THE scale of the death toll from coronavirus in Scotland is not only significantly higher than previous figures suggested, but appears to have coincided with a mystery spike in deaths from other causes.

That was the puzzle which emerged when National Records of Scotland (NRS) published its first data set based on all death certificates where Covid-19 had been mentioned, up until April 5.

Two key findings emerged.

Firstly, the number of Covid-19 deaths recorded by NRS was 61% higher than previously thought. First Minister Nicola Sturgeon herself acknowledged these statistics, which crucially includes 'presumed' Covid-19 cases, was "unfortunately" probably closer to the truth. If so, it would suggest a death toll in excess of 800 by now.

Secondly, something strange happened in March. After two consecutive months of comparatively low mortality (the total number of deaths, from all causes, in January was five per cent lower than the average for the previous five years, and in February 7% lower), there was a sudden spike. And most of it did not appear to be linked to Covid-19.

READ MORE: Heart patients becoming 'much sicker' as they delay going to hospital 

In the two weeks to April 5, the number of deaths were 27% higher than the five-year average. Of the 643 "extra" deaths in week 14, only 282 mentioned Covid-19.

One possible explanation is the "secondary victims" phenomenon, known to occur during epidemics when people either change their behaviour - for example not seeking much-needed medical help - or because the healthcare system becomes so overwhelmed that people miss out on life-saving care.

The number of people attending A&E in Scotland has more than halved. In the week that lockdown was announced it fell to a record low of just over 11,000.

Dr David Chung, vice-president of the Royal College of Emergency Medicine (RCEM) Scotland, said this steep decline is a warning that people who need treatment are staying away, either because they fear burdening the NHS or are scared of contracting Covid-19 in hospital.

"We are certainly seeing cases anecdotally around Scotland of people who have had some kind of infection which could have been treated with antibiotics, but they've left it and by the time they've come into A&E it's got so bad that they've needed surgery.

"There's people with heart problems who have been feeling very unwell - maybe their heart has been beating very slowly - but they've left it until absolutely the last gasp before calling an ambulance.

"Or people having appendicitis but leaving it so long that it becomes a ruptured appendix, which is a much more serious thing."

However, Dr Chung stresses that most patients were "not unsalvageable" by the time they turned up.

He believes the spike is really about a tranche of Covid-19 deaths which, so far, have been slipping below the radar.

"It may not be a typical Covid death but Covid could certainly have played an important part in precipitating that heart attack, causing that stroke, causing that blood clot on the lung," said Dr Chung.

"It's very definitely known to cause problems with blood clotting, or diabetes and metabolism.

"They're starting to recognise those patterns now down south. In Scotland we haven't quite caught up with that yet."

HeraldScotland:

READ MORE: Flurry of 'do not resuscitate' cases is an alarming angle in this outbreak 

There was something else notable in the figures.

The death rate in NHS Greater Glasgow and Clyde is 40% higher than NHS Lothian's. According to NRS, NHS GGC had recorded 122 deaths by April 5 in a population of 1.2 million, compared to 41 in a population of 800,000 in NHS Lothian.

That translates to ten deaths per 100,000 in the Glasgow health board region to six per 100,000 in the Lothian region, even though both rhave very similar age demographics.

One explanation is higher overall incidence. NHS GGC accounts for a quarter of all Scotland's known coronavirus cases.

But there are also concerns that poverty could be a factor, as it appears to be in the US where the urban black population is dying in disproportionate numbers.

One public health expert familiar with the issues, who asked not to be named, said: "In GGC we actually have considerably more very old poor people than very old rich people, despite places like East Dunbartonshire.

"If you have a lot of 85-year-olds who are poor they will be extremely vulnerable to this virus. So that could be part of the explanation, definitely."

Some food banks are already reporting 300% increases in demand, and there are also concerns that those living below the poverty line will struggle with rising utility bills and lack of internet access as libraries close.

A spokeswoman for the Glasgow Centre for Population Health said their researchers will be monitoring the socio-economic impacts of Covid-19 on the city but added that it was "too early to say anything specific or conclusive at the moment".

She added: "Given the concentrated levels of deprivation in Glasgow and well-known links to health and wellbeing, it is likely that existing poverty and co-morbidities, which are experienced disproportionately in Glasgow, are contributing factors to the Covid-19 related death rate in the city."

READ MORE: Care home staff claim masks were 'locked away' as they battled fatal Covid outbreak 

There is also disquiet among some public health professionals that the sheer severity of the lockdown measures, designed to curtail the virus and bring Covid fatalities under 20,000, will precipitate an excess of deaths from other causes.

Modelling suggests at least 5,700 - but maybe far more - will die from side effects of this strategy.

One Scotland-based expert, who has a background in flu pandemic planning for the NHS, said mass testing and contact tracing should have been introduced at a much earlier stage, but that the apparent lethality of the virus globally owes much to the record numbers of elderly and sick people around the world who were "living on borrowed time as a result of modern medicines that extend their lives and reduce symptoms, but make them vulnerable to a novel zoonotic infection like this one".

Speaking on condition of anonymity, they added: "I believe we will have to pay a high price for this lockdown in terms of the backlog of clinical problems put on hold by GPs and hospitals; a rise in gender based violence; a return to abuse of children on the at-risk register who should be in school; a rise in mental health problems induced by isolation that will be most prevalent in those without access to space and outdoor greenery; a loss of jobs, particularly for the low paid; and the demise of businesses and even industries.

"There is no doubt in my mind that this attempt to control a pandemic, for which planning was woefully inadequate from the beginning, will increase social inequalities in health."

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