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COVID deaths comparison

Since the COVID-19 epidemic started just over three years ago, a large number of people have died either directly from the disease or in combination with other factors. The exact number will never be known and will always be a matter of controversy because of an unclear definition of what constitutes COVID-19-related death or the lack of reliable data.

One way of looking at it is to look at excess deaths, with estimates ranging from just over 15 million to nearly 30 million, while nearly 7 million are classified as “confirmed”.

For comparison, the Great Chinese Famine of 1959-61 caused between 15 million and 55 million, due to starvation. Both can be seen on the plot below as comparable peaks in the annual number of deaths:

A similar point has just been made on Twitter, with another striking graph:

Black death pandemic at perhaps 75-200 million and Spanish flu pandemic at 50-100 million still dwarf the COVID-19 outbreak, as does the Second World War at 70-85 million.

But, in the First World War, total casualties are listed as 15 million to 22 million, including both military and civilian deaths as well as malnutrition and diseases, but excluding Spanish flu.

Going back in time, the Napoleonic wars might have caused between 2.4 and 6 million deaths.

But the COVID-19 pandemic has not finished yet…

COVID-19 winter wave

Since the beginning of December, the UK has been experiencing another COVID-19 wave. In my The Conversation article published on 13th December, I predicted:

Predictions of a large COVID wave as we head into winter have so far not materialised. The most likely scenario is that the small-scale outbreaks will continue throughout winter as COVID becomes “endemic”. 


At the time of writing, there was considerable uncertainty about what was likely to happen over Christmas, both associated with new variants (particularly XBB), loss of immunity, and behaviour (mainly the effect of Christmas mixing). This is an England prediction by IHME dated 16th December

My expectations, briefly discussed here on the blog, were that the wave would be limited, both in size and duration. I was expecting the wave to either be similar to the most recent one – the Autumn wave – or perhaps a slightly larger one, like the Spring 2022 wave.

Although the current wave starting in December 2022 is not yet over, the numbers have started to go down. Comparing the last five waves, it looks like England is simply following the same pattern again and again.

We had about the same outbreak roughly every 3 months (January, April, July, October 2022), peaking around the middle of the month. But the shape of each outbreak is almost exactly the same:

I find this picture amazing (the most recent 3-4 points in the current wave should be ignored as they will be revised upwards). The earlier two waves are very similar as well, except the magnitude is higher. If scaled down by 1.5, they look almost exactly the same.

So, is this how the “endemic” COVID-19 will look like in the future?

The recent two papers speculate that in the future, it will be endemicity that will determine the outbreaks.

New Year’s update on selected infectious diseases in England

Happy New Year to all my readers and followers! TL&DR: The apparent collapse of the NHS is not due to the unprecedented numbers of cases.

Covid wave has slowed down although it is expected that it will pick up later this winter. RSV has definitely peaked, with flu cases possibly unreported creating some uncertainty about the peak. Scarlet fever cases are very high.

The data for major diseases in England have just been released, so here is a quick update on where we are with the major diseases. Bearing in mind that this is a festive period so the numbers are usually lower due to reporting, and also likely to change in the next week’s update.


The wave is definitely in. I am pretty sure the last point (week 52) will be revised upwards next week.

I still think that barring a new variant, this wave will be similar to the earlier ones this year – optimistically, the Autumn wave, but perhaps more realistically the two Spring ones.

The current trajectory lines up quite well with the death records over all the previous waves, except the two early omicron ones (December-March and March-June).


RSV is clearly past the peak. Moreover, as the graph above shows, the actual number of hospital admissions was lower than in the pre-pandemic years. So, it looked bad, but turned out to be better than expected.


Influenza epidemic is where the main actions seems to be at the moment. The last two data points suggest we are riding the wave’s crest and following the 2019-20 pattern. If that holds over the next couple of weeks, we can expect a quiet spring.

But, as in the previous weeks, I expect the last two readings to be revised upwards and then we could enter a big flu year territory.

Scarlet Fever

This is not routinely reported by UKHSA and needs some digging in, but given interest in this disease, I decided to add it to the overview. I will be studying this very interesting graph in more details in future posts, but a couple of observations about the current year.

Firstly, notice the logarithmic scale. As a result, the 2022-23 outbreak is clearly unprecedented.

I do not know what to make of the week 50-52 readings with a jump of 20,000 cases in one week; I suspect part of it is due to reporting – cases from the previous weeks accumulating in the subsequent times.

Another hypothesis of a superspreader event (or events) is contradicted by wide geographical spread of cases. So, if genuine, this looks like a big and unusual outbreak, but the one that has been growing over the last season (notice the yellow line of 2021-22 data).

Moreover, comparison with other years suggests that we are not finished yet and I expect more cases – perhaps not as many as 20,000 per week, but certainly in the 4-digits range.