Why you can’t compare deaths after a positive Covid-19 test with deaths after a vaccine

We’ve been asked by many readers via email, WhatsApp and Twitter whether there is a double standard in the way that deaths are reported during this pandemic.

Specifically, people want to know why deaths after a positive test for Covid-19 are usually considered to be caused by it, whereas deaths after a Covid-19 vaccination are usually considered to be caused by something else.

The answer is that both types of death are assessed by a doctor, and they are quite different.

Deaths after a positive test

As of 9 April, 127,040 deaths have been recorded within 28 days of a positive Covid test in the UK. This is the figure that’s most commonly reported by the media and used by ministers during the Downing Street press briefings. 

It is true that this total may include some people who died for other reasons, besides Covid. However, it also does not include people who did die of Covid, but died more than 28 days after their first positive test.

The 28 day cut-off was included in this measurement after it was pointed out that a death could be recorded in this data if someone tested positive for Covid, then died in a road accident some time afterwards. Public Health England (PHE) published a blog about the difficulty of counting Covid deaths shortly afterwards, but this argument has persisted throughout the pandemic, even after the introduction of the 28 day cut-off.

In short, this data does not tell us what caused these people’s deaths. For that, we have to wait until a doctor has assessed each case and completed a death certificate. 

But when we look at deaths where Covid is mentioned as either a contributing or underlying cause on the death certificate, the picture is very similar.. 

As of 9 April, 149,968 people have died with Covid mentioned on their death certificate, among those registered and reported so far—and in England and Wales about 90% of them died with Covid as the underlying cause. 

This suggests that even if some people who did not die of Covid are included in deaths after a positive test, the measure has actually tended to undercount the true number of deaths that Covid causes. 

Deaths after vaccination

In its latest report, the Medicines and Healthcare products Regulatory Agency (MHRA) has received reports of 786 deaths after a Covid-19 vaccination, up to 28 March 2021. Of these, 302 involved the Pfizer/BioNTech vaccine, 472 the Oxford/AstraZeneca vaccine, and 12 more did not specify the brand.

A total of 19 deaths occurred as a result of a very rare type of blood clot that may be associated with the AstraZeneca vaccine.

Overall, however, in reports where people died after vaccination, the MHRA says: “Review of individual reports and patterns of reporting does not suggest the vaccine played a role in the death.”

As it also explains: “Vaccination and surveillance of large populations means that, by chance, some people will experience and report a new illness or events in the days and weeks after vaccination. 

“A high proportion of people vaccinated in the vaccination campaign so far are very elderly, many of whom will also have pre-existing medical conditions. Older age and chronic underlying illnesses make it more likely that coincidental adverse events will occur, especially given the millions of people vaccinated.”

In other words, since more than 31 million people have now received their first dose of a Covid-19 vaccine, and more than 6 million have also received their second, it was always likely that some of them would die shortly afterwards, by chance, for other reasons. 

In fact, the government says, based on data taken from ONS death registrations, “several thousand” deaths are expected to have occurred naturally within a week of receiving the vaccine simply due to the fact many millions of doses have been administered, mostly in the elderly.

We have written before about the Yellow Card adverse event reporting scheme, and the reporting of deaths after a dose of the vaccine.