This data on general mortality from the national register is available for each of Belgium’s 43 administrative arrondissements for the period from 10 March to 19 April 2020. “If we take the average mortality for the years 2015 to 2019 in the corresponding period as a reference for the expected mortality, we can assess the impact of Covid-19 on the mortality rates for each arrondissement. We can further break this down by age and gender,” says Prof Deboosere.
Two observations based on this graph:
1. Mortality in Belgium is exceptionally high, reaching unprecedented levels, especially in the period from 1 to 12 April, with 639 deaths on 10 April, more than double the number that would have been expected for that day. April 2020 was the deadliest April since the Second World War, both in absolute numbers and per capita.
2. Registration of Covid-19 deaths is almost completely equivalent to the measured excess mortality. In all probability, this excess mortality can be fully attributed to Covid-19.
Thus, the Covid-19 crisis is causing many additional premature deaths in the 65-84 age group and, in the worst affected districts, also in the 45-64 age group. The most seriously affected arrondissements for this period is Mons, followed by Brussels and Hasselt. Hasselt includes Sint-Truiden and Alken, which both suffered high excess mortality. For these three arrondissements, mortality due to Covid-19 is about twice as high as the expected mortality rate. Liège was also particularly hard hit, with 80% higher mortality. Two arrondissements did not show excess mortality: Diksmuide and Huy. In many other places, the excess mortality rate remained relatively low, with figures between 10% and 30%, comparable to a severe flu episode.
Deboosere places the excess mortality in its historical context: “If we look at the timeline in the longer term, excess mortality in the first half of April will be a historical low point for us. Never before has the month of April seen such a high mortality rate in our country. Given the rapid spread of the virus from various sources of infection, the measures taken on 13 March may have saved us from a much worse crisis just in time. For Belgium, therefore, the registration of mortality caused by Covid-19 appears to have been very accurate right from the start. Internationally, the figures for several countries may have to be adjusted upwards in the future, especially when the excess mortality appears to be significantly higher than the reported Covid-19 deaths. In any case, Belgium will be one of the countries where the pandemic struck particularly hard.”
Fewer young people died
The lower mortality than expected among young people in most arrondissements is notable. The Covid-19 protection measures have strongly reduced the mortality rates in this group, as well as for the 25-44 age group and, in several arrondissements, the 45-64 age group. The decrease among younger people was expected and can also be seen elsewhere in Europe. The measures that have drastically reduced mobility and nightlife for young people are likely to be a factor: in normal circumstances, one in five deaths among 15- to 24-year-olds is the result of a road accident.
“However, the fact that younger age groups are much less represented in mortality statistics does not mean they are not affected by the disease. There is a significant higher mortality under age 65. And besides the fact that many younger persons are hospitalized, new evidence is popping up on more long term health impact on infected persons. In younger children, an inflammatory syndrome seems to be appearing. Although the number of cases is still relatively limited, this could indicate much more long-term and serious consequences of the Covid-19 epidemic than was previously assumed,” says Deboosere.
Mortality by gender, age group and district
Number of observed deaths in 2020 for the period from 10 March to 19 April compared to the number of expected deaths based on the average for 2015 to 2019. Source: National Register - Statbel - Sciensano - Processing: Interface Demography
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