COVID deaths may have been 'underestimated'

The number of excess deaths from March to December 2020 in Malta was more than twice that of COVID-19 deaths, a report by the OECD and the European Observatory on Health Systems and Policies reveals.

While 217 people lost their life to COVID-19 between March and December 2020, Malta registered around 500 extra deaths over and above what is normally registered in pre-pandemic years.

The cumulative mortality rate from COVID-19 to the end of August 2021, was about 46% lower in Malta than the average 855/million across EU countries, compared with an EU average of about 1,590.

The report suggests that while deaths attributed to COVID-19 in 2020 were considerably lower than the EU average, “these may have been underestimated” although “the extent to which these deaths were caused by COVID-19 is unclear”.

According to a spokesperson for the health ministry, excess deaths not attributed to COVID in 2020 are still being analysed in depth by public health officials.

“The OECD reports provides a crude estimate of excess deaths, compared to the previous 3-5 years, the methodology used and also fluctuations in population amongst different age groups might give a different estimate than real figures,” the spokesperson told MaltaToday.

Malta is not unique in Europe where excess deaths were considerably higher than deaths directly attributed to COVID-19.

For example, in Cyprus the number of excess deaths during March-December 2020 (567) was four times higher than COVID-19 deaths.

In Spain during the same period, excess mortality (about 82,000 deaths) was about 60% greater than reported COVID-19 deaths (about 51,000).

But in Germany the average gap between excess mortality and deaths related to COVID-19 amounted to only 2%. Of these, one quarter can be attributed to the peak in excess mortality during August 2020, when there was a heatwave.

What is ‘excess mortality’?

Excess mortality refers to the number of deaths from all causes measured during a crisis, above what could be observed under ‘normal’ conditions. The baseline adopted consists of the average number of deaths that occurred in each of the 12 months during the period 2016-2019.

Eurostat set up the ‘excess mortality’ indicator to monitor the situation in all member states statistics on excess deaths. The aim is to provide information about the burden of mortality potentially related to the COVID-19 pandemic, “thereby covering not only deaths that are directly attributed to the virus but also those indirectly related to it”.

In addition to confirmed deaths, excess mortality captures COVID-19 deaths that were not correctly diagnosed and reported, as well as deaths from other causes that may be attributed to the overall crisis situation.

It also accounts for the partial absence of deaths from other causes like accidents that did not occur due, for example, to the limitations in commuting or travel during the lockdown periods.

A report by The Economist in September estimates that 15 million more people have died during the COVID-19 pandemic compared to historical norms. This figure was more than three times the reported COVID-19 deaths, which stood at 4.6 million people. While 1.1 million deaths were attributed to COVID-19 in Europe, the number of excess deaths stood between 1.8 and 1.9 million.

How excess deaths fluctuated

Fluctuations of excess deaths in Malta through 2020 and 2021 have largely followed the epidemiological waves of the pandemic.

Statistics show that in Malta deaths immediately increased by 17% over pre pandemic averages at the outset of the pandemic in March. But by June 2020 deaths were 4% lower than in pre pandemic years. Deaths started increasing again in autumn increasing to nearly 40% above pandemic levels in November and December. Excess deaths decreased again by April when deaths were back to normal levels in pre pandemic years but started to increase again in the summer in July and August.

In 2020, the EU experienced two waves of excess mortality: the first between March and May 2020 (reaching a 25.3 % excess rate in April), then a longer one between August 2020 and February 2021 (reaching a 40.0 % excess rate in November 2020). In 2021, excess mortality reached a new peak in April (21.0 %) then decreased to 10.6 % in May and fell to a minimum of 5.6 % in July. During summer 2021, the downward trend reversed and the EU rate increased again to reach 12.7 % in September, over the baseline period. In the autumn, there was a new rebound, with the EU excess mortality rate reaching 17.7 % in October and 26.5 % in November 2021.