The Office for National Statistics (ONS) said 21,284 people had died in England by April 17 with mentions of COVID-19 on their death certificate. Together with figures from Scotland, Wales and Northern Ireland, the total United Kingdom death toll was at least 24,000 as of April 19.

“The United Kingdom is going to be right up there among the worst-hit nations in the initial surge,” said Bill Hanage, associate professor of epidemiology at Harvard’s T.H. Chan School of Public Health.

“With the most optimistic views of the amount of immunity that might be being generated, it would be still not be close to having enough to be able to return to normal,” he told Reuters.

Unlike the hospital death tolls announced daily by the government, the fresh figures include deaths in community settings, such as care homes where overall fatalities have tripled in a few weeks.

Overall, Tuesday’s figures for COVID-19 deaths in England and Wales up to April 17 were more than 50 per cent higher than the daily toll for deaths in hospitals initially announced by the government.

The figures underline the scale of the challenge facing Johnson as he returns to work after himself recovering from COVID-19, the respiratory disease caused by the novel coronavirus, and the dangers of relaxing Britain’s lockdown too soon.

He warned on Monday that it was still too dangerous to relax stringent measures wreaking havoc on the economy, for fear of a deadly second outbreak.

In a reminder that much is still unknown about the novel coronavirus, Health Secretary Matt Hancock appeared to say that some children with no underlying health conditions had died from a rare inflammatory disease linked to COVID-19. But the British health ministry later clarified that he had been speaking about COVID-19 more generally.

“We are not aware of any confirmed cases of children dying from this syndrome,” a ministry spokesperson said Tuesday. “The minister did not say that there are confirmed cases of children dying from this syndrome.”

Hancock had said the condition was a new disease believed to have been caused by the coronavirus.

Italian and British medical experts are investigating a possible link between the COVID-19 pandemic and clusters of severe inflammatory disease among infants who are arriving in hospital with high fevers and swollen arteries. While those investigations are ongoing, junior British interior minister Victoria Atkins said parents should be vigilant.

“It demonstrates just how fast-moving this virus is and how unprecedented it is in its effect,” Atkins told Sky News.

U.K. crisis

The ONS bases its figures on mentions of COVID-19 in death certificates, including suspected cases rather than those who actually tested positive.

Scotland last week reported 1,616 deaths that mentioned COVID-19 on the death certificate as of April 19. Northern Ireland posted 276 as of April 17. Another 1,016 had died in Wales.

A UK death toll of more than 24,000 puts it among the worst-hit in Europe, exceeding France — which also counts deaths in care homes — by about 5,000 at that time.

Britain’s true toll may be closer to Spain or even Italy, Europe’s worst-affected countries, although their reporting of deaths outside hospital is patchy so exact comparisons are difficult.

The latest daily figures released by Britain’s health ministry for COVID-19 deaths in hospitals hit 21,678 on Tuesday.

Including all causes of death, 22,351 people died in England and Wales in the 16th week of 2020, the biggest total since comparable records began in 1993, the ONS said.

This was 11,854 more than average for the week. Given that only 8,758 cases mentioned COVID-19 in death certificates, it is possible that even the comprehensive ONS data are undercounting the true toll.

Last week, a Financial Times analysis based on the gap between the significant increase in all deaths and those that mentioned coronavirus put Britain’s true death toll at over 40,000.