5. The scale of death would been even higher had more people with learning disabilities lived in larger, congregate settings and not in dispersed small community settings. The long struggle for people with learning disabilities to live within their communities saved lives.

6. all of the above have echoes of the 1918-11919 pandemic. I'm currently looking at data with @SJaneBernal @odriscolld @WalmsleyJan that pandemic also magnified already exceptionally high rates of death within asylums. Influenza alone was not responsible.

7. One in four people in asylums died in 1918. One in five died in 1917. War associated food shortages, living in increasingly overcrowded institutions, fewer staff were already a deadly accelerant for any infectious pathogens.

8. The pandemic passed, deaths started to fall back to pre-pandemic levels but it was some time before they fall back to pre WW1 levels. Even then within institutions it was about 7-8 times higher than that reported within modern learning disability, community based settings.

9. That and this pandemic both led to additional spikes in already and alarmingly high levels of deaths in people with learning disabilities. Celebrate when this additional spike diminishes but premature mortality will extend beyond it.

10. People with learning disabilities must be a priority group for a vaccination. the report publication coincides with hope about a possible vaccination. There should be no question other than how do we ensure their safe and complete participation in a vaccination roll out.

11 There are still other important questions to ask. What was the care people with learning disabilities received in last days of life? And for 1000s of people who have been affected by those deaths, how have they been supported? What have been their experiences of grief?