EXCESS deaths in Scotland were the third highest in Europe during the first half of 2020, with only England and Spain faring worse.

And among the population aged 64 and under, Scotland’s excess deaths’ rate put it second only to England out of the 29 countries compared in a comprehensive international review carried out by the Office for National Statistics.

The bombshell report came on the same day that Nicola Sturgeon was criticised by the UK Statistics Authority for repeatedly claiming the prevalence of coronavirus in Scotland is five times lower than it is in England.

Ed Humpherson, its director general for regulation, said such a comparison was “not straightforward”.

READ MORE: Scotland's excess deaths paint grim picture of pandemic performance 

Excess deaths are seen as the most accurate way of measuring of how countries have coped during the pandemic because it takes into account mortality from all causes - not only Covid-19.

That means differences in countries’ testing regimes for the virus or how they count Covid deaths become irrelevant.

It compares the total number of deaths which have occurred in a particular country, city or region over a set period against the average for the same period in the previous five years.

Any increase compared to the average are ‘excess’ deaths.

As well as virus deaths, Scotland - like many other countries - has experienced a spike in deaths from strokes, heart attacks, cancer and dementia during the pandemic, possibly from delayed treatment or people avoiding hospitals.

The ONS data is the first time that countries’ excess death rates have been compared on an ‘age-standardised’ basis, which controls for the fact that some countries populations may be much more elderly than others.

It also compares the mortality rate on the basis of deaths per 100,000 people, which means differences in population size cannot skew the comparison. 

Countries' excess deaths can therefore be compared fairly using an age-standardised mortality rate relative to the five-year average, and for the year to May 29.

HeraldScotland: Cumulative excess mortality for the four UK nations and Spain, by age group and per 100,000Cumulative excess mortality for the four UK nations and Spain, by age group and per 100,000

On this measure - the relative cumulative age-standardised mortality rate (rcASMR) - Scotland’s excess death rate was 5.11 per cent, compared to 7.55% in England and 6.65% for Spain.

For the over-65s, Scotland’s excess death rate was 5.45% - third behind England on 7.88% and Spain’s 7.34%.

But when the figures were limited to those aged 64 and younger, Scotland rose into second place with an rcASMR of 3.42% compared to 5.65% for England.

READ MORE: Surgery will run at 60% capacity for at least two years as NHS Scotland adjusts to 'new normal'

All four of the UK nations are among the eight countries with the largest jumps in their overall excess death rates in the first half of 2020.

Meanwhile, several Eastern European and Nordic countries, including Slovakia, Hungary, Lithuania, Denmark and Norway, have actually recorded lower mortality rates than average despite the Covid pandemic.

The review states: "Spikes in mortality during 2020 are concentrated in the countries of Western Europe, with little evidence of abnormal mortality rates in Eastern Europe."

While Spain and Italy have been struck by bigger peaks in excess mortality during the pandemic, England had "the longest continuous period of excess mortality of any country compared".

HeraldScotland: Scotland's mortality rates have historically exceeded England, but overlapped during the pandemicScotland's mortality rates have historically exceeded England, but overlapped during the pandemic

The report draws no conclusion on the causes of the UK's comparatively poor performance within Europe, but offers various key statistics that might have been expected to play a part.

The UK is noted to have one of the lowest concentrations of doctors - 2.81 per 1000 population - compared to 4.3 per 1000 in Switzerland, where excess mortality fell.

In the UK, 3.2% of our elderly population are in care homes. Yet France, with 4.5% of its older citizens in care, saw excess mortality among its over-65s rise by just 0.49%.

During a visit to North Yorkshire, Prime Minister Boris Johnson was asked if he was ashamed that England had the highest excess death rate in Europe.

Mr Johnson said that the country owes it to the families of those who died "to continue our work in driving the virus down", adding that it had "massive success" in reducing the number of deaths.

READ MORE: Forget an end of obesity - the fallout from this pandemic is only likely to make the problem worse 

A spokeswoman for the Scottish Government said: “This is the greatest public health challenge we have faced in our lifetimes.

"Every life lost to the virus is a tragedy and it is important to remember that behind every statistic are friends and family who have lost a loved one.

"We remain focused on suppressing COVID-19 in Scotland and at all times our actions have been guided by the best and most up to date expert scientific and medical advice.

“Work is ongoing to better understand excess deaths during the pandemic.”

Broken down by local authorities, Central Spain and Northern Italy had the highest rates of excess mortality.

During a single week ending March 20, as northern Italy grappled with an explosion of Covid cases, the city of Bergamo in Lombardy saw its excess death rate soar to 848%. Almost nine times as many people were dying as should have been, under normal circumstances.

HeraldScotland:

HeraldScotland: Excess death week-by-week compared to five year averageExcess death week-by-week compared to five year average

In comparison, Glasgow and Edinburgh peaked with excess mortality of 122% and 98% respectively for separate weeks in April.

Edward Morgan, health analysis statistician for the ONS said the pandemic had triggered "extraordinary increases" in mortality rates for Western Europe during the first half of 2020.

But he added that the pattern had differed in the UK, compared to clusters of high excess deaths on the continent.

“While none of the four UK nations had a peak mortality level as high as Spain or the worst-hit local areas of Spain and Italy, excess mortality was geographically widespread throughout the UK during the pandemic, whereas it was more geographically localised in most countries of Western Europe," said Mr Morgan.

“Combined with the relatively slow downward ‘tail’ of the pandemic in the UK, this meant that by the end of May, England had seen the highest overall relative excess mortality out of all the European countries compared.”

It came as UK Statistics Authority said the sources used by Nicola Sturgeon to repeatedly claim that the prevalence of coronavirus in Scotland is five times lower than it is in England do not "allow for a quantified and uncaveated comparison of the kind that was made".

Ed Humpherson, its director general for regulation, wrote: "It is important to recognise that a comparison of Covid-19 prevalence rates is not straightforward.

"If it is to be undertaken, the results and the uncertainties should be communicated transparently."

The First Minister told the Scottish Parliament that the issue with the comparison is that the "UK, English part of that statistic has not been published, and that is not down to me".

She added that she stands by "the view, which I think is backed up by the evidence, that prevalence of the virus is significantly lower in Scotland right now than in England, although this is not something I have a shred of complacency about".