Sunday, 30 August 2020
The care homes of Belgium suffered an excess mortality of 86% during the early weeks of the coronavirus epidemic, according to a report compiled for the prime minister by two Brussels academics.
The 130-page report, obtained by The Brussels Times, was drawn up by Professors Raphaël Lagasse of the ULB, an epidemiologist, and Patrick Deboosere of the VUB, a statistician, at the request of prime minister Sophie Wilmès.
In it, the two academics delve into the figures available to evaluate the impact of Covid-19 in Belgium.
Among its most striking conclusions is the fact that the virus may have been present in Belgium as early as January; that Belgium is not in fact the country with the most deaths per capita; and that the care homes across the country suffered more than anyone has hitherto imagined.
Taking the last point first, the report dismisses the simple death count noted at the time, instead referring to the figure – more reliable from an epidemiological point of view – on excess mortality.
Excess mortality means simply the number of deaths reported in a given period, compared to the number of deaths that would be expected for the period, based on the figures from previous years.
The report takes an average for 2018 and 2019 of deaths according to age and sex, for the population in general (GP) and for those aged 65 and over in care homes (NH). For those over the age of 90, the difference for both men and women is slight: NH is 1.4 times higher than GP for men and 1.5 times for women.
The ratio increases the younger the age group, with NH finally reaching 7.7 times higher for men aged 65 to 69, and 9.6 times for women of the same age.
In other words, the excess mortality is almost ten times more among women aged 65-69 in care homes than among their contemporaries in the population as a whole.
When it comes to the period from the start of week 11 (9 March) to the end of week 20 (May 17) this year, however, the ratio of NH to GP varies significantly by age, as follows:
For men aged 65-69 – 15.3; aged 70-74 – 13; 75-79 – 9.8; 80-84 – 7.2; 85-89 – 4.1; over 90 – 2.4.
For women aged 65-69 – 16.7; aged 70-74 – 17.2; 75-79 – 10.6; 80-84 – 6.6; 85-89 – 4.0; over 90 – 2.3.
In total, during that period of ten weeks, 681 deaths took place among men aged over 65 in the general population, compared to 3,313 in care homes. Among women over 65 in the general population, 447 deaths were recorded. In the care homes, on the other hand, 2,070 deaths were recorded.
On the second point, the data appear to show that SARS-CoV-2, the coronavirus that causes the disease known as Covid-19, was present in Belgium, and specifically the care homes, even before the first known victim showed up in Belgium.
That conclusion, again, is based on epidemiological evidence on the rate at which the disease develops and spreads.
“A detailed analysis of the figures, week by week, shows that the virus caused excess mortality a little faster in retirement homes,” the authors point out.
“From an analysis of reports and what appeared in the press, we have a strong suspicion that the virus was already in our country on January 15. There are clinical reports of people in hospital needing to be ventilated or even in a coma.”
These, they explain, are typical features of the virus, as well as the immune system overreaction also reported.
“This suggests that the infection was probably present there from the start of the epidemic. The measures taken in the week of March 9 were already too late for many institutions.”
Finally, the question of Belgium being placed top of the list for deaths per 100,000 population has already been addressed by the health institute Sciensano.
Put briefly, their response was that Belgium counts deaths presumed to be Covid-19 based on symptoms, even when the diagnosis is not confirmed by a test. Other countries only tally deaths where Covid-19 is confirmed.
The same conclusion is reached by the report, using excess mortality figures. In general, the death toll reported day by day matches well with the excess mortality figures. On this point, Belgium’s reporting seems to have been more accurate that some other countries, where the excess mortality is far higher than the number of deaths attributed to Covid-19.
Belgium’s excess mortality places it in the middle of a table of 10 European countries, with four countries having a higher death rate: Scotland, Italy, Spain and England/Wales (Scotland, Northern Ireland and England/Wales report separately).
The Brussels Times