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Surveillance Open Access
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Abstract

Background

COVID-19-related mortality in Belgium has drawn attention for two reasons: its high level, and a good completeness in reporting of deaths. An ad hoc surveillance was established to register COVID-19 death numbers in hospitals, long-term care facilities (LTCF) and the community. Belgium adopted broad inclusion criteria for the COVID-19 death notifications, also including possible cases, resulting in a robust correlation between COVID-19 and all-cause mortality.

Aim

To document and assess the COVID-19 mortality surveillance in Belgium.

Methods

We described the content and data flows of the registration and we assessed the situation as of 21 June 2020, 103 days after the first death attributable to COVID-19 in Belgium. We calculated the participation rate, the notification delay, the percentage of error detected, and the results of additional investigations.

Results

The participation rate was 100% for hospitals and 83% for nursing homes. Of all deaths, 85% were recorded within 2 calendar days: 11% within the same day, 41% after 1 day and 33% after 2 days, with a quicker notification in hospitals than in LTCF. Corrections of detected errors reduced the death toll by 5%.

Conclusion

Belgium implemented a rather complete surveillance of COVID-19 mortality, on account of a rapid investment of the hospitals and LTCF. LTCF could build on past experience of previous surveys and surveillance activities. The adoption of an extended definition of ‘COVID-19-related deaths’ in a context of limited testing capacity has provided timely information about the severity of the epidemic.

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/content/10.2807/1560-7917.ES.2021.26.48.2001402
2021-12-02
2022-01-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2021.26.48.2001402
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References

  1. European Centre for Disease Prevention and Control (ECDC). Rapid Risk Assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, Wuhan, China; first update. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/risk-assessment-outbreak-acute-respiratory-syndrome-associated-novel-1
  2. Reuters.com. Repatriated Belgian tests positive for coronavirus. 4 Feb 2020. Available from: https://www.reuters.com/article/us-china-health-belgium-idUSKBN1ZY0OK
  3. Sciensano. Epistat - Belgian COVID-19 open data interactive dashboard. Brussels: Sciensano. [Accessed: 9 Dec 2020]. Available from: https://epistat.wiv-isp.be/covid
  4. Roser M, Ritchie H, Ortiz-Ospina E, Hasell J. Coronavirus (COVID-19) deaths. London: Our World in Data. [Accessed: 7 Dec 2020]. Available from: https://ourworldindata.org/covid-deaths
  5. European Centre for Disease Prevention and Control (ECDC). Weekly surveillance report on COVID-19, Week 24, 2020. Stockholm: ECDC. [Accessed: 21 Jun 2020]. Available from: https://covid19-surveillance-report.ecdc.europa.eu/#4_severity
  6. Morgan D, Ino J, Di Paolantonio G, Murtin F. Excess mortality: Measuring the direct and indirect impact of COVID-19. OECD Health Working Papers, No.122. Paris: OECD publishing; 2020.  https://doi.org/10.1787/c5dc0c50-en 
  7. Comas-Herrera A, Zalakaín J, Lemmon E, Henderson D, Litwin C, Hsu AT, et al. Mortality associated with COVID-19 outbreaks in care homes: early international evidence. International Long-Term Care Policy Network. 1 Feb 2021. Available from: https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence
  8. National Institute of Demographic Studies (INED). The demography of COVID-19 deaths - Pooled metadata file. INED. [Accessed: 14 Dec 2020]. Available from: https://dc-covid.site.ined.fr/en/data/pooled-datafiles
  9. Aron J, Giattino C, Muellbauer J, Ritchie H. A pandemic primer on excess mortality statistics and their comparability across countries. Our World in Data. [Accessed: 7 Dec 2020]. Available from: https://ourworldindata.org/covid-excess-mortality
  10. Lagasse R, Deboosere P. Évaluation épidémiologique de l’impact du Covid-19 en Belgique à la date du 15 juillet 2020. [Epidemiological assessment of the impact of Covid-19 in Belgium as of July 15, 2020]. Brussels: Université Libre De Bruxelles; 2020. French. Available from: https://esp.ulb.be/fr/les-actus/les-actualites-de-lesp/rapport-d-analyse-de-l-epidemie-covid-19-n-ii
  11. Sciensano. COVID-19 - Bulletin épidémiologique hebdomadaire du 5 juin 2020. [COVID-19 - Weekly Epidemiological Bulletin of 5 June 2020]. Brussels: Sciensano. [Accessed: 20 Jun 2020]. French. Available from: https://www.sciensano.be/fr/biblio/covid-19-bulletin-epidemiologique-hebdomadaire-du-5-juin-2020
  12. Bustos Sierra N, Bossuyt N, Braeye T, Leroy M, Moyersoen I, Peeters I, et al. All-cause mortality supports the COVID-19 mortality in Belgium and comparison with major fatal events of the last century. Arch Public Health. 2020;78(1):117.  https://doi.org/10.1186/s13690-020-00496-x  PMID: 33292536 
  13. Statbel. Evolution of the mortality rate in Belgium. Brussels: Statbel. [Accessed: 25 Jun 2020]. Available from: https://statbel.fgov.be/en/visuals/mortality
  14. Michaels D. Extent of Covid-19 deaths failed to be captured by most countries. New York: Wall Street Journal; 28 May 2020. Available from: https://www.wsj.com/articles/most-countries-fail-to-capture-extent-of-covid-19-deaths-11590658200?mod=searchresults&page=1&pos=3
  15. Bustos Sierra N, Bossuyt N, Braeye T, Haarhuis F, Peeters I, Proesmans K, et al. Excess mortality during the first and second waves of the COVID-19 epidemic in Belgium (data from 10 March 2020 to 14 February 2021). Brussels: Sciensano; 2021. Report No.: D/2021/14.440/62. Available from: https://epistat.wiv-isp.be/docs/momo/Be-MOMO_report_Excess%20mortality%20during%20the%20COVID-19%20epidemic%20in%20Belgium.pdf
  16. World Health Organization/Regional Office for Europe (WHO/Europe). Surveillance strategies for COVID-19 human infection, Interim Guidance, May 10th 2020. Copenhagen: WHO/Europe; 2020. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/epidemiology-and-surveillance/surveillance-strategies-for-covid-19-human-infection-interim-guidance,-10-may-2020
  17. Statbel. Causes of death. Brussels: Statbel. [Accessed: 16 Nov 2021]. Available from: https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/causes-death#documents
  18. Federal Public Service (FSP) Health, Food Chain Safety and Environment. Menaces pour la santé publique. [Threat for public health]. Brussels: FPS. [Accessed: 9 Dec 2020]. French. Available from: https://www.health.belgium.be/en/node/35662
  19. Federal Public Service (FSP) Public Health. Protocole d’accord entre les autorités sanitaires belges établissant les structures génériques pour la gestion sectorielle santé des crises de santé publique et leur mode de fonctionnement pour l’application du Règlement Sanitaire International. [Agreement between the Belgian health authorities establishing generic structures for the management of public health crisis in view of the application of the International Health Regulations]. Brussels: FPS. [Accessed: 12 Sep 2020]. French. Available from: https://www.health.belgium.be/sites/default/files/uploads/fields/fpshealth_theme_file/protocole_daccord_entre_les_autorites_sanitaires_belges.pdf
  20. Agence pour une Vie de Qualité (AViQ). MATRA - Déclaration des maladies transmissibles. [Communicable disease reporting]. Charleroi: AViQ. [Accessed: 30 Nov 2021]. French. Available from: https://www.wiv-isp.be/matra/CF/liste_matra.aspx
  21. Le Moniteur Belge (MB). Loi portant création de Sciensano. [Law establishing Sciensano]. Brussels: MB. 2018. French. Available from: http://www.ejustice.just.fgov.be/cgi/article_body.pl?language=fr&caller=summary&pub_date=18-03-21&numac=2018011241
  22. Meurisse M, Lajot A, Dupont Y, Lesenfants M, Klamer S, Rebolledo J, et al. One year of laboratory-based COVID-19 surveillance system in Belgium: main indicators and performance of the laboratories (March 2020-21). Arch Public Health. 2021;79(1):188.  https://doi.org/10.1186/s13690-021-00704-2  PMID: 34706768 
  23. European Centre for Disease Prevention and Control (ECDC). Case definition for coronavirus disease 2019 (COVID-19), as of 5 May 2020. Stockholm: ECDC. [Accessed: 17 May 2020]. Available from: https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition
  24. Sciensano. Case definition, indications for requesting a test and mandatory COVID-19 case reporting, as of May 15th. Brussels: Sciensano. [Accessed: 16 May 2020]. Available from: https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_Case%20definition_Testing_FR.pdf
  25. Revel MP, Parkar AP, Prosch H, Silva M, Sverzellati N, Gleeson F, et al. COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). Eur Radiol. 2020;30(9):4903-9.  https://doi.org/10.1007/s00330-020-06865-y  PMID: 32314058 
  26. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology. 2020;296(2):E32-40.  https://doi.org/10.1148/radiol.2020200642  PMID: 32101510 
  27. World Health Organization (WHO). Emergency use ICD codes for COVID-19 disease outbreak. Brussels: WHO. [Accessed: 16 Nov 2021]. Available from: https://www.who.int/standards/classifications/classification-of-diseases/emergency-use-icd-codes-for-covid-19-disease-outbreak
  28. World Health Organization (WHO). International guidelines for certification and classification (coding) of COVID-19 as cause of death. Geneva: WHO; 2020. Available from: https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19.pdf
  29. Gerkens S, Merkur S. Belgium: Health system review. Health Syst Transit. 2010;12(5):1-266, xxv. PMID: 21224177 
  30. Federal Public Service (FSP) Public Health. Institutions de soins. [Care institutions]. Brussels: FPS. [Accessed: 14 Dec 2020]. French. Available from: https://www.health.belgium.be/fr/sante/organisation-des-soins-de-sante/partage-de-donnees-de-sante/institutions-de-soins
  31. For a Healthy Belgium. Types of hospitals. Brussels: Belgium.be. [Accessed: 16 Nov 2021]. Available from: https://www.healthybelgium.be/en/key-data-in-healthcare/general-hospitals/organisation-of-the-hospital-landscape/types-of-hospitals
  32. Le Moniteur Belge (MB). Loi spéciale relative à la Sixième Réforme de l’Etat. [Special Law on the Sixth Reform of State]. Brussels: MB; 2014. French. Available from: http://www.ejustice.just.fgov.be/cgi_loi/change_lg.pl?language=fr&la=F&cn=2014010654&table_name=loi
  33. Federal Public Service (FPS) Public Health. Hospital and Transport Surge Capacity Committee (HTSC). Brussels: FPS. [Accessed: 30 Nov 2021]. Available from: https://consultativebodies.health.belgium.be/en/hospital-transport-surge-capacity-committee-htsc
  34. Van Goethem N, Vilain A, Wyndham-Thomas C, Deblonde J, Bossuyt N, Lernout T, et al. Rapid establishment of a national surveillance of COVID-19 hospitalizations in Belgium. Arch Public Health. 2020;78(1):121.  https://doi.org/10.1186/s13690-020-00505-z  PMID: 33292566 
  35. Le Moniteur Belge (MB). Arrêté royal concernant un flux d’information correct et en temps voulu sur les chiffres de patients COVID-19, la capacité de traitement dans les hôpitaux et les stocks de matériel de protection individuelle. [Royal Decree concerning the correct and timely flow of information on COVID-19 patient numbers, treatment capacity in hospitals and stocks of personal protective equipment]. Brussels: MB; 2020. French. Available from: http://www.ejustice.just.fgov.be/eli/arrete/2020/04/30/2020010389/moniteur
  36. Leroy M, Dupont Y, Braeye T, Bossuyt N, Bustos Sierra N. Epistat – Belgian Mortality Monitoring (Be-MOMO). Brussels: Sciensano. [Accessed: 9 May 2020]. Available from: https://epistat.wiv-isp.be/momo
  37. Société Belge de Gériatrie. Arbre décisionnel suspicion COVID-19 résident MR/MRS. [Decision tree suspicion COVID-19 in nursing homes residents]. Gavere: Société Belge de Gériatrie; 2020. French. Available from: https://geriatrie.be/media/2020/03/2020-03-19_Arbre-decisionnel-admission-suspicion-COVID-19-resident-MRS_SBGG.pdf
  38. National Institute for Demographic Studies (INED). The demography of COVID-19 deaths. Seven data-related key issues. INED. [Accessed: 15 Dec 2020]. Available from: https://dc-covid.site.ined.fr/en/presentation
  39. Moniteur Belge. Protocole d’accord concernant le Plan national Multidrug Resistant Organisms [Protocol Agreement on Multidrug resistantorganims National Plan]. Brussels: Moniteur Belge; 2013/24362. French. Available from: https://www.ejustice.just.fgov.be/doc/rech_f.htm
  40. Ben Adbelhafidh L, Latour K. Zorginfecties en antimicrobieel gebruik in Belgische woonzorgcentra: resultaten van de HALT-3 puntprevalentiestudie (september-november 2016). [Healthcare-associated infections and antimicrobial use in belgian residential care centres: results of the HALT-3 point prevalence study (September-November 2016)]. Brussels: Scientific Institute for Public Health (WIV-ISP); 2017. Dutch. Available from: https://www.sciensano.be/nl/biblio/zorginfecties-en-antimicrobieel-gebruik-belgische-woonzorgcentra-resultaten-van-de-halt-3
  41. Latour K, Jans B. Zorggerelateerde infecties en antimicrobieel gebruik in Belgische woonzorgcentra: resultaten van de HALT prevalentiestudie 2010. [Healthcare-associated infections and antimicrobial use in Belgian residential care centres: results of the HALT prevalence study 2010]. Brussels: Scientific Institute for Public Health (WIV-ISP); 2012. Dutch. Available from: https://www.sciensano.be/nl/biblio/zorggerelateerde-infecties-en-antimicrobieel-gebruik-belgische-woonzorgcentra-resultaten-van-de-halt
  42. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities, April–May 2013. Stockholm: ECDC; 2014. Available from: https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-2
  43. Jans B, Latour K, Broex E, Catry B. Surveillance of influenza-like illness in Belgian nursing homes. Arch Public Health. 2010;68(3):100.  https://doi.org/10.1186/0778-7367-68-3-100 
  44. European Centre for Disease Prevention and Control (ECDC). Infection prevention and control and preparedness for COVID-19 in healthcare settings - third update. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Infection-prevention-control-for-the-care-of-patients-with-2019-nCoV-healthcare-settings_third-update.pdf
  45. Molenberghs G, Faes C, Aerts J, Theeten H, Devleesschauwer B, Bustos Sierra N, et al. Belgian covid-19 mortality, excess deaths, number of deaths per million, and infection fatality rates (8 March - 9 May 2020). medRxiv. 2020.06.20.20136234. Preprint.  https://doi.org/10.1101/2020.06.20.20136234 
  46. Deforche K. An age-structured epidemiological model of the Belgian COVID-19 epidemic. medRxiv. 2020.04.23.20077115. Preprint.  https://doi.org/10.1101/2020.06.20.20136234 
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