"Everyone has the right to clear, accessible, timely and meaningful information about the nature and extent of the threat to their health".

(Esteban Beltrán, Director of Amnesty International's Spanish Section, before the Economic and Social Reconstruction Commission of the Spanish Parliament, European Union Group, 12 June 2020)










notes


1: "The National Center of Epidemiology clarifies to eldiario.es that, indeed, 'today we have made an important update resulting from the work we have been doing with the Ministry of Justice'. The objective is to 'recover those deaths that had not entered the MoMo System due to delays in notification during the previous three months'. (...) The Instituto de Salud Carlos III provides in its graphs the estimated average time in delay of notifications, and for these days in which the 12,032 deaths have been added, the delay is 35 days. (...)
The minimum personnel services due to the state of alarm and the increase in deaths due to the coronavirus led to a situation of collapse in several civil registries and morgues, especially the one in Barcelona and the morgue of the City of Justice of the Catalan capital. In a report from early April, the time of the peak, the Generalitat's (Catalan government's, R.W.) sub-directorate general for planning the administration of Justice revealed that the death section of the Barcelona civil registry had not been carrying out death registrations since March 17 as its minimum services are focused on issuing family books and burial licenses due to the 'high workload.'" (My translation.)
Belén Remacha / Raúl Sanchez, El registro de muertes suma de golpe 12.000 fallecidos durante el pico de la pandemia, más de la mitad en Catalunya, https://m.eldiario.es, 27/05/2020, last accessed 05/06/2020.

2: "The excess mortality observed, according to Amparo Larrauri, epidemiologist and head of the MoMo team and scientist at the National Epidemiology Centre, 'May be due to cases with confirmed COVID-19, to cases with unconfirmed COVID-19 that surveillance systems do not identify, and to the pandemic indirectly. The latter is very important. We have experienced a change in the social and health structure, and this has meant that many people with underlying pathologies have not gone to the doctor for a multitude of reasons, such as fear of contagion or that their consultations did not work as they usually did. And a host of reasons that are not medical, but social. Many studies suggest that the fact that a vulnerable, older person has been isolated and in confinement affects their health and evolution more than younger people. Unfortunately, we can all see such cases around us. These are deaths that are not COVID-19, but are related to this whole process.'" (My translation and emphasis.)
Belén Remacha, Amparo Larrauri, epidemióloga: "Nunca llegaremos a saber cuántas de las 43.000 muertes de más fueron directamente por COVID-19", https://www.eldiario.es, 02/06/2020, last accessed 05/06/2020.

3: Instituto Nacional de Estadística (INE) (Nationales Statistik-Institut), https://www.ine.es, last accessed 30/04/2020.

4: INE data on monthly deaths in Spain from 01/2019 until 06/2019 are provisional: https://www.ine.es, last accessed 22/04/2020, published 11/12/2019. The final data for the first half of 2020 will be published in December 2020.

5: https://momo.isciii.es/public/momo/dashboard/momo_dashboard.html, updated and corrected daily. The shaded area is the normal range, as in EuroMoMo, https://www.euromomo.eu/, determined from long-term values, and only when it is exceeded does one speak of excess mortality.

Amparo Larrauri, epidemiologist and head of the MoMo team and scientist at the National Epidemiology Centre: "What exactly are we talking about when we say that there is an 'excess' in Spain of almost 43,000 deaths during the months of the pandemic, if the Health Ministry reports 28,000? These 43,000 deaths are the results of the daily all-cause mortality surveillance of the MoMo system, and mean the difference between the deaths we observe for a period, and the expected mortality from the historical series in Spain over the last ten years. The latter, the expected mortality, is derived from data from the National Institute of Statistics (INE), with a mathematical model of moving averages adjusted for trend and seasonality. The daily observed mortality comes from data from the Ministry of Justice from the computerised civil registers of almost 4,000 Spanish municipalities, including all the provincial capitals, which correspond to 93% of the Spanish population. This is a very important amount of information.
Using the MoMo system, we have estimated an excess of deaths from all causes during the first pandemic wave of COVID-19. It is very logical to assume that part of the excess mortality corresponds directly to COVID-19. It is also logical to think that the actual deaths due to COVID-19 have been higher than the number provided by the Ministry of Health, since these are official figures from the autonomous communities that cannot cover the totality, only the microbiologically confirmed deaths. And they are all within these excesses estimated by the MoMo. This is neither abnormal nor contradictory: they are studies that do not contradict each other but complement each other in order to establish the true impact of the pandemic. The abnormal thing would be for them to be the same. Health provides the confirmed deaths by COVID-19; MoMo provides the deaths from all causes, many of them attributable to COVID-19. And it will still be some time before we definitively consolidate the true mortality of these months". (My translation.)
Belén Remacha, Amparo Larrauri, epidemióloga: "Nunca llegaremos a saber cuántas de las 43.000 muertes de más fueron directamente por COVID-19", https://www.eldiario.es, 02/06/2020, last accessed 05/06/2020.

6: https://momo.isciii.es/public/momo/dashboard/momo_dashboard.html#datos, last accessed 04/06/2020.

7: Accessed 03/04., 01/05., 27/05., 02/06. and 04/06/2020.

8: https://www.euromomo.eu/graphs-and-maps/, updated every Thursday; here the chart for Spain from the Bulletin of week 20/2020, accessed 15/05/2020.

9: A maximum of 2,466 deaths occurred on 31/03/2020. In comparison, in 2018, the last year for which the Instituto Nacional de Estadística provides definitive figures (https://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736177008&menu=ultiDatos&idp=1254735573002), an average of 1,172 people died every day.
I was unable to establish the daily maxima during the past flu epidemics, so I concentrate on the more easily comparable monthly values, especially since the contemplation of temporally as well as geographically very small sections tends to focus on extreme values.

10: Instituto Nacional de Estadística (National Statistics Institute), https://www.ine.es/dynt3/inebase/index.htm?padre=1132&capsel=1134, accessed 22/04/2020.

11: Centro Nacional de Epidemiología, Monitorización de la Mortalidad diaria (MoMo) [National Centre of  Epidemiology, Monitoring of daily mortality (MoMo)], https://momo.isciii.es/public/momo/dashboard/momo_dashboard.html,  accessed 04/06/2020.

12: https://momo.isciii.es/public/momo/dashboard/momo_dashboard.html#nacional, accessed 04/06/2020.

13: Own calculation.








14: Excess mortality is, according to Amparo Larrauri, epidemiologist and head of the MoMo team and scientist at the National Epidemiology Centre, "... the difference between the deaths we observe for a period, and the expected mortality from the historical series in Spain over the last ten years. The latter, the expected mortality, is derived from data from the National Institute of Statistics (INE), with a mathematical model of moving averages adjusted for trend and seasonality." https://www.eldiario.es/sociedad/llegaremos-cuantas-muertes-directamente-COVID-19_0_1033797562.html?_ga=2.257052940.607369215.1590683111-795171950.1590683111, 02/06/2020, accessed 05/06/2020.















Attempt to view in perspective the health hazard posed by the COVID-19 pandemic:

Mortality in spring of 2020 in Spain and Germany compared to the general death rate in both countries


2. SPAIN


2.1. General mortality pattern

From 2014 to the end of 2018, between 30,000 and 50,000 people died in Spain each month, more in the winter, especially during the flu season, and fewer in the summer, except for periods of intense heat.3

The same was true from January to June 2019.4

The mortality monitoring page of the Instituto de Salud Carlos III in Madrid5, the equivalent of the Robert Koch Institute in Berlin, has been providing the corresponding data since December 2019, but the graph shows daily deaths. The monthly figures as comparable data can be determined by using the database provided in .csv format.6

The data is updated and corrected daily, even after 5 weeks.7.

Thus, at the end of May 2020, there was an extraordinary delayed reporting of approximately 12,000 deaths.1



2.2. Deaths in Spain between February and the end of May 2020

As can be seen on the mortality monitoring page of the Instituto de Salud Carlos III7 and is also particularly clear from the European Mortality Monitoring (EuroMoMo) charts8, mortality has been unusually low this flu season, unlike the 2016/17 and 2017/18 flu seasons.

Sterbegeschehen Spanien Woche 20-2020


(https://www.euromomo.eu/graphs-and-maps/, updated every Thursday; diagram for Spain, bulletin week 20/2020, consulted on 15/05/2020)

Particularly striking, however, is the occurrence of deaths in the period between 13 March and 22 May, 2020.9

It can be assumed that this anomaly is due to the new virus, and I will try to place it in the context of the general mortality pattern in Spain by comparing it on the one hand with the mortality pattern during the flu seasons, and on the other hand with some other, constantly present causes and courses of death.

Mortality at times of flu and COVID

March and April 2020 are both months with well over 50,000 deaths, which did not occur even in previous strong flu epidemics.

So-called excess mortality, the difference to long-term averages for this time of year14, is almost 41,000 people for the four-month period.

What is striking is the concentration of excess mortality in a relatively small period of only 10 weeks, the extreme steepness of the curve.

Looking at this four-month period, which is common for influenza epidemics, independent of what is common for the time of year, the number of deaths is 6 % or about 10,000 people higher than in the 2017/18 influenza epidemic, and 11% or about 17,300 people higher than in the 2016/17 influenza epidemic.

Regardless of how it is viewed or presented, this is an unusual phenomenon in terms of the severity of its progression and its timing in the year. In purely quantitative terms, too, it is no longer within the range of deaths during the 2017/18 influenza epidemic, when no extraordinary measures were taken, but 6% above it2 - following the delayed reporting of around 12,000 deaths at the end of May1.



---> Continue reading: Germany

Contents

1. Definition of the problem and summary

1.1. Definition of the problem

1.2. Summary


2. Spain

2.1 General mortality pattern

2.2 Deaths in Spain between February and the end of May 2020

Table 1: Monthly deaths (all causes) in Spain at times of influenza and COVID-19


3. Germany

3.1 General mortality pattern

3.2 Deaths in Germany between January and the end of April 2020

Table 2: Monthly deaths (all causes) in Germany at times of influenza and COVID-19


4. The usual "background" mortality patterns in Spain and Germany
compared to deaths with COVID-19


5. Open questions


6. Personal follow-up comments in May 2021


7. Sources


8. Materials




Download this page as PDFDownload als PDF

Download all pages in English as PDF
Download als PDF
52 pages, 800 KB

I appreciate hints on errors and suggestions for improvement:
r_a_wagner@gmx.de