Complex reality of dip in COVID’s death rate

When is a COVID-19 death counted as a COVID-19 death? The answer is not as straightforward as one might think, because different countries have different methods for determining a COVID-19 case or declaring COVID-19 as a deceased person’s cause of death. Some countries, like Spain, carry out post-mortem COVID-19 tests, while in others like Germany, the UK, or Turkey it is not a common practice.

Belgium, for example, counts all coronavirus deaths outside hospitals in its daily statistics: This means the country includes people suspected of having died of coronavirus, without a confirmed positive test result, whereas countries like Italy only count deaths in hospitals. Spain only recently started to count non-hospitalised, coronavirus-related deaths from some regions.

Why is the all-cause death number relevant? There are a few essential lessons we can learn from all-cause death data. According to many scientific experts, it is the only unbiased information we can trust to measure the real impact of the pandemic, and create policies to minimise its effects. The number of people dying of COVID-19 is huge, but it still is not the leading cause of death in many countries. People are more reluctant to go to hospitals because they fear contagion, or simply do not want to burden the health system further. A scenario in which the leading causes of death, such as heart disease or cancer, increase by even 5% could translate into hundreds of thousands of people.

David Spiegelhalter, Professor of Public Understanding of Risk from the University of Cambridge, notes the differences in each country: “I would say the all-cause death number is the really unbiased measure of the impact of this epidemic. And it’s the one I look up far more closely,” he said. Data collected by DW both on all-cause deaths and COVID-19 deaths shows: Thousands more people are dying directly or indirectly due to COVID-19 than the official numbers suggest. Data analysis focused on Spain, England and Wales, but indicates a pattern present in other countries too. If overall death rates in a given time-frame and place went up but COVID-19 death rates did not, why did more people die? Amparo Larrauri, the leading investigator at Spain’s Epidemiology and Public Health Center, said that there are several possible reasons. “The excess mortality may be due in part to deaths from COVID-19 that have not been identified,” she said, while pointing out other possible factors such as “early mortality.”

Early mortality affects people with a short remaining life expectancy and a major underlying disease, mainly the elderly. If someone in this category gets infected with COVID-19, he or she is likely to clinically decompensate rapidly. This is thus a death that occurs earlier than expected, whose cause is the underlying disease — but the virus precipitates the death.

That is why some experts in demographics expect much lower death rates in the post-COVID-19 era, since many people are currently dying earlier than expected. According to Spiegelhalter, “early mortality” alone is not enough to explain the extra deaths. There are other important reasons, he said.

In England and Wales, between March 20 and April 24 this year, about 38,550 more people died than on average over the last 10 years. Almost 11,000 of them are not labelled as COVID-19 deaths. Is today’s excess number of all-cause deaths already giving hints? Reliable information about how many of the excess deaths were or were not caused by COVID-19 may not be available for months or years. However, the all-cause death numbers already indicate that the ultimate death toll from the pandemic will be much higher around the globe than is currently reported.