Wigan health experts say town's Covid-19 death toll could have been worse

At first glance the numbers do seem extremely high. Data showed there had been 251 deaths with Covid-19 at the hospital trust on June 28 and 338 deaths involving the illness occurring in the borough by June 19 but registered by June 27.

The WWL figure is notably above that recorded by many North West NHS organisations, with the exceptions of trusts in big cities such as Manchester and Liverpool and a couple of others such as Pennine.

And there has been no attempt to downplay the scale of human tragedy and the grief that lies behind every single one of the individual deaths.

However, when the death rate is compared to the population size and the borough’s age and health profile is taken into consideration, the experts insist a much more positive picture of how Wigan has handled the pandemic emerges.

It is often said that Wigan has the fastest-ageing population (as well as the second-largest) of any of the 10 unitary authorities in Greater Manchester.

And the borough has high levels of what are known in the medical world as co-morbidities, which are existing conditions including diabetes, heart disease and lung or breathing conditions.

These can have a dramatic impact on how likely people are to survive Covid-19 or for it to prove fatal.

Prof Ardern said: “Any death is a huge tragedy which is awful to think about, but as a borough we’ve done as well as we could have expected.

“We have come through this first wave better than I would have hoped for. I had expected it to be worse, to be honest.

“We have a higher proportion of the population in Wigan who are potentially at risk of more severe illnesses and death,

“I’ve been talking to colleagues on the pandemic influenza modelling group at Sage and it is very clear Wigan is not an outlier in any way.

“We just have more people susceptible to Covid-19.”

Dr Arya said: “The absolute numbers might look high but we are one of the biggest boroughs in Greater Manchester.

“Covid-19 is a challenge we have faced very well. We had never heard of this new virus until the outbreak started happening around the world at the end of last year and the beginning of this year.

“We have large numbers of patients with high blood pressure, diabetes, heart disease, kidney disease and so on. These are the patients who have sadly died. If you have more patients with these co-morbidities that explains the excess deaths.”

Prof Ardern said the average age of a Covid-19 fatality in Wigan was 82, with four-fifths of deaths involving residents aged 80 or over.

In absolute terms Wigan did have the second-highest number of Covid-19 deaths in the three months from March to May, with 319.

However, the rate per 100,000 people was 109.6, the fourth-lowest figure in Greater Manchester.

It is similar with deaths of all causes, where Wigan is second-highest as a number but sixth per 100,000 residents.

Prof Ardern said other stats, such as 54 per cent of Wigan’s Covid-19 victims being male, are roughly in line with the national picture.

And Dr Arya gave another statistic which is not included in NHS England’s regular updates of how hospital trusts are faring, which is the number of patients who have recovered.

WWL has seen 297 patients survive the disease and then been discharged, or 54 per cent of all those who have come into hospital with Covid-19.

Dr Arya said: “There is no evidence that we have had more excess deaths than other organisations. I have received two sets of hospital mortality data and they both show rates are coming down.”

As of June 5 around 78 per cent of Wigan’s Covid-19 deaths had occurred in hospital, with 19 per cent in care homes and two per cent in residents’ own homes.

The stats released for the period up to June 19 show a very slight rise of around one per cent in both of these figures.

Some commentators have suggested post-industrial towns may be experiencing high Covid-19 deaths as a legacy of its old workplaces, but Prof Ardern does not think this is significant.

She said: “I think it’s much more to do with cigarette smoking and things like that. I’ve spent 10 years getting people off thinking about mines and on to things they can actually do something about, like keeping themselves physically active.

“People under 74 in the borough predominantly die of cardio-vascular disease. In the older population the cardio-vascular system isn’t as good, you are not as fit and you might be frail from other conditions. This is to do with people living longer and there are issues with this virus particularly which mean older people’s immune systems aren’t as well able to cope.#

“Unfortunately this is a virus that goes for older people and those who have pre-existing conditions, predominantly.

“What is fantastic is the way we’ve wrapped support around care homes. We’ve done infection control to minimise risk to our most vulnerable citizens and there has been some lovely stuff going on keeping residents physically fit. That’s really important.”

There has also been some discussion of how deaths are recorded, with countries using varying criteria.

The NHS England statistics record deaths of patients in hospital who have tested positive for Covid-19 by NHS trust, with a separate table divided into regions for those where there has been no positive test but Covid-19 was mentioned on the death certificates. As of June 23 this total stood at 1,042.

Dr Arya said at WWL that every death in the hospital trust had been reviewed by a consultant, which was not the practice across the board in the NHS with some hospitals having to rely on junior doctors to sign off the final death certificates.

He said the internal scrutiny had found no causes for concern.

The available statistics suggest the increase in coronavirus cases has notably slowed in recent weeks, while registrations of deaths with Covid-19 peaked in the week ending April 24 in the borough.

Inevitably, that means attention is turning to how the borough will cope with a possible return or second spike of the virus or with other pandemics in the future, a scenario some scientists have warned is increasingly likely.

Dr Arya says WWL will be much better prepared to cope with a return of Covid-19 as it will no longer face the daunting prospect of battling an unknown condition.

He says some lessons have been learned this time, such as patients needing to be moved between wards less while in hospital and staff being redeployed to cover colleagues who are ill or having to work from home in ways that better use their skills.

He also praised the trust’s leadership, colleagues who had transferred non-Covid patients to Wrightington Hospital to free up bed space at Wigan Infirmary and the GPs manning the Leigh Infirmary ward for people who were recovering from the illness but were not immediately ready to go home.

Dr Ardern said it was not necessarily the case that high levels of susceptibility to the first wave of Covid-19 inevitably meant the borough would be at increased risk every time the virus or a similar illness appeared.

However, given the incomplete picture around the coronavirus, both experts sounded notes of caution.

Dr Arya said he believed it was more likely, looking at medical research into other viruses, that a vaccine will be found as opposed to some form of anti-viral treatment.

Prof Ardern said: “The message with Covid-19 is that none of us are immune. We all have a degree of risk, though it is higher if you are older or have pre-existing conditions.

“There are things we can all do to minimise the risk.

“Lockdown isn’t over, despite what some people seem to think. People should still work from home if that’s possible. We’re working very closely with schools to re-open them safely.

“Good old-fashioned measures are also really important. Good hand and respiratory hygiene can protect us against all sorts of viruses, not just Covid-19.

“People are used to having childhood vaccination programmes and getting flu jabs. It sometimes makes us a bit more complacent about things.

“We haven’t got a vaccine for Covid-19 so it focuses our minds around around infection control and prevention.”