Why does Belgium have so many Coronavirus deaths?

Why does Belgium have so many Coronavirus deaths?
Illustration image from 2020. Credit: Belga

Belgium, with roughly 11.5 million inhabitants, has recorded the most deaths as a consequence of the coronavirus (Covid-19) per capita, but how did that happen, and can all figures be compared to other countries?

On Monday, the total number of deaths in Belgium since the beginning of the pandemic reached 5,828, of which 47% occurred in hospitals. 52% of the deaths occurred in residential care centres, of which only 4% are confirmed cases, according to official figures. The other 96% of cases in the care centres are suspected, based on symptoms.

Unlike many other countries, Belgium also counts suspected coronavirus deaths that occur outside hospitals. Even though Belgian virologist Marc Van Ranst called this "dumb" in the past, and several politicians are concerned for the country's good reputation, the National Research and Public Health Institute Sciensano stands by this system.

“In a good recording system you take into account both confirmed and suspected cases,” said inter-federal Covid-19 spokesperson Steven Van Gucht of Friday 17 April. “That is good standard practice. Any system can overestimate or underestimate. That is inherent in a counting system," he said, adding that Sciensano is "not concerned in the least with our international rankings."

However, with 49.75 deaths per 100,000 inhabitants, Belgium has the highest mortality rate for the coronavirus, figures by the Johns Hopkins Coronavirus Resource Centre show on Monday 20 April, even putting the country ahead of Spain (43.77) and Italy (39.15), which both suffered heavily and earlier than Belgium.

“In Europe, no country counts like the others. We just have the most detailed method,” Federal Public Health Minister Maggie De Block told the television news channel LN24, when asked about the system.

After Belgium's National Security Council met on Wednesday, Prime Minister Sophie Wilmès also said that the government "made the choice of full transparency when communicating deaths" linked to the virus, even if it resulted in "numbers that were sometimes overestimated."

"Our way of counting is very complete, as we do not only count the cases in hospitals, but also those in residential care centres. Not only the confirmed cases, but also the suspected cases. Those suspected cases are very probable cases, and are registered by a doctor," Van Gucht said.

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"Belgium has one of the best healthcare systems in the world, as well as one of the best surveillance systems," said Van Gucht at the daily coronavirus press briefing on Monday, adding that it is useful to compare countries, but only if very close attention is being paid to what exactly is being compared. "Such as comparing hospital figures with hospital figures," he added.

Comparisons should only be made between comparable countries or region, said Van Gucht. "You have to take into account the population density and demographic structure of an area, so one can compare similar areas. In that comparison, it is also important to realise that not all areas or countries were affected in the same way at the beginning, when the measures were being taken," he added.

The suspected deaths are also being counted because not everyone can be tested. "We have not had enough testing capacity in the past to confirm all of them in the laboratory, but that does not mean that those cases are any less real," Van Gucht said, adding that we cannot afford to only paint half the picture of the situation just because we do not have enough tests.

"Additionally, more and more countries are starting to register and report cases outside of hospitals. At the moment, it is a bit too early to really make a global analysis, but this will be possible in a few weeks or months. Then you can start making analyses, and comparisons between countries that are scientifically correct," he said.

Maïthé Chini

The Brussels Times

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