May 5, 2021

In 1665, the plague raged across London, killing about 100,000 people, nearly a quarter of its population. In one week, 15 to 22 August 1665, it killed 3,880 victims across 96 of London’s 130 parishes; more than two-thirds of people who died in the capital that week were killed by Yersinia pestis. The other 1,439 had their lives ended by such things as “grief”, “spotted feaver and purples”, “apoplexie”, and “kild by a fall down stairs at St Thomas Apoſtle”.

In 2021, people in Britain die of different things. No one has died of the plague so far, and certainly no one has succumbed  to “spotted feaver and purples”, but we have just had a pandemic of another kind.

On Monday, though, there was a piece of good news. The total number of reported deaths from Covid in the UK was one. After a year in which the numbers reached as high as 1,300 per day, it feels like a note of optimism, if a sad one.

Alas, it’s not quite as good as it sounds. There was only one death reported on 3 May, but there are always fewer deaths reported on Mondays, because of delays in reporting over the weekend. That has led to news outlets and social media systematically giving a distorted picture — during the first and second waves, it meant that they reported the scary Wednesday peaks and ignored the less exciting Monday troughs. And now that it’s the other way, now that the exciting thing is the downward movement, we focus on the excitingly low number — one! — but will probably not pay much attention when it’s up again on Wednesday.

So it’s worth saying that the rolling seven-day average of deaths by actual date of death is still around the 15 mark and, when the complete numbers come in, Monday’s total will probably be more like that.

It’s also worth noting that we’ve been here before. On 3 August and 30 August last year, only one death was reported; on 30 July, zero were reported. (The number of deaths by date of death, when those numbers eventually came in, were 15, six, and 10, respectively.) And we all know that wasn’t the end of anything.

Still though: this feels like a psychologically significant moment. And it feels as though it is time for a look at the deaths the UK has suffered from Covid, and to put them in context. People aren’t diagnosed with “chriſomes” or “scowring”, as they were in 1665, but what are people dying of, now that they aren’t dying so much of Covid? How do those averages of 15 coronavirus deaths a day compare to the other big killers?

If Monday, 3 May was a fairly normal day, then we can work out roughly how many people died in total. As a broad rule, about 9,000 people die in England and Wales each week, and about 1,000 in Scotland, and 300-ish in Northern Ireland. That’s about 1,500 a day — although it’s usually a bit more than that in winter and a bit less in summer.

About two or three of those people are murdered; another five die on the roads. Some 20 kill themselves; about 40 die of diabetes. (A lot of these numbers are taken from England and Wales data; I have added an extra 10% to account for Scotland and Northern Ireland.) About 80 die of Alzheimer’s — who are, of course, far older than average. 

But the biggest killers are cancers and cardiovascular diseases (heart and circulatory problems, such as stroke): they each kill about 450 people a day, or one every three minutes or so.

Of course, it’s somewhat arbitrary how you divide things up. In 1665, for instance, “griping of the guts” (74) and “stopping of the stomach” (16) are recorded as two separate causes; but they could easily have simply lumped them together as “gaſtrointeſtinal problems” and recorded a total of 90.

In modern times, similarly, you could (and the ONS does, as does the British Heart Foundation) break down cardiovascular conditions into “ischaemic heart disease”, “transient ischemic attacks”, “vascular dementia” and so on. You could also talk about lung, bowel, prostate, breast and pancreatic cancers separately, as again the ONS and Cancer Research UK do.

By doing that, cancer and cardiovascular disease are knocked off the top spots. Once you break those down into their constituent parts, the biggest killer is dementia and Alzheimer’s disease, with about 30,000 deaths a year (or, as we saw earlier, about 80 a day).

I often see charities and pressure groups saying things like “[this many] people are killed by [cause] every [period of time]”, and I wish they’d give the denominator — how many people die of other things every day? Is it a big number? I have no idea whether one person dying every two days of something is a big deal or not; there are a lot of people, after all.

Another complicating factor is talking about different types of causes. About 75,000 deaths a year, 200 or so a day, are “attributable to smoking” — but since smoking kills people by giving them, for instance, cancer, heart disease or dementia, it’s a bit meaningless to try to compare it to those things.

Now that the worst of the second Covid peak is (touch wood) behind us, we should reflect on just how much better it is than it was. We’ve been talking about how many people die on a normal day. But it hasn’t been normal: over the last 14 months, about 130,000 British people have died from Covid.

There’s been some dispute over that figure, so let’s look at it more closely. That 130,000 is the number of people who died within 28 days of a positive Covid test. Some people get annoyed about that, because they think it will include a lot of people who died of something else.

An alternative is to look at the number of deaths in which Covid was mentioned as a cause on the certificate. That’s 150,000. It wouldn’t have been the primary cause of death in every case, but more than 90% of them were, and even in the remaining 10%, the doctor who certified the death felt that the infection was relevant. I think it’s absolutely fair to say that Covid has killed somewhere in the region of 130,000 people in the UK: about 315-ish a day since the beginning of the first lockdown.

Let’s compare that to other outcomes, like the 3,880 dead of plague vs the 113 dead of “teeth” in 1665. The Covid figure is not — quite — as many as die of cancer or heart disease, but it’s very much in that ballpark. It’s four times as many as die of dementia. Depending how you want to break up the numbers, it’s either the biggest killer by miles, or one of the top three.

There’s another layer to that, of course. For much of the year, Covid hasn’t been killing anything like as many people as heart disease has, or cancer — it did all its work in a few horrible months in spring and winter. At the highest peak of both the two waves, the seven-day rolling average of Covid deaths, according to the death certificates, was a little over 1,300, compared to around 15 now. For those two periods, about 9,000 people died in a week from Covid alone. For a few weeks in March and April last year, and again in January and February this year, about 20,000 people (18,000 in England and Wales) died every week. Covid caused almost half of all deaths in the UK. 

(But it’s all false positives, of course!)

There’s been a clamour in certain quarters lately to open up sooner; after all, if it really was down to one death a day (which, again, it’s not, but it will be soon) then that will be roughly at the level of fire deaths, at about 200 to 300 a year. And while we take fire safety seriously, we don’t shut down society to stop those 200 or 300 fatalities — or even the 1,500 or so on the roads. We accept those as part of the cost of doing business in society.

The difference, of course, is that if we fail to prevent one fire death, it is unlikely that it will lead to two fire deaths tomorrow. Unfortunately, the exponential nature of the pandemic means that one death from Covid isn’t something we can relax about.

The Great Plague of 1665 reached greater heights, after that August week: in September, over 6,000 were recorded a week,  around 1.5% of the city’s population — and that is likely a major underestimate. But it died away over the winter and following spring, and by the time of the Great Fire, the following September, it had largely ended. (It appears to have been a myth that the fire ended the plague.)

Once the plague had gone, though, people still died of “impoſthume” and “surfeit”; they were still found dead in the Street at St Bartholomew the Leſs. I don’t know when only one plague death was recorded in a week, rather than 3,808 or 6,000; when the disease was on a par with “suddenly” and “sore legge” as a cause of death. But perhaps, when it did, the news had the same sense of sadness and optimism that we do in our own plague year.

Hopefully, London doesn’t now burn down.