Deaths and excess deaths

Death rates

Main figure: deaths per 100,000 of the whole population per year, from official death registrations: ONS for England and Wales (the UK column) and CDC WONDER for the US. They are split into vaccinated and unvaccinated people only where an official body has published that split. Otherwise it says "not published"; this guide never calculates a split. The ICD-10 code under each figure shows which causes of death were counted.

The difference: Deaths per 100,000 of the whole population per year counts everyone, including people who never caught the disease, so it shows how many people the disease kills in a country each year; deaths per 100,000 who caught it shows how dangerous it is once you have it.

Small case numbers make some rates unreliable; those figures are flagged ⚠ (under 20 deaths, the threshold CDC WONDER uses for "unreliable").

Excess deaths since 2020

"Excess deaths" means deaths registered above the number expected. The expected number depends on the method, so different official bodies give different totals for the same year.

These headline figures (ONS age-standardised mortality rates, CDC age-adjusted rates, and the post-2024 ONS and OHID baselines) already account for population ageing and growth. ONS: 'Unlike the current method, the new method accounts for trends in population size, age structure and mortality rates.' source

UK: England and Wales, official figures

Highlighted: 2020–2022

ONS changed its method in February 2024. The old method used a simple 5-year average of deaths; the new one uses a model that accounts for population size, age and trends. Whole UK, both methods: source

• England 2023, OHID new method (rolling 5-year trend baseline, revised population): 10,890 excess deaths (2% higher than expected). source
• England 2023, OHID previous method (2015-2019 trend baseline): 26,976 excess deaths (5%). Same previous method: 2020 (from 21 March) 70,718; 2021 43,102; 2022 30,587. source
• OHID: 'The flatter gradient leads to higher expected deaths and therefore lower excess deaths.' OHID paused its report after May 2026 because 'ONS and OHID adopted a similar excess mortality methodology'. source source 2

Scotland and Northern Ireland publish their own figures (National Records of Scotland, NISRA); they are included only in the whole-UK ONS row above.

US: official figures

• CDC's official weekly excess-deaths estimates stopped in September 2023: 'Effective September 27, 2023, this dataset will no longer be updated. Similar data are accessible from wonder.cdc.gov.' This guide therefore shows CDC's age-adjusted death rates rather than an excess count for the US, and does not calculate one. source

Excess broken down by cause of death

England 2023, OHID official estimate by underlying cause (age- and population-adjusted baseline) source

OHID: "the causes in the table do not sum to the total: some causes are missing". OHID dropped diabetes from its cause list because, as an underlying cause, the numbers were too small. Its earlier report, based on any mention on the death certificate, is not comparable.

England and Wales: deaths by cause group, 2019-2025 (registered deaths; counts, not adjusted for age or population, and not excess estimates) source

US: age-adjusted death rate per 100,000 by cause, 2019-2024 (CDC does not publish an excess figure by cause after September 2023) source

Infectious-disease share of the excess

• England 2023 (OHID): OHID's cause groups have no 'infectious diseases' group and do not include COVID-19. The one infection group shown, influenza and pneumonia, had 7,791 excess deaths out of 10,890 for all causes (OHID notes the causes 'do not sum to the total'). source
• That is about 72% (7,791 / 10,890, calculated by this guide from the OHID figures; because OHID's groups are not additive, this is a rough indication, not an official share). (calculated by this guide)
• England and Wales, ICD-10 chapter 1 (infectious and parasitic diseases, which excludes COVID-19 and flu/pneumonia): registered deaths 5,113 in 2019; 4,332 in 2020; 5,484 in 2021; 6,793 in 2022; 7,714 in 2023; 8,007 in 2024; 8,383 in 2025. These are counts, not adjusted for age or population, and not excess estimates. ONS does not publish an excess estimate for this chapter. source
• Within that chapter, most of the 2019-2022 rise was sepsis (A40-A41: 2,453 in 2019; 3,761 in 2022). TB, malaria and measles were each under 200 deaths a year (see the table below). source
• US: no official excess-by-cause series after September 2023, so no official infectious share is published. Age-adjusted death rate for infectious and parasitic diseases (A00-B99, excludes COVID-19): 16.2 per 100,000 in 2019, 15.8 in 2024. COVID-19 (U07.1): 85.0 in 2020, 104.1 in 2021, 7.3 in 2024. source

England and Wales: infectious-disease deaths by type, 2019-2022 (ONS; underlying cause; latest year in this file is 2022) source

⚠ Rows with fewer than 20 deaths a year are unreliable as rates.

Imported and non-endemic infections, 2020 onwards

Tuberculosis (TB) - England

• Notifications: 4,831 in 2023; 5,490 in 2024 (13.6% rise). Share born outside the UK: 73.7% in 2019, 73.2% in 2020, 77.1% in 2021, 79.0% in 2022, 80.0% in 2023, 81.9% in 2024. Rate per 100,000 in 2024: 46.9 for people born outside the UK, 2.1 for UK-born. source
• UKHSA on recent arrivals: 'This likely reflects the increased migration from higher incidence countries and effects of global disruptions in TB care due to the COVID-19 pandemic.' (UKHSA links this to TB cases, not to excess deaths.) source
• Deaths: of people notified in 2023, '4.6% of people had died at their last reported treatment outcome', down from 'the peak of 6.0% in 2021 for people notified in the peak pandemic year of 2020'. source
• Deaths with TB as the underlying cause (A15-A19), England and Wales: 156 in 2019; 168 in 2020; 152 in 2021; 169 in 2022 (latest year in this ONS file). source

Tuberculosis (TB) - US

• Cases: 8,895 in 2019; 7,170 in 2020; 7,866 in 2021; 8,335 in 2022; 9,626 in 2023; 10,388 in 2024. Share among non-US-born people: 71.2% in 2019, 77.2% in 2024. Rate per 100,000 in 2024: 15.7 non-US-born, 0.8 US-born. source
• Deaths with TB as the underlying cause (A16-A19): 526 in 2019; 600 in 2020; 602 in 2021; 565 in 2022; 572 in 2023; 622 in 2024. CDC: 'the TB death rate has remained stable at 0.2 per 100,000 population.' source source 2

Malaria (not caught in the UK or US; all cases imported)

• UK 2023: 2,106 imported cases. 'A total of 6 deaths were reported in 2023, which is the same as the annual average of deaths between 2014 and 2023.' Of cases with travel information, 72% were UK residents travelling abroad (74% of those visiting friends and relatives); 15% were new entrants to the UK (including foreign students); 5% were foreign visitors. source
• Deaths with malaria as the underlying cause (B50-B54), England and Wales: 12 in 2019; 7 in 2020; 1 in 2021; 6 in 2022. source ⚠ small numbers
• US deaths with malaria as the underlying cause (B50-B54): 14 in 2023; 18 in 2024; 2018-2022 not shown by CDC WONDER (fewer than 10 a year, or none). source ⚠ small numbers

Measles

• England and Wales deaths with measles as the underlying cause (B05): 4 in 2019; 0 in 2020; 1 in 2021; 0 in 2022. source ⚠ small numbers
• England 2025: 958 lab-confirmed cases (2,911 in 2024); 3 measles-related deaths registered in England and Wales in 2025. source ⚠ small numbers
• US 2025: 2,289 confirmed cases (including 26 international visitors); 3 deaths. CDC WONDER shows no measles deaths for 2018-2024. source ⚠ small numbers

Migration-linked infection as a suggested cause

• Not listed as a suggested cause. In the official and peer-reviewed sources checked (ONS, OHID, UKHSA, CDC/NCHS, PubMed searches), none names imported or migration-linked infection as a cause of excess deaths in the UK or US. That does not mean no such source exists. (search done 22 Oct 2026)
• Related but different findings: UKHSA links the recent rise in TB cases to migration from higher-incidence countries (see above). A peer-reviewed study found that 'Migrants from 17 of 19 countries/regions examined had higher mortality from COVID-19 than non-migrants' in England and Wales in 2020-2021. Neither source presents migration-linked infection as a cause of the overall excess. source source 2

Flu: deaths, lab tests, and the children's nasal spray

England and Wales: deaths with flu or pneumonia as the underlying cause (ICD-10 J09-J18; deaths registered; counts, not adjusted for age or population)

• ONS publishes influenza and pneumonia separately each year (Table 7, all ages excluding under-1s). The 2023 split is available there: 2,179 flu, 22,061 pneumonia (24,240 together, the same total as ONS Table 4). source
• The last two columns are this guide's own count from the ONS 21st Century Mortality file (all ages, including babies under 1 but excluding newborns under 28 days, who are not given an underlying cause). That file ends at 2022. (calculated by this guide from raw/ons/21stcmortality.xlsx)
• 'Flu and pneumonia' is mostly pneumonia: flu itself was between 34 and 4,309 deaths a year in this period. ONS: 'We often count “influenza and pneumonia” together because many cases of pneumonia are in fact caused by influenza.' source
• In 2020, deaths due to flu and pneumonia were 'below the five-year average (2015 to 2019) in every month' from January to August (ONS, deaths by date of occurrence). source

Flu in laboratory tests, 2020-2022

• England, Respiratory DataMart (hospital and public health laboratories): in winter 2020-21 flu 'detections ... were extremely low, never reaching more than 0.2% of samples tested. This compares to peak positivity of 25.3% in 2019 to 2020 and 28.6% in 2018 to 2019.' source
• England, winter 2021-22: flu positivity 'remained low', rising to 1.1% in December 2021, then to 5.3% by early April 2022 ('a late-season increase'). source
• England, UKHSA model of flu-attributable deaths (FluMOMO): 9,123 in 2019-20; 0 in 2020-21; 432 in 2021-22; 14,378 in 2022-23; 4,431 in 2023-24; 9,740 in 2024-25; 3,798 in 2025-26. source
• US clinical laboratories: share of flu tests positive fell 'from a median of 19.34% to 0.33%' (before vs after 1 March 2020), while the number of specimens tested fell 61%. source
• Australia, Chile and South Africa (WHO FluNet), April-July 2020: 51 positive out of 83,307 specimens tested (0.06%), against 13.7% (24,512 of 178,690) in the same months of 2017-2019. source
• Australia 2020: 21,266 laboratory-confirmed flu notifications and 37 flu-associated deaths. The report warns that 2020 data 'may not accurately reflect influenza activity' because of distancing, changed health-seeking and 'focussed testing for COVID-19'. source
• Note: the swab figures above come from laboratory flu tests, not from death certificates. (note by this guide)

Why flu fell: the two explanations

Both are shown with their sources. This guide does not choose between them.

(a) Official view: distancing and lockdowns stopped flu spreading

• CDC (MMWR): the fall 'were attributed to both artifactual changes related to declines in routine health seeking for respiratory illness as well as real changes in influenza virus circulation because of widespread implementation of measures to mitigate transmission of SARS-CoV-2.' source
• UKHSA: the small rise in December 2021 then fall 'coincides with the introduction of non-pharmaceutical intervention measures to prevent the spread of the Omicron variant'. source
• Australian Department of Health: 'COVID-19 related public health measures and the community's adherence to public health messages are also likely to have had an effect on transmission of acute respiratory infections, including influenza.' source

(b) Critics' view: some flu (and other) deaths were recorded as COVID-19

• Published critics (McGowan, Hunt and Mitteldorf, 2023) argue that US CDC guidance from April 2020 'encourages physicians and others to assign COVID-19 as the underlying cause of death in any death where COVID-19 is detected by tests or even just suspected, raising the possibility that heart attack and stroke deaths might be wrongly classified as COVID-19 deaths, as well as the traditional pneumonia and influenza deaths'. source
• ONS (England and Wales, Jan-Aug 2020): where both flu/pneumonia and COVID-19 were on the death certificate, COVID-19 was recorded as the underlying cause in 95.8% (18,642 deaths). Pneumonia was mentioned on 69,781 certificates and influenza on 506, against 52,327 for COVID-19, but COVID-19 was the underlying cause in 3.4 times as many deaths. source
• UK daily counts: in July 2020 University of Oxford researchers reported that Public Health England counted anyone who had ever tested positive and later died: 'A patient who has tested positive, but successfully treated and discharged from hospital, will still be counted as a COVID death even if they had a heart attack or were run over by a bus three months later.' source
• After a review, from 12 August 2020 the UK switched its daily count to deaths within 28 days of a positive test (41,329 UK deaths on that basis at the time). PHE's analysis 'found 96% of deaths occurred within 60 days or had COVID-19 on the death certificate. 88% of deaths occurred within 28 days.' source
• No official or peer-reviewed study was found that measures how many flu deaths, if any, were recorded as COVID-19. (search done 22 Oct 2026)

Hospital payments for COVID-19 patients

• US (documented): section 3710 of the CARES Act told Medicare to 'increase the weighting factor of the assigned Diagnosis-Related Group (DRG) by 20 percent for an individual diagnosed with COVID-19' during the public health emergency. From 1 September 2020, a positive viral test had to be in the patient's record for the extra payment. source
• UK (England): from April 2020 NHS hospital trusts were paid fixed monthly sums: 'Payment will be made on the block basis ... for each month from April to July 2020', instead of payment per contract activity. This guide found no per-case payment for COVID-19 patients in the UK sources checked. source

Children's nasal flu vaccine (Fluenz) and the 2025-26 UK flu season

The vaccine

• The children's nasal spray (Fluenz) is the only live flu vaccine used in the UK: 'LAIV contains live viruses that have been attenuated (weakened) and adapted to cold so that they can only replicate at the lower temperatures found in the nasal passage.' source
• It is 'the first-line option for most children' in England's programme; children who cannot have it get an injected (inactivated) vaccine. source

The 2025-26 season in the UK

• UKHSA: 'the season started in the second half of October 2025 in children and young adults with rising influenza A(H3N2) activity. It peaked around the second week of December (2025) and declined after.' source
• UKHSA (Nov 2025): 'Flu activity has risen unusually early this season, with increases first seen in teenagers and young adults, followed by younger children.' source
• Lab-test positivity was highest in 5-14 year olds, peaking at 47.4% on 2 December 2025. source
• Size compared with other years: 'activity started earlier than in the 2024 to 2025 season but also declined earlier and the overall level of activity over the course of the season was lower'. Flu-attributable deaths in England: 3,798 (2025-26) vs 9,740 (2024-25) and 4,431 (2023-24). Flu-related deaths in under-18s: 36 vs 66, 36 and 89 in the three previous seasons. source

The strain mismatch (subclade K)

• Of 1,615 H3N2 viruses sequenced in England, 97.3% were subclade K. Of 293 tested antigenically, 280 (95.6%) were 'antigenically distant' from the 2025-26 vaccine strains. source
• ECDC: subclade K was 47% of H3N2 sequences in the EU/EEA and 33% worldwide (May-November 2025), found in 'Oceania, Asia, Africa, Europe and North America'; Hong Kong and Taiwan also had H3N2-dominated epidemics. source

Uptake in children (England, 2025-26)

• Age 2-3: 44.2%. School years reception to 11: 52.2% (primary 55.5%, secondary 48.0%). source

How well it worked in children

• Early estimate (autumn 2025, ages 2-17, any flu vaccine): 74.8% against emergency-department attendance and 73.8% against hospital admission with flu A; 74.7% and 72.8% against H3N2. source
• End of season (ages 2-17): 51.6% against GP-diagnosed flu; 67.9% against hospital admission. source
• A published critic asks: 'If nearly half of flu tests in children are positive despite nearly half of children being vaccinated, what does that say about the effectiveness of the vaccine?' source

Did the spray cause or spread the outbreak? (shedding evidence)

• UKHSA sequencing: 'Genome sequencing has confirmed the detection of LAIV viruses in 9 influenza A/B positive samples in surveillance samples collected since week 40 2025, all from children aged between 2 and 16 years, consistent with known shedding characteristics of LAIV viruses.' (Compare: 1,615 H3N2 viruses sequenced, 97.3% subclade K.) source
• UKHSA: its child flu-death estimates 'may include deaths that are not attributable to influenza infection, including detections due to live-attenuated influenza vaccine (LAIV)'. source
• UK shedding study (PHE, 2016-18): the H3N2 vaccine strain was found in the nose of 19.7% and 18.7% of vaccinated children (swabs on days 1, 3 and 6). source
• Day-care trial (Finland, under-3s): 80% of vaccinated children shed vaccine virus; one vaccine strain passed to one unvaccinated child; estimated chance of passing it on per close contact 0.58% (95% CI 0-1.7%); 'No clinically significant illness occurred'. source
• UK guidance: over 30 million LAIV doses in the UK with 'no reported instances of illness or infections from the vaccine virus among immunocompromised patients inadvertently exposed'. It still notes a 'theoretical potential for transmission of live attenuated influenza virus in LAIV to immunocompromised contacts for 1 to 2 weeks following vaccination'. source
• Critics: Children's Health Defense's chief scientific officer: 'Live virus vaccines shed with consequences, especially to pregnant women and infants where this vaccine is contraindicated.' (said about US FluMist home use, 2024). source
• No official or peer-reviewed source was found that says the spray caused the 2025-26 outbreak. No published critic was found who presents data showing that it did. (search done 22 Oct 2026)
• What the cited sources show: the virus behind the outbreak was subclade K, which differs from the vaccine strain; vaccine virus turned up in 9 surveillance samples; the season began in teenagers and young adults as well as children; and subclade K drove early seasons in other countries too. None of these sources studied the question directly. (summary by this guide of the sources above)

What independent analysts have highlighted

Summaries of what each person says in the linked video (from the video captions). Wording is theirs or close to it; this guide has not checked their claims, and they are not official sources.

Suggested causes under investigation

Explanations named in official or peer-reviewed sources (and, for the COVID jab, by the analysts above), in no particular order. This guide does not rank them. Population ageing is not listed: the headline figures above already account for it.

COVID-19 infection and its after-effects (including long COVID)

• Deaths with COVID-19 as the underlying cause: England and Wales 73,767 (2020), 67,369 (2021), 22,485 (2022), 11,847 (2023), 6,636 (2024), 3,095 (2025). source
• US age-adjusted COVID-19 death rate per 100,000: 85.0 (2020), 104.1 (2021), 44.5 (2022), 11.9 (2023), 7.3 (2024). source
• Peer-reviewed (US veterans): 'beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease'. source
• Peer-reviewed (24 countries): results 'suggest important indirect effects of the pandemic on non-COVID-19 mortality through the consequences of COVID-19 infection, nonpharmaceutical interventions, and underreporting of COVID-19-related deaths.' source

Delayed or missed care, including NHS waiting times

• Peer-reviewed (England, 2016-18, before the pandemic): delays over 5 hours from arrival to admission 'are associated with an increase in all-cause 30-day mortality'; 'For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours... there is one extra death.' source
• Peer-reviewed (England, 2021-22, ONS authors): 'Longer time spent in the ED for nonimmediate care is associated with increased risk of all-cause mortality within 30 days', but 'the reasons for this association are uncertain and may reflect residual confounding'. source

Cardiovascular disease and diabetes trends

• Peer-reviewed (24 countries incl. England and Wales, US): 'Life expectancy losses due to cardiovascular disease (CVD) mortality were widespread during the pandemic'. source
• England 2023 (OHID, underlying cause): circulatory diseases +2% above expected; stroke +5%; ischaemic heart disease 0%. source
• US age-adjusted diabetes death rate per 100,000: 21.6 (2019), 24.8 (2020), 25.4 (2021), 24.1 (2022), 22.4 (2023), 21.7 (2024). Circulatory: 214.6 (2019), 233.3 (2021), 212.9 (2024). source

Influenza and other respiratory infections

• OHID: in England in 2023, 'the underlying cause group resulting in the largest excess in 2023 was influenza and pneumonia'; for January 2023 peaks in circulatory, respiratory and dementia deaths, 'It is likely that the high levels of flu circulating contributed'. source

The COVID jab (mRNA vaccine)

• Raised by the analysts listed above. Dr John Campbell points to timing ('after the vaccine roll out') and to countries with no mRNA roll-out having lower deaths than expected, and cites the Mostert et al. paper (below). source
• Peer-reviewed paper often cited: Mostert et al., BMJ Public Health, May 2024 (excess deaths in 47 Western countries, 2020-2022). Its discussion named possible causes including COVID-19 vaccination. The journal retracted it on 11 Aug 2026 'for misinformation in the discussion regarding the possible causes of excess mortality, and because the limited nature of the original work by the authors was not sufficiently described'. Two authors agreed with the retraction but 'do not agree that the article contains misinformation'; Mostert 'disagrees with the decision to retract and the reasons for retraction'. source source 2
• Official data on the question (England, ONS, April 2021 to May 2023): age-standardised rate of deaths NOT involving COVID-19 in May 2023 was 901.6 per 100,000 person-years in unvaccinated people and 840.6 in ever-vaccinated people. ONS caution: 'the characteristics of people in the different vaccination status groups, such as health, may differ, particularly due to the prioritisation of the vaccine to more clinically vulnerable people.' source
• CDC and US official bodies: no published assessment of the COVID jab as a cause of overall excess deaths was found in the sources checked. (search done 22 Oct 2026)