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Excess deaths, dramatic increase, week ending 21 April 2023 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending21april2023 The number of deaths registered in the UK in the week ending 21 April 2023 (Week 16) Was 14,024 22.1% above the five-year average 2,540 excess deaths, of these deaths, 615 involved COVID-19 England and Wales Week 16, 12,420 deaths were registered in England and Wales 538 of these deaths mentioned novel coronavirus (4.3% of all deaths) Of the 538 deaths involving COVID-19, 66.5% (358 deaths) had this recorded as the underlying cause of death The number of deaths was above the five-year average Private homes (29.0% above, 771 excess deaths) Hospitals (20.2% above, 924 excess deaths) Care homes (25.3% above, 525 excess deaths) Other settings (11.7% above, 92 excess deaths) Could Bradford Hill criteria help? The larger the association, the more likely that it is causal. Consistent findings observed by different persons in different places Lack of alternative explanations The effect has to occur after the cause Greater exposure should generally lead to greater incidence of the effect. A plausible mechanism between cause and effect is helpful Coherence between epidemiological and laboratory findings increases the likelihood of an effect. Occasionally it is possible to appeal to experimental evidence Analogies or similarities between the observed association and any other associations. Sometimes, reversibility

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