England, Wales and Spain suffered the biggest increases in deaths by all causes during the first wave of the covid-19 pandemic, while countries including New Zealand, Norway and Poland appear to have escaped relatively unscathed.
The three worst-hit countries each saw around 100 “excess deaths” per 100,000 people between February and May, which researchers say was probably due to governments being slow to implement lockdowns and scale up testing and tracing.
To arrive at the results, Majid Ezzati at Imperial College London and his colleagues took weekly death data from 2010 to early 2020 for 22 countries and used 16 models to factor in influences such as temperature, estimating how many deaths there would have been in a pandemic-free world for February to May. The researchers then compared those figures with official data for deaths by all causes, to arrive at excess deaths.
Across the countries – 20 in Europe, plus Australia and New Zealand – there were 206,000 excess deaths. But how countries fared differed wildly.
Hungary, Denmark and Australia were among the group where there was no detectable rise in deaths. In the middle were countries such as Sweden, which fared poorly compared with its Nordic neighbours. Those with most excess deaths were Belgium, Italy, Scotland, Spain, England and Wales, with the last three in a class of their own.
“What puts England, Wales and Spain doing worst than other countries is this combination of long and intense – long period of impact and quite large rises,” says Ezzati.
The UK government dropped international covid-19 death figures from its daily briefings in May, which it justified by saying comparisons were “difficult” due to differences in how countries report data. Yet by the yardstick of excess deaths, considered the fairest way to compare countries, much of the UK emerges badly. Excess deaths were up 37 per cent in England and Wales, when adjusted for population, behind only Spain at 38 per cent. “All-cause mortality moves past the differences in how countries report data,” says Hannah Ritchie at Our World in Data.
Demographic differences such as the UK’s high rate of obesity, a risk factor for severe covid-19, cannot explain the country’s poor performance alone, Ezzati and his colleagues say, noting that Australia and New Zealand both have worse obesity rates. The team found two consistent features for the countries with the worst mortality rates: late lockdowns and slow ramping up of testing and tracing.
Ezzati says the results don’t tell us which countries will have large numbers of deaths during the second wave currently engulfing much of Europe. “We are seeing noticeable differences. Italy has so far been later than other countries in the rise [in excess deaths], whereas it was the first country [where excess deaths were] detectable,” he says. “We cannot use this for predicting the second wave because, hopefully, countries will act differently.”
The research also found that, surprisingly, excess deaths affected men and women largely equally. That differs from covid-19-assigned deaths, where more men have died. We don’t know the reason why, says Ezzati, but he speculates that it could be because women are older on average, so they are worst affected by secondary impacts, such as delayed care for dementia.
“Timing of policies, whether lockdowns or ability to scale up testing quickly, have been the real drivers of excess mortality,” says Oliver Watson, also at Imperial College London but not involved in the study. “It’s pretty clear early action has a large impact.”
Journal reference: Nature Medicine, DOI: 10.1038/s41591-020-1112-0
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