As Covid-19 was spreading worldwide, it became a grim routine for governments to publish daily death tolls. However, there is still a lot of uncertainty as the death numbers only approximate the actual effects of the pandemic. The total number of Covid-related fatalities can be three times higher, according to the World Health Organization (WHO).
One good way to measure the true impact of Covid-19 is ‘excess deaths’. This article examines how excess deaths are counted and what are other causes of higher mortality during the pandemic.
There has been no shortage of reports and headlines in the media about excess mortality. But what does it mean exactly, and how do we estimate ‘excess deaths’?
Excess deaths are typically defined as the number of people who died from any cause in a given place and period, compared to the number of expected deaths, what is called a historical baseline. To give an example, if 300 deaths were expected for a given week and 400 people died in that week, that means 100 excess deaths.
At this time, we are interested in how the number of deaths during the Covid-19 pandemic compares to the mortality we would have expected, had the pandemic not occurred.
The heat map below uses data from Eurostat, where the monthly excess mortality indicator is expressed as the percentage of additional deaths compared to the baseline for that month, the average deaths in the period 2016-2019. The higher the value, the more additional deaths have occurred compared to the baseline, whereas a negative value means fewer people died than the baseline period average.
The map shows that Lithuania was in fourth place in the European Union (42%) in terms of excess mortality in October. Only Romania, Bulgaria, and Latvia ranked higher in October. Looking at the case of Lithuania, excess deaths were on the rise in late 2021. For example, the number of excess deaths was 32% in September, 12% in August, and 10% in July. The highest percentage in Lithuania was only in December 2020, standing at 70%.
According to Saulius Čaplinskas, a professor of medical sciences and virologist, excess mortality is associated with two causes: Covid-19 and the resulting deterioration in health care services. According to him, several overlapping factors make Lithuania stand out.
“There have been a lot of discussions recently about the Republic of South Africa (PAR), where the omicron variant has been diagnosed for the first time. There, a relatively large percentage of the population is very young. So, this is a good demographic indicator.
“We know that Covid-19 has severe consequences for the elderly and those with serious illnesses. However, comparing South Africa and Lithuania, in South Africa there are considerably more cases of AIDS, much fewer in our country,” Čaplinskas says.
Therefore, various mortality factors need to be considered: we have many seniors who naturally have many comorbidities.
“When it all comes together, we have this result,” says Čaplinskas, adding that the health care system is also crucial.
“We see what the reaction to the omicron variant has been now. The parties have re-introduced restrictive measures, quarantines, closures without any coordination. It is naive to think that this will stop the spread of the virus. Insurance measures can only give us a little bit of time,” he said.
The excess deaths map also shows that, in most places, excess mortality increased most in the period from October 2020 to January 2020 – winter apparently makes the pandemic worse.
However, according to Vytautas Kasiulevičius, medicine professor at Vilnius University (VU), excess deaths are mostly related to the Covid-19 pandemic. The higher numbers seen in the winter are indeed associated with the Delta variant, which is more contagious and affects more people, says Kasiulevičius.
The graph below shows how mortality rates were affected by gender. Attempts have also been made to estimate excess mortality in different EU countries. Looking at Lithuania’s case, excess mortality seems to be slightly higher among women (11.82%) than men (10.61%).
The pandemic is still spreading in 2021, with the timing and scale varying among European countries. For example, from August 2 to October 17, 1,600 excess deaths occurred in Lithuania, according to preliminary estimates by the Lithuanian Department of Statistics (Statistics Lithuania).
However, perhaps the most striking thing about recent mortality data is that less than half of excess deaths can be directly linked to Covid. In fact, a comparison of mortality in January–October 2021 with the 2016–2019 averages shows an increase of deaths from most leading non-Covid-19 causes.
The chart below compares the number of non-Covid deaths and official Covid-19 mortality in 2021 with the baseline period.
The first and narrowest definition includes only the cases where Covid-19 is the leading cause of death. The second definition also includes deaths where Covid-19 was the primary, immediate, or intermediate cause. Finally, the third definition includes all deaths within four weeks of a Covid-19 diagnosis, whether or not it was the direct cause. Additionally, external causes of death are not included in statistics.
The following charts use the third definition to better account for concerns about the Covid-19 pandemic causing an increase in deaths from other severe conditions such as heart disease.
The lowest number of deaths involving the coronavirus was reported in week 29 (July 19–25). However, from week 31 (August 2–8), Covid-19 deaths started rising sharply, a development probably linked to the coming cold season.
The table below investigates how the numbers of Covid-19 deaths compare with deaths from other causes. It is evident that Covid-19 has changed the health profile of the population.
In 2020, it became the third leading cause of death in Lithuania, accounting for 16.7 percent of all deaths. However, it did not overtake the most common causes of death: cancer and vascular diseases.
Statistics on deaths from Covid-19 do not give us a complete picture of pandemic-related mortality. There are both positive and negative consequences to how the pandemic has affected the number of deaths. The most obvious example is non-Covid deaths and quarantine restrictions.
“Decreased mobility may have reduced car accident deaths to some extent, but it cannot be ruled out that the stress caused by the pandemic and the reduced availability of healthcare services may have increased the number of such deaths,” comments Kasiulevičius.
The impact of the consequences of Covid-19 on the disruption of various healthcare services is inevitable and may be the cause of delayed diagnoses of diseases, according to Kasiulevičius.
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