Hawaiian Pizza, obesity and a second wave?

Episode Summary

Executive Summary: The episode examines how Covid death counts and case trends can be misread due to differing reporting rules, showing Scotland undercounts deaths with a 28-day cutoff while England’s daily figures can overcount. It also debates whether rising UK cases reflect more testing or real spread, debunks a Jamie Oliver pizza statistic, and finds obesity explains only a small fraction of the UK’s Covid death toll.

Main Topics: Covid death reporting methods across the UK: The hosts compare Scotland, England, Wales, and Northern Ireland, showing that daily death figures are not consistent: Scotland and others use a 28-day post-test cutoff, while England’s daily count includes anyone who ever tested positive and later died. ONS/NRS death-certificate data are presented as more reliable but slower. Rising UK Covid cases: testing vs transmission: The program investigates whether increasing case counts reflect broader testing or genuine spread. One expert argues the rise is largely explained by testing more people, while another says the increase in positive cases outpaces testing growth and could signal early resurgence. Jamie Oliver and the pizza fruit/veg claim: Ruth Alexander checks a viral claim that pizza provides over a quarter of children’s fruit and veg intake. The claim is shown to be false or at least badly misstated, with the underlying source referring to different categories and much smaller shares. Obesity and the UK’s Covid death toll: The episode tests whether the UK’s higher obesity rate explains its high Covid mortality. Using modelling from OpenSAFELY and European comparisons, the conclusion is that obesity raises risk but accounts for only a small portion of excess deaths. The need for clearer and more transparent health statistics: Across the Covid and obesity segments, the show stresses that headlines can be misleading when definitions change or evidence is weak. More transparent publishing of multiple measures is recommended so the public can interpret trends properly.

Key Arguments: Scotland’s zero daily deaths were misleading because the 28-day cutoff excludes deaths occurring after that window, while the death-certificate-based National Records of Scotland still recorded 34 Covid-related deaths in the same period. England’s Public Health England daily death count can overstate deaths because it includes anyone who ever tested positive and later died, regardless of how long ago the test was. The ONS death-certificate measure is slower but more credible than daily test-based counts, especially when testing is widespread. Rising case counts cannot be explained solely by increased testing: in community testing, positive results rose faster than the number of people tested. However, experts disagree on interpretation: some see case growth as an early warning sign, while others argue the data are too noisy and not yet showing exponential growth. Jamie Oliver’s quoted statistic was not supported by the source material; it conflated fruit and veg with veg only, changed the percentage, and added baked beans to pizza. Obesity increases individual Covid risk, especially in severe obesity, but because the overall prevalence differences are modest, the effect on total UK deaths is limited. If the UK had Italy-like obesity rates, the model suggests only about 1,300 fewer Covid deaths would have occurred by late July, not a fundamental change in the epidemic’s shape.

Data Points: Scotland daily Covid deaths: 0 for five weeks - Daily test-based figure reported by Scotland during the episode Covid-related deaths in Scotland: 34 - National Records of Scotland death-certificate count during the first four of those five weeks England daily Covid deaths: around 50 per day - Public Health England daily count at the time of recording England ONS Covid deaths: around 20 per day - Office for National Statistics death-certificate-based figure England deaths excluded by 28-day cutoff: about 10% of current cases published up to mid-July - Public Health England estimate cited by Mary Gregory UK rolling average daily cases: around 5-6 hundred in early July, rising past 850 - Trend in confirmed cases over the month Community positivity rate: 1.66% - Current positivity rate cited by Christina Pagel Community positivity rate two weeks earlier: 1.35% - Used to show a modest increase in positivity People tested in community testing: up by almost 40% over July - Pagel’s description of Pillar 2 testing growth Positive people in community testing: up by 40% since mid-July - Compared with a 12% rise in people tested People tested vs positives since mid-July: 12% vs 40% increase - Used to argue increased testing alone does not explain case rise Positivity rate in the US surge areas: 10-15% - Benchmark given by Christina Pagel UK obesity rate: 20% clinically obese - Stuart MacDonald’s comparison of UK and Europe EU overall obesity rate: 16% clinically obese - Compared with the UK Italy obesity rate: about 11% clinically obese - Lower-obesity comparator country OpenSAFELY sample size: more than 17 million UK patients - Study used to estimate Covid risk by BMI group Obesity class 1 risk: 5% higher risk - BMI 30-35 compared with healthy weight Obesity class 2 risk: 40% higher risk - BMI 35-40 compared with healthy weight Obesity class 3 risk: 92% higher risk - BMI over 40 compared with healthy weight Overall UK risk from obesity: 5% higher than if no one were obese - Derived hazard ratio for UK population overall Overall Europe risk from obesity: 4% higher - Equivalent estimate for Europe overall Overall Italy risk from obesity: 3% higher - Equivalent estimate for Italy UK excess deaths to 24 July: 62,100 - Base figure used in the obesity counterfactual calculation Fewer deaths with EU-average obesity: around 600 fewer deaths - Estimated impact if UK matched EU obesity profile Fewer deaths with Italy-like obesity: around 1,300 fewer deaths - Estimated impact if UK matched Italy’s obesity profile PHE England deaths under 28-day cutoff: about 10% of current cases published would not be included - Estimate of the mismatch between reporting systems Children’s veg from pizza claim: not 25%; even Food Foundation analysis suggests less than 4% - Debunking Jamie Oliver’s interview claim Food Foundation figure: 17% of children's veg from pizza and baked beans - Underlying source cited by Jamie Oliver’s team Budget of NHS England: well over £100,000 million a year - Used to show Matt Hancock’s £100 million saving claim is tiny יחסually Matt Hancock saving claim: over £100 million over five years - Claim about everyone overweight losing 5 pounds Per-person NHS saving implied: about £1.50 over five years - Reframed by the presenter Per-person annual saving implied: about 30 pence a year - Further scaling of the Hancock claim

Pivotal Quotes: "if you have a positive Covid test and you later die, that death will appear in England's daily Covid death toll" — Kate Lamble: Explaining why England’s daily death figures can overcount compared with death-certificate data "What we're trying to do is detect the signal from the noise." — Professor Carl Hennigan: Describing the difficulty of interpreting case trends amid expanded and changing testing "Over a quarter of all kids' fruit and veg is coming through pizza alone." — Jamie Oliver: The claim that triggered the fact-check on children’s diet statistics

Implications: Listeners should treat headline Covid numbers cautiously because reporting rules can distort both deaths and cases. Better transparency and consistent definitions are needed; obesity matters for individual risk, but it explains only a small share of the UK’s excess Covid mortality.