Excess Mortality

Belarus: The Country With No Restrictions, and No Disaster

Belarus has finally, after several months of delay, published its overall mortality figures up to March 2021, meaning for the first time we have a plausibly reliable indicator of the true impact of the pandemic in the country famous for refusing to impose even minimal measures.

Few have trusted the official Covid case and death statistics from the authoritarian country, which are implausibly low. However, the overall death statistics are generally thought to be reliable, and indeed by comparing them to neighbouring countries we can see that they are comparable, adding to the sense that they are accurate.

While the country did not impose any Covid restrictions or ‘guidance’ at all, there was some voluntary behaviour change, as mobility data shows, but it was limited compared with other places.

EuroMOMO Analysis Indicates That Europe’s Third Wave Was A Blip

Has Europe seen two mortality peaks or three? According to many news outlets, the continent experienced a deadly third wave of COVID-19 during the spring of 2021.

“Europe is enduring a grim spring,” said an FT article dated 4th April. “COVID-19 infections, hospitalisations and deaths are rising in many countries,” it goes on to claim. The article presents data suggesting that March saw elevated COVID-19 death rates in a number of European countries.

This characterisation is borne out by Our World in Data’s chart of the daily number of confirmed COVID-19 deaths for the European Union – which is shown below. (The chart for Europe as a whole is highly similar.)

According to the chart, there was a peak of mortality in the spring of 2020, corresponding to the first wave (which afflicted countries such as Italy, Spain and the U.K). Then there was another peak of mortality in the winter, corresponding to the second wave (when countries such as Poland, Czechia and Hungary were also afflicted).

And the chart indicates there was an additional peak of mortality in the spring of 2021, corresponding to the third wave. This peak is lower than the first two, but still quite considerable. On April 13th, there were more than 2,800 COVID-19 deaths in Europe (compared to just under 3,600 at the peak of the second wave).

Yet as I’ve noted repeatedly, “confirmed COVID-19 deaths” can be misleading, since some of the people who die of COVID-19 (either shortly after a positive test, or with COVID-19 on the death certificate) would have died anyway. Excess mortality provides a far better gauge of the pandemic’s impact.

Estimates of excess mortality for 26 European countries are provided by researchers at EuroMOMO. The chart below plots excess mortality z-scores (numbers of standard deviations above or below the average) from week 1 of 2020 to week 27 of 2021. I’ve omitted the last three weeks of data, as these are subject to revision.

The first and second wave peaks are clearly visible: the former can be seen at week 14 of 2020, and the latter at week 3 of 2021. By comparison, the peak of the third wave (at week 16 of 2021) is barely noticeable.

It does technically rise above the red line, which the researchers oddly classify as a “substantial increase”. However, increases of this magnitude are seen every few months going all the way back to 2017. Hence the third peak cannot be regarded as a major epidemic wave.

Part of the difference between the two charts may be due to the composition of countries. For example, EuroMOMO does not cover Poland, Romania or Czechia. Having said that, the countries it does include make up the vast majority of Europe’s population, so this probably can’t account for much.

The EuroMOMO analysis indicates that Europe has seen two mortality peaks, not three. In terms of excess mortality, the third wave was just a blip.  

New York Times Article Wrongly Claims Britain’s Second Wave Was More Deadly Than the First

In a recent article published in the New York Times, the science writer Zeynep Tufekci argues that the B.1.617.2 “Indian” variant appears to be more transmissible than even the B.1.1.7 “Kent” variant, and could therefore be “catastrophic” for parts of the world with low rates of vaccination. 

As a consequence, she argues, vaccine supplies should be “diverted now to where the crisis is the worst, if necessary away from the wealthy countries that have purchased most of the supply.”

While asking rich countries to share their vaccine supplies with poorer countries surely makes sense, one of the points Tufekci makes in support of her argument is based in error. Linking to Our World in Data’s chart of UK daily deaths, she writes:

Britain had more daily Covid-related deaths during the surge involving B.1.1.7 than in the first wave, when there was less understanding of how to treat the disease and far fewer therapeutics that later helped cut mortality rates. Even after the vaccination campaign began, B.1.1.7 kept spreading rapidly among the unvaccinated.

In other words, she’s saying that the higher mortality rate observed in Britain’s second wave, following the emergence of the “Kent” variant last November, constitutes evidence that new variants can pose serious and unforeseen challenges to national healthcare systems. 

However, it simply isn’t true that there were more COVID-related deaths “during the surge involving B.1.1.7”. As I’ve noted before, the chart showing deaths within 28 days of a positive test (to which Tufekci links) gives a very misleading impression of the relative severity of the first and second waves. 

The correct chart to use is the one the ONS published on 19 March, which plots age-adjusted excess mortality up to 12 February:

The peak weekly mortality in the first wave was 101% higher than the five-year average. Yet in the second wave, it was only 42% higher.

What’s more, cumulative excess mortality was 483% in the first wave, but only 328% in the second wave. Of course, the latter figure is an underestimate because the series stops in mid-February. However, extending the series forward wouldn’t make that much difference. Indeed, there were nine consecutive weeks of negative excess mortality in March, April and May.

Countries with low rates of vaccination should certainly remain vigilant with respect to new variants, but decisions need to be based on the best available data – and that means age-adjusted excess mortality wherever possible.

Why has this Mortality Monitor Suddenly Changed its Baseline From the Ten-Year Average to 2019 – the Lowest Mortality Year Ever?

One of the most reliable and informative sources of mortality data over the past year has been the Institute and Faculty of Actuaries’ weekly mortality monitor report. It shows weekly and cumulative mortality for the year, and unlike the ONS, adjusts for population size and age so we get a truer reflection of how the current trends compare with the past.

Last week the report showed that the trend of deaths in 2021 has been so low since mid-March that all the excess deaths in January and February had been almost cancelled out and cumulative standardised mortality stood at just 1.1% above the 10-year average (see graph below).

At Lockdown Sceptics we were waiting for the moment when, at some point in the next few weeks, this figure would hit 0% so we could announce that, despite the winter Covid surge, 2021 was now officially a low mortality year with below average age-standardised mortality.

However, it appears that moment now may never come, as unexpectedly this week the Institute changed the baseline on its key chart. The 10-year baseline is gone, and in its place is a straight comparison to 2019.

The important thing to know about 2019 is it is the year with the lowest age-standardised mortality ever (see below).

What Second Wave? Total Deaths in UK and Sweden Now Average for 2021

New figures from the ONS released yesterday show that deaths in England and Wales are running 7.3% below the five-year average for the week ending April 30th. This is the eighth consecutive week that registered deaths have been below the five-year average.

While the UK’s winter epidemic has been over for some months now, Sweden, like much of the continent, has seen a spring wave.

ICUs have been busier in spring than they were in winter.

The Case Against the UK’s Lockdowns

We’re publishing an essay today by Dr Noah Carl arguing that the UK’s lockdowns were a mistake. Looking at the Western world, he says, lockdowns have not been associated with substantially fewer deaths from COVID-19, except in geographically peripheral countries that imposed strict border controls at the start. In addition, the increases in mortality associated with COVID-19 – even in the worst-hit Western countries – have been quite small, particularly when compared to the range of mortality between different groups in society. If good governance is about reducing overall mortality, why hasn’t the Government addressed these inequalities? Finally, he argues, the societal costs of lockdowns have been substantial, and preliminary analyses suggest they almost certainly outweighed the benefits.

Here is an extract in which he makes the point about the Government’s inconsistent approach to reducing mortality:

As Simon Wood noted in an article last October, “the gap in life expectancy between the richer and poorer segments of British society amounted to some 200 million life years lost for the current UK population, which is somewhere around 70 times what Covid might have caused”. He added: “Even the firmest believer in laissez-faire would have to concede that some percentage of that loss is preventable.” The fact that the Government never locked down society (or imposed costs of equivalent magnitude) to reduce much larger differences in mortality within Britain calls its coronavirus strategy into serious question.

Lockdown proponents might say this logic doesn’t apply to COVID-19, since lockdowns prevent individuals from harming others, whereas pre-existing differences in mortality are not due to such “externalities”. But I don’t find this argument very convincing. First, it’s not clear that lockdowns do have much impact on mortality over and above that of basic restrictions. Second, some of the pre-existing differences in mortality are caused by other people’s behaviour (e.g. air pollution, road accidents, flu deaths). And third, blanket lockdowns impose costs on people regardless of whether they contribute to the “externalities” of viral transmission (e.g. people who live away from major population centres, those who have already been infected).

Noah is a rigorous, fair-minded analyst who sticks closely to the evidence. His piece is worth reading in full.

Sweden Had Lower Excess Mortality Last Year Than Most of Europe

According to new excess mortality data compiled by Eurostat and Reuters, Sweden emerged from 2020 with a smaller increase in its overall mortality rate than most European countries in spite of eschewing the lockdown policy. Reuters has more.

Preliminary data from EU statistics agency Eurostat compiled by Reuters showed Sweden had 7.7% more deaths in 2020 than its average for the preceding four years. Countries that opted for several periods of strict lockdowns, such as Spain and Belgium, had so-called excess mortality of 18.1% and 16.2% respectively.

Twenty-one of the 30 countries with available statistics had higher excess mortality than Sweden. However, Sweden did much worse than its Nordic neighbours, with Denmark registering just 1.5% excess mortality and Finland 1.0%. Norway had no excess mortality at all in 2020.

Sweden’s excess mortality also came out at the low end of the spectrum in a separate tally of Eurostat and other data released by the UK’s Office for National Statistics last week.

That analysis, which included an adjustment to account for differences in both the age structures and seasonal mortality patterns of countries analysed, placed Sweden 18th in a ranking of 26. Poland, Spain and Belgium were at the top.

Lockdown enthusiasts often point to the lower excess mortality in the other Nordic countries, implying that had Sweden locked down it would have had even lower excess mortality. Against this, two things can be said. The first is the point made by Dr Paul Yowell which is that if you include the Baltic states among Sweden’s neighbours – and there is no non-arbitrary reason for not doing so – Sweden’s excess mortality begins to look less atypical for the region. The second is the argument made by Dr Oliver Robinson which is that Finland itself didn’t lock down, so pointing to Finland’s lower excess mortality than Sweden’s is not an argument in favour of lockdown.

The Reuters piece is worth reading in full.

Stop Press: MailOnline has summarised the Reuters story here.