COVID-19 Excess pandemic mortality

https://coiosresear.ch/covid-19/f/covid-19---excess-pandemic-mortality

Airplanes grounded. Public parks closed. Only essential shops open. Every day the restrictions tighten as nations attempt to restrict the spread of SARS-CoV-2. Our debt to the armies of doctors, nurses and key workers grows with every passing day. By staying at home and focusing our contacts, we protect the vulnerable and those in need.

Everyone recognises the need and urgency for more testing. In the midst of this global pandemic, we need greater certainty over the challenges that we face. How many individuals are already infected? Studies to carry out randomised sampling of the population with serological tests are vitally needed. Public and private health systems are combining to increase the capacity of hospital beds and intensive care units in anticipation of the peak weeks that will follow.

The only tragic certainty is the increasing number of deaths from COVID-19 that we see reported every day from national briefings, the World Health Organisation and informative websites such as Worldometer. We cannot help but compare and speculate how far behind the curve our country may be.

Until 2020, our enemy every winter and spring was influenza. Even this year, the CDC reports that there have already been 23,000 deaths in the US alone. It is this enemy that moved countries away from annual mortality reports to providing weekly summaries that show the seasonal changes. COVID-19 as in many other spheres pushes us still further and the declarations for COVID-19 alone are now daily. This means that there is an inevitable lag between what we see from COVID-19 and our understanding of the wider mortality trends.

As we try to achieve greater certainty over the case fatality rates of COVID-19, public health officials need to be able to determine the excess number of deaths caused by COVID-19. Identifying those who have tragically died from the SARS-CoV-2 virus as opposed to those just as regrettably who have died with SARS-CoV-2 but from other causes. Country comparisons may provide some information although this is complicated by the different age profiles of confirmed cases and those in hospital. Many experts have commented on the relatively low number of deaths in Germany given the number of confirmed infections.

One possible contributory explanation of differences seen between Italy and Germany is that in Italy, post-mortems routinely test whether the SARS-CoV-2 virus was present whereas in Germany, post-mortem tests are not carried out if the patient has not tested positive during their lifetime. The number of deaths associated with, or attributed to, SARS-CoV-2 in Italy would be inevitably higher. The Italian health ministry does distinguish in its declarations between those believed to have died from COVID-19 as opposed to those who have died with COVID-19, but only the summary statistics are routinely reported.

Every Thursday at 12pm GMT, EUROMomo (European Monitoring of Excess Mortality for Public Health Action) releases a weekly summary of additional mortality collated across Europe). EUROMomo correctly highlights the possibility of delayed registrations, but this is likely to be less of an issue with COVID-19 given the huge attention and focus. It is sites like these that will provide the quantification of excess mortality that we need both for our models and for our assessment of how successful the restrictions are providing. Influenza forced us to shift from years to weeks. Perhaps COVID-19 will force us to shift from weeks to days.

The most recent data from EUROMomo is in respect of Week 11, 2020 - which covers 9-15 March. During that week, Italy reported that 1,443 had died from COVID-19. This would be equivalent to approximately 12% of the deaths expected each week in Italy. The conclusions from EUROMomo as to the number of excess deaths are not yet clear. But, tragically the numbers of deaths in Italy and elsewhere have been growing exponentially day by day. As of Thursday this week we will have a clearer picture of the number of unexpected deaths, and hence another step forward in achieving clarity on the case fatality rate of SARS-CoV-2.

Until then, the focus is on more testing and helping our health systems by reducing unnecessary contacts.