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Surveillance Open Access
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Abstract

Background

COVID-19 mortality, excess mortality, deaths per million population (DPM), infection fatality ratio (IFR) and case fatality ratio (CFR) are reported and compared for many countries globally. These measures may appear objective, however, they should be interpreted with caution.

Aim

We examined reported COVID-19-related mortality in Belgium from 9 March 2020 to 28 June 2020, placing it against the background of excess mortality and compared the DPM and IFR between countries and within subgroups.

Methods

The relation between COVID-19-related mortality and excess mortality was evaluated by comparing COVID-19 mortality and the difference between observed and weekly average predictions of all-cause mortality. DPM were evaluated using demographic data of the Belgian population. The number of infections was estimated by a stochastic compartmental model. The IFR was estimated using a delay distribution between infection and death.

Results

In the study period, 9,621 COVID-19-related deaths were reported, which is close to the excess mortality estimated using weekly averages (8,985 deaths). This translates to 837 DPM and an IFR of 1.5% in the general population. Both DPM and IFR increase with age and are substantially larger in the nursing home population.

Discussion

During the first pandemic wave, Belgium had no discrepancy between COVID-19-related mortality and excess mortality. In light of this close agreement, it is useful to consider the DPM and IFR, which are both age, sex, and nursing home population-dependent. Comparison of COVID-19 mortality between countries should rather be based on excess mortality than on COVID-19-related mortality.

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/content/10.2807/1560-7917.ES.2022.27.7.2002060
2022-02-17
2022-05-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.7.2002060
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References

  1. Our World in Data. Coronavirus Pandemic Data Explorer. Oxford: Our World in Data; 2020. [Accessed: 23 Sep 2020]. Available from: https://ourworldindata.org/grapher/total-covid-deaths-per-million? tab=table
  2. Our World in Data. A pandemic primer on excess mortality statistics and their comparability across countries. Oxford: Our World in Data; 2020. Available from: https://ourworldindata.org/covid-excess-mortality
  3. The Economist. Tracking COVID-19 excess deaths across countries. London: The Economist; 2020. [Accessed: 23 Sep 2020]. Available from: https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
  4. 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?ua=1
  5. International Long-Term Care Policy Network (LTC). Mortality associated with COVID-19 outbreaks in care homes: early international evidence. London: LTC; 2020. Available from https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/
  6. Renard F, Scohy A, Van der Heyden J, Peeters I, Dequeker S, Vandael E, et al. Establishing an ad hoc COVID-19 mortality surveillance during the first epidemic wave in Belgium, 1 March to 21 June 2020. Euro Surveill. 2021;26(48).  https://doi.org/10.2807/1560-7917.ES.2021.26.48.2001402  PMID: 34857066 
  7. Khafaie MA, Rahim F. Cross-country comparison of case fatality rates of COVID-19/SARS CoV-2. Osong Public Health Res Perspect. 2020;11(2):74-80.  https://doi.org/10.24171/j.phrp.2020.11.2.03  PMID: 32257772 
  8. Porcheddu R, Serra C, Kelvin D, Kelvin N, Rubino S. Similarity in case fatality rates (CFR) of COVID-19/SARS-CoV-2 in Italy and China. J Infect Dev Ctries. 2020;14(2):125-8.  https://doi.org/10.3855/jidc.12600  PMID: 32146445 
  9. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. Lancet Infect Dis. 2020;20(7):773.  https://doi.org/10.1016/S1473-3099(20)30195-X  PMID: 32171390 
  10. Grewelle RE, De Leo GA. Estimating the global infection fatality rate of COVID-19. medRxiv. 2020.05.11.20098780. Preprint  https://doi.org/10.1101/2020.05.11.20098780 
  11. Organisation for Economic Co-operation and Development (OECD). Excess mortality: Measuring the direct and indirect impact of COVID-19. Paris: OECD; 2020. Available from: https://www.oecd.org/health/excess-mortality-c5dc0c50-en.htm
  12. Herzog S, De Bie J, Abrams S, Wouters I, Ekinci E, Patteet L, et al. Seroprevalence of IgG antibodies against SARS coronavirus 2 in Belgium - a serial prospective cross-sectional study of residual samples. medRxiv. 2020.06.08.20125179. Preprint.
  13. Sciensano. EPISTAT. COVID-19. Brussels: Sciensano; 2020. [Accessed: 23 Sep]. Available from: https://epistat.wiv-isp.be/covid/
  14. Molenberghs G, Kenward MG. Missing Data in Clinical Studies. New York: Wiley; 2007.
  15. 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 
  16. STATBEL (Directorate General Statistics - Statistics Belgium). Number of deaths per day, sex, age, region, province, district. Brussels: STATBEL; 2020. [Accessed: 23 Sep 2020]. Available from: https://statbel.fgov.be/en/open-data/number-deaths-day-sex-district-age
  17. STATBEL (Directorate General Statistics - Statistics Belgium). Structure of the Population, Brussels: STATBEL; 2020. [Accessed: 23 Sep 2020]. Available from: https://statbel.fgov.be/en/themes/population/structure-population
  18. Abrams S, Wambua J, Santermans E, Willem L, Kuylen E, Coletti P, et al. Modelling the early phase of the Belgian COVID-19 epidemic using a stochastic compartmental model and studying its implied future trajectories. Epidemics. 2021;35:100449.  https://doi.org/10.1016/j.epidem.2021.100449  PMID: 33799289 
  19. Willem L, Abrams S, Libin PJK, Coletti P, Kuylen E, Petrof O, et al. The impact of contact tracing and household bubbles on deconfinement strategies for COVID-19. Nat Commun. 2021;12(1):1524.  https://doi.org/10.1038/s41467-021-21747-7  PMID: 33750778 
  20. Pellis L, Scarabel F, Stage HB, Overton CE, Chappell LH, Lythgoe KA, et al. Challenges in control of Covid-19: short doubling time and long delay to effect of interventions. medRxiv. 2004.00117. Preprint  https://doi.org/10.1101/2020.04.12.20059972 
  21. Nishiura H, Klinkenberg D, Roberts M, Heesterbeek JA. Early epidemiological assessment of the virulence of emerging infectious diseases: a case study of an influenza pandemic. PLoS One. 2009;4(8):e6852.  https://doi.org/10.1371/journal.pone.0006852  PMID: 19718434 
  22. Richards FJ. A flexible growth function for empirical use. J Exp Bot. 1959;10(2):290-301.  https://doi.org/10.1093/jxb/10.2.290 
  23. Faes C, Abrams S, Van Beckhoven D, Meyfroidt G, Vlieghe E, Hens N. Time between symptom onset, hospitalisation and recovery or death: statistical analysis of Belgian COVID-19 patients. Int J Environ Res Public Health. 2020;17(20):E7560.  https://doi.org/10.3390/ijerph17207560  PMID: 33080869 
  24. Bustos Sierra N, Asikainen T, Bossuyt N, Braeye T, De Jonghe E. Surveillance de la mortalité en Belgique, Flandre, Wallonie et Bruxelles durant l’hiver 2017-2018. [Monitoring of mortality in Belgium, Flanders, Wallonia and Brussels during the winter of 2017-2018.]. French. Brussels: Sciensano; 2019. Available from: https://epistat.wiv-isp.be/docs/momo/Be-MOMO%20winter%202017-18%20report_FR.pdf
  25. Eggerickx T, Sanderson JP, Vandeschrick C. Mortality in Belgium from nineteenth century to today. Revue Quetelet. 2020;8(2):7-59.  https://doi.org/10.14428/rqj2020.08.02.01 
  26. Wyper GMA, Assunção RMA, Cuschieri S, Devleeschauwer B, Fletcher E, Haagsma JA, et al. Population vulnerability to COVID-19 in Europe: a burden of disease analysis. Arch Public Health. 2020;78:47.
  27. Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, et al. , ECDC Public Health Emergency Team. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020;25(22). PMID: 32524949 
  28. European Social Observatory. Declercq A, de Stampa M, Geffen L, Heckman G, Hirdes J, Finne-Soveri H, et al. Why, in almost all countries, was residential care for older people so badly affected by COVID-19? Brussels: European Social Observatory; 2020. Available from: http://www.ose.be/files/publication/OSEPaperSeries/Declercq_Et_Al_2020_OpinionPaper23.pdf
  29. O’Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, et al. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2021;590(7844):140-5.  https://doi.org/10.1038/s41586-020-2918-0  PMID: 33137809 
  30. Levin AT, Hanage WP, Owusu-Boaitey N, Cochran KB, Walsh SP, Meyerowitz-Katz G. Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. Eur J Epidemiol. 2020;35(12):1123-38.  https://doi.org/10.1007/s10654-020-00698-1  PMID: 33289900 
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