I have been banging on about how the number of people dying right now of Covid-19 is much higher than it should be, if Chief Medical Officer Chris Whitty and Chief Sceintific Adviser Sir Patrick Vallance are right that the infection fatality rate (IFR) has fallen significantly because of improvements in care and treatment.

The below chart show shows this worrying rise in the mortality rate very clearly.

It plots reported daily coronavirus deaths in England as a proportion of daily infections 23 days earlier, as per the Office of National Statistics survey.

And as you can see, a significant fall in the infection fatality rate from July to September has since gone into serious reverse.

The irony here is that when Vallance warned about the second wave all those weeks ago, he seems to have overstated the likely growth in infections while being right about deaths – though I am not sure if that is good or bad for his reputation or for that of the Scientific Advisory Group for Emergencies.

So what is going on?

Well the regular reports from the Intensive Care National Audit and Research Centre (ICNARC) , which carries out weekly audits of the social and medical characteristics of Covid-19 patients in hospitals’ intensive care units, give important clues.

What stands out from the ICNARC reports, the latest of which was published on Friday, are the rises in seriously ill coronavirus patients who are obese and are poor.

In the first wave, for example, the proportion of acutely ill coronavirus patients classified as most deprived on the index of multiple deprivation (by quintiles or fifths) was 26%.

That has risen to 37.9% since September 1 (and see below chart).

And there is an analogous rise in the proportions who are obese, from 31.4% to 35.6% for the second most severe category of obesity and from 8% to 10.7% for the morbidly obese (again see below).

There is a conspicuous corollary between rising deprivation and rising obesity, which you can see in a final chart that is based on NHS data.

It is also of course relevant that the increasing prevalence of the infection has been focused disproportionately on the north, where the incidence of poverty and obesity is higher.

All of which is to say that the rising death count in this second wave is in one way a tragic manifestation of what some would argue is this nation’s greatest defect, namely the connected and huge inequalities between our incomes, prospects and health.

These inequalities are scandalously large both within regions and between regions.

If more people are dying of Covid-19 than the experts expected because we cannot protect the poorest, that should prompt a fundamental reconfiguration of how the resources of this country are allocated.

And if not, why not?



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