In an open letter to the Health Secretary Matt Hancock, Dr John Lee, former professor of pathology at Hull York Medical School and Dr Clare Craig, who runs the Covid19 Assembly Covid Deaths Audit, call for the government to take steps in order to avoid any doubt regarding the future attribution of Covid deaths. The full text of the letter appears below:

An open letter to:

Matt Hancock, Secretary of State for Health and Social Care

Copied to:

Humza Yousaf, Cabinet Secretary for Health and Social Care, Scotland

Eluned Morgan, Minister for Health and Social Services, Wales

Robin Swann, Minister of Health, Northern Ireland 


Dear Mr Hancock,

Re: Covid Deaths Recording

We call on you to change the way COVID deaths are recorded, so that the numbers can be clearly compared with previous years.

Every winter season has a wave of deaths above the summer baseline, the majority of which are attributable to respiratory viruses.

Unfortunately COVID deaths have been counted in a way that is not comparable to previous recording of respiratory deaths. There are at least five differences:

  1. Figures from 2019/2020 and 2020/2021 have been added together to give a cumulative total. This has never been done before. 
  2. Deaths directly due to COVID and deaths that occurred with the virus detected in a patient have been merged. Despite assurances that the very real difference between these two categories is officially understood, the two groups are presented as one number.
  3. The criterion of attributing a COVID death on the basis of a positive test in the previous 28 days, even in the absence of symptoms of respiratory infection, is clinically dubious and has never previously been used.

We acknowledge the NHS recently adjusted criteria to define a COVID case to reduce overdiagnosis. These changes must apply to all people equally and ultimately apply to any subsequent deaths

  1. Mass testing for a respiratory virus has never previously been carried out on the scale used for COVID. It is well known that respiratory viruses are incidentally present in nearly half of all deaths, giving ample opportunity for misattribution of causes of death in a way which is not comparable to previous years.
  2. Doctors deciding on a cause of death, knowing that a patient with a positive COVID test is already recorded by Government as a COVID death are inevitably under pressure to attribute death to COVID or mention it on the death certificate.

The inevitable exaggeration of deaths “due to” COVID has meant that all-cause mortality has to be analysed to give a true indication of the extent of the harm caused by the new coronavirus, rather than having a genuine direct measure of its impact. The gap between apparent COVID mortality and excess all-cause mortality since Autumn has been obvious.

In order to return to a measure that is comparable with respiratory virus deaths from previous years (e.g. due to influenza) it is important that the Government urgently takes the following steps:

  1. Cease adding future COVID deaths to the historic tally, put aside the headline grabbing “COVID death toll”, and  separate the 2019/20, 2020/21, 2021/22 and subsequent cohorts.
  2. Advise doctors not to record COVID as a cause of death without sufficient clinical and laboratory evidence to defend that decision at inquest. A single positive test alone is not adequate evidence. 
  3. Ensure that post mortems are carried out for a significant sample of clinically and laboratory confirmed COVID deaths.
  4. Remove the criterion of  “deaths within 28 days of a positive test” from all future counting of COVID deaths.

Many members of the public, politicians, and even medical professionals have a distorted understanding of the deaths that COVID has caused.

This is due to poor data quality acknowledged by the government from the outset, but compounded by the idiosyncratic, never previously used, and non-comparable way in which COVID deaths have been attributed.

Successful reopening of society requires dialling-down the fear of COVID which has been so successfully generated.

Presenting the COVID death data in a way that is comparable to previous years will be an important part of that.

Yours Sincerely,

Dr Clare Craig BM B

Dr John Lee BMBS PhD FRCPath