020 (the approximate point at which Public Health England may have stopped recording any death as a COVID-19 death if a person ever was diagnosed with COVID-19 but later died of anything else, as exposed by Oxford University) until the 26 November 2020.

2. If possible, please tell me how many of these happened within 48 hours of a COVID-19 diagnosis, as I understand that it is currently the case that anyone who has died within 28 days of a COVID-19 diagnosis is recorded as a COVID-19 death (https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.cebm.net%2Fcovid-19%2Fpublic-health-england-death-data-revised%2F&data=04%7C01%7CFOI.Team%40ons.gov.uk%7C7f3403efd4c740069d9c08d891c58b52%7C078807bfce824688bce00d811684dc46%7C0%7C1%7C637419625505869982%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=uBnWSBJ4pvsOmVrtcL2YfeznxuCN3Gra%2FSh3L1jlmmw%3D&reserved=0),

3. If possible, please tell me how many of the death certificates in relation to the above were approved by doctors who physically examined the patient, and

4. If possible, please tell me how many deaths where COVID-19 was registered as the cause of death were backed up by a second medical professional.

We said

Thank you for your enquiry.

The mortality data we publish are derived from the formal process of death registration.

We only hold information that is recorded by a doctor, or information about the cause and circumstances of death which are provided by a coroner. COVID-19 tests are not recorded on the death certificate. Deaths from COVID-19 may include cases where the doctor completing the death certificate diagnosed possible cases of COVID-19, for example, where this was based on relevant symptoms but no test for the virus was conducted.  This differs to the data published on the GOV.UK website which are counts of all causes of death where a positive test for COVID-19 has been confirmed.   We do not have access to data on when the test was conducted as this is not recorded on the death certificate. Using the World Health Organisation International Classification of diseases (ICD10), deaths with a positive test are coded using the ICD10 code U0.71 and those with suspected COVID-19 but no test has been conducted or the test result was inconclusive are coded with ICD10 U0.72.

During the first wave of the coronavirus (COVID-19) pandemic period (March to September 2020), there were a variety of changes to the processes in which deaths are certified and registered under the Coronavirus Act 2020. Analysis of the initial impact of these changes shows that registration delays decreased and the median time between deaths occurring and deaths being registered was shorter than in the previous year.

During the emergency period for the pandemic, the attending doctor may have cared for the deceased during their last illness in person (as normal times) or via video or visual consultation, but not via audio only (for example, via telephone). The length of time for a doctor to have seen the deceased has increased from 14 days to 28 days during the emergency period. Furthermore, if the doctor who would normally certify the cause of death is not able to complete the MCCD, as the result of sickness, self-isolation or some other reason, another doctor can complete the certificate as long as they can certify the cause to the best of their knowledge and belief. However, if there is no doctor who can certify the cause, or the cause appears to be unknown, the registrar will be obliged to refer the death to the coroner before they can register the death.

Where there is no certifying doctor, the death is referred to the coroner with any accompanying information. The coroner may from this information determine no investigation is needed and inform the registrar that the death can be registered. This information will be used for mortality statistics, but the death will be legally "uncertified" if the coroner does not determine the cause of death. However, once the registrar has received the coroner's notification, the death may be registered.

Further information on completion of death certificates and changes to death certification for COVID-19 are available in our  Quality of mortality data during the coronavirus pandemic, England and Wales: 2020, Mortality Statistics in England and Wales QMI and User Guide to Mortality Statistics publications.

You can find guidance designed for doctors completing the Medical Certificate of Cause of Death (MCCD) on the GOV.UK website via the following link: Guidance for doctors completing Medical Certificates of Cause of Death in England and Wales

We do not have information on where a second medical opinion was requested, therefore we consider this information not held.

Within our Deaths Registered Weekly publication, we publish deaths where COVID-19 is the underlying cause of death and where COVID-19 has been mentioned on the death Certificate.

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

We use the term "due to COVID-19" when referring only to deaths where that illness was recorded as the underlying cause of death. We use the term "involving COVID-19" when referring to deaths that had that illness mentioned anywhere on the death certificate, whether as an underlying cause or not.