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of death. One resident, well into her 80s, tested positive for Covid at the end of March 2020, when she had mild symptoms. She recovered, but went on to die in August. A covering doctor who had never met the resident, or seen the body, insisted that Covid must have been a cause of death. The care home worker told me ‘she actually died of old age, quite peacefully and contentedly. Old age isn’t supposed to be used on death certificates, but sometimes it’s what it is. There wasn’t really anything wrong with her, people do wear out. That’s why people come here. Before, old age would go on death certificates occasionally if there were no other underlying issues, but it would not go on a death certificate now.’

How many times did this happen in care homes across the country? There is an abundance of anecdotal stories on social media from families or care home workers who say Covid has been incorrectly put as a cause of death on the certificate.

The coroner had a similar story. They were called by a doctor they know personally, asking for advice about ‘an old boy who’d had multiple kidney infections and died eight hours later in hospital.’ Against her better judgement, the doctor agreed to do a Covid swab, although she knew he’d died because of his kidneys. It was positive and she had to put Covid on the death certificate. I asked the coroner if they think this will be a common tale. ‘We have no idea,’ they retorted.

There are a number of dangers. The Covid death total is probably inflated, because Covid has been used too liberally on death certificates. Early on, when testing was not routine, it would have been an easy mistake due to the uncertainty around symptoms common to Covid and also other coronaviruses, flu and respiratory diseases. But even a positive test doesn’t mean Covid was truly influential in death. Many residents in care homes did not see doctors for months, testing was not routine, and families were largely unable to visit and check on their relatives’ health or be able to form an opinion about their condition in the lead up to death. As all of my interviewees said, we have no idea how often it has happened, and now we never will. If, in the most horrible of circumstances, a resident was neglected or suffered some grave misfortune, it could be passed off as Covid. Before 2020, a care home or hospital might have been sued for poor treatment or negligence. That is much harder without the same oversight and with minimal forensics.

Lockdown itself caused a horrifying number of excess deaths, just as Easthope warned. A SAGE report4 predicted that the overall death toll would be 222,000, but over 100,000 deaths would be non-Covid deaths caused by lockdown and other impacts. There were nearly 30,0005 excess non-Covid deaths at home between 21 March 2020 and 15 January 2021, and 2,937 in care homes. These might be due to delays in treatment or a reluctance to seek treatment, or ‘missed’ Covid deaths, or other causes like suicide. Non-Covid deaths in private homes, and deaths from conditions which can quickly become fatal if not treated in time, are well above the five-year average. You could say there was an ‘epidemic’ of people needlessly dying at home because they were reluctant, or unable, to seek medical help.

Frontline mental health professionals were concerned about the impact of lockdown. Suicide is the biggest killer of young people in the UK.6 Some children were on lengthy waiting lists for mental health treatment in 2020. Ged Flynn, CEO of suicide charity Papyrus, said, ‘This is scandalous. Saving young lives is no longer a national priority and we must change that.’ While suicide must never be attributed to a single cause, nine out of 10 calls to Papyrus during the first lockdown reflected the impact of Covid and lockdown, with many concerned about a loss of income, reduction in service provision, domestic violence and abuse, and the potential to become infected with Covid-19. Ged warned of the ‘longer-term problem of emotional distress’ for young people as the impact of lockdown continues and mental health services are stretched.

A report Suicide in England since the COVID-19 pandemic – early figures from real-time surveillance7 claimed that suicide had not increased in the first lockdown. I was surprised and asked Easthope why suicide had not increased, because I thought the isolation and impact on income would have been detrimental to people already struggling with mental health. She responded by telling me that disaster literature says that suicides only tend to increase from six to nine months into a disaster. The first months don’t normally reveal it. She also urged caution about early reports as only a coronial inquest can determine suicide.

The report Traumatic Stress and Suicide After Disasters8 details the phases after a disaster and, while you would not expect to see increased suicides or ideation in the immediate ‘impact’, ‘heroic’ and ‘honeymoon’ phases, they could come later during ‘disillusionment’ and ‘reconstruction’. This is a long-running disaster, so the ‘impact’ point for one person might be the beginning of lockdown, for another it might be a few months later when they lost a relative they couldn’t say goodbye to, or for yet another it might be when they lose their job when furlough ends.

Lockdown is a new experiment in response to an epidemic, Covid is a new disease, and fear has been leveraged in new ways. The impact of lockdown will be felt in economic and social ripples for many years. Of course people want to believe that lockdown hasn’t caused an increase in suicide. No one wants to see suicides increase, that would be horrific, and this pressure is probably felt even more acutely by the policymakers and those around them.

A generous interpretation of Suicide in England since the COVID-19 pandemic – early figures from real-time surveillance would be that it sought to evaluate the most

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