"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)
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
(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.
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
1. Definition
of the problem and summary
1.1. Definition of the problem
1.2. Summary
4.
The usual "background" mortality patterns in Spain and Germany
compared to deaths with COVID-19
6. Personal follow-up comments in May 2021
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I appreciate hints on errors and
suggestions for improvement:
r_a_wagner@gmx.de
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