FLU and respiratory diseases contributed to a bigger spike in winter deaths three years ago than that recorded during December to March this year, in spite of the Covid outbreak.

Scotland recorded the second highest seasonal increase in mortality for more than 20 years last winter, according to a new report from the National Records of Scotland (NRS), with Covid blamed for almost two thirds of the additional deaths.

However, the increase was actually lower compared to the 2017/18 winter, and comes amid signs that the long-term downward trend dating back to the 1950s has been slowing over the past decade.

Winter deaths are recorded as the difference between the total number of deaths registered during the four-month period from December to March each year compared to the average for the two four-month periods before and after winter.

HeraldScotland: Winter excess deaths over time (Source: National Records of Scotland)Winter excess deaths over time (Source: National Records of Scotland)

READ MORE: Winter deaths at start of 2018 highest since 1986 amid flu spike

In 2020/21, therefore, there were 4,330 'extra' deaths compared to the combined average for August to November 2020 and April to July 2021. This was the second highest figure since 1999/2000.

Of these, 2,850 recorded Covid-19 as a cause of death.

The other causes of death with the largest seasonal increases last winter were dementia and Alzheimer's disease and coronary heart disease - both with 210 additional deaths each.

Very few deaths were directly due to cold weather such as hypothermia, while mental, behavioural or nervous system conditions resulted in 70 additional deaths, and cancer accounted for 60.

Accidental falls was recorded as the underlying cause of 50 additional deaths.

HeraldScotland: Winter excess deaths 2020/21Winter excess deaths 2020/21

HeraldScotland: Although the total number of deaths in winter 2017/18 was lower than winter 2020/21, the 'excess' deaths figure was around 500 higherAlthough the total number of deaths in winter 2017/18 was lower than winter 2020/21, the 'excess' deaths figure was around 500 higher

In 2017/18, however, there were an additional 4,810 deaths during winter, with a spike in flu deaths during early 2018 along with pneumonia, heart disease, dementia and strokes contributing to the surge.

The period from January and March 2018 saw a 36 per cent increase year-on-year in respiratory deaths to 2855, of which 331 were deaths from influenza.

The compared to an average of 34 flu deaths during the same three-month period between 2008 and 2017. 

The figures remain a far cry from a peak of 9,170 extra deaths during the winter of 1958/59, and the average seasonal increase during the 1950s and 1960s of 5,200 winter deaths.

Over the past decade, the figure has averaged 2,600.

HeraldScotland: Flu rates were notably higher than normal during winter 2010/11 and winter 2017/18Flu rates were notably higher than normal during winter 2010/11 and winter 2017/18

However, the National Records of Scotland, who compiled the report, noted that "figures for the most recent years suggest a departure from the long-term downward trend".

It added: "It is not clear whether this will continue as there have been similar increasing periods in the past which were followed by a return to the longer term decreasing trend."

Older age groups are consistently affected most by the winter increase in mortality, a pattern reinforced by the pandemic.

READ MORE: 'Confusion' over different Covid messaging from Scotland and UK ministers 

During December 2020 to March 2021, of those aged 85 and over, there were 13 additional deaths per 1,000 of the population compared with fewer than one death per 1,000 amongst those aged under 65.

Pete Whitehouse, director of statistical services at the NRS, said: "These figures show again the significant impact Covid-19 had in Scotland last winter.

"Compared to the average of the previous five winters, the winter of 2020/21 saw a 10% higher level of mortality, with the majority of additional deaths being due to Covid-19."

The Scottish Government has earmarked £300 million extra for the NHS and social care in Scotland this winter, but Health Secretary Humza Yousaf warned of severe pressure from Covid, a potential resurgence of flu, and treatment backlogs Labour health spokeswoman Jackie Baillie warned that Scotland was "on track for another winter catastrophe" with A&E waiting times already at a record high.

She said: "We must do everything possible to make sure we don't see this scale of devastation again - but as it stands we are woefully unprepared."

Scottish LibDem leader Alex Cole-Hamilton added: "Last year mortality soared as we were struck by a once-in-a-century global pandemic. This was made all the worse by a lack of preparation and a series of questionable ministerial decisions.

"This year, with vaccines on hand and months to prepare, SNP ministers will not have the same excuse."