Health in times of corona: CBS celebrated

The article below is an adaptation of a part of the CBS report Health in times of corona (cbs.nl). Virusvaria attaches great importance to the theme of 'excess mortality'. However, the explanation of CBS is of such a nature that the editors of virusvaria had to make some corrections before informing their readers about this. Of course on the basis of exactly the same figures. What you read below is therefore not the explanation of Statistics Netherlands but an analysis of the figures by virusvaria. Feel free to put both pieces next to each other to see the differences and judge for yourself.

In addition to being a policy crisis, the corona crisis is also a health and information crisis. The fear of a pandemic has gripped the world for almost two years now. Policymakers and health advisors complain about the fact that the figure that they themselves have elevated to a key figure is not known. Their key figure is knowing "how many people are infected or have been infected". This remains a source of discussion, despite the fact that infections have not had a correlation with pressure on healthcare, serious illness or mortality for some time. The 'infection rate' depends mainly on the number of people who have been tested. This can vary greatly from country to country, from region to region and over time. Also, a positive test indicates whether someone has been in contact with the virus but not whether someone is 'infected', let alone whether that person becomes ill from it. (Think of an object: a table surface can also be 'contaminated' but does not get sick from it and does not have to be 'contagious'.). To know exactly how many people have died from COVID-19, we look at the cause of death. The excess mortality therefore does not give any indication of how many people have died due to corona, the vaccinations or the consequences of the lockdowns and other measures, respectively. From this point of view, the mortality figures are explained below.

Excess mortality due to corona, measures and/or vaccinations

In the cold months of the year (roughly from mid-November to mid-April), more people die on average than in the rest of the year. If there is a cold or there is a lot of flu, mortality rises above 'normal' mortality. This is called excess mortality. This happened, for example, in 2018, when a long-lasting flu epidemic occurred. In eighteen weeks, more than 2,500 more people died from the flu than what has been normal for that period in the last five years ('normal' is 6,500 more than expected). After a period of excess mortality, mortality is usually lower than normal for that period.

In 2020, there was excess mortality due to the COVID-19 outbreak. In the first nine weeks of the coronavirus pandemic, excess mortality was estimated to be nearly 9 thousand people, i.e. almost 2,500 more than the average over the past five years. This is about the same as during the flu epidemic in 2018, but the number was now reached in only half the time. This does not necessarily say anything about the severity of the disease, because a faster spread due to a higher infectivity has the same effect. The curve then peaks higher and is over faster. Worldwide, we see steep, short-term peaks that indicate this.

The highest point in the Netherlands was reached in the first week of April, when more than 5 thousand people died, more than 2 thousand more than normal for that period. The coronavirus pandemic only started in the second week of March, while the period of excess mortality during the flu epidemic in 2018 already started in the penultimate week of 2017. Due to the lower infectivity, the curve was longer and flatter: it took thirteen weeks before the highest point (over 4 thousand) was reached.

The first wave of the coronavirus pandemic in 2020 was followed by a period of lower mortality (yellow shading). Since mid-May, mortality has fluctuated around 2,600 per week. At the beginning of August, for the first time in 13 weeks, there was some excess mortality related to the heat wave. In the second week of August, 3.2 thousand people died as a result.

From mid-September 2020, mortality rose again. There had been excess mortality since the end of September. This continued until mid-January of 2021.

Substantially higher mortality after March 2021

In the first weeks of 2021, the considerable excess mortality disappeared and even, in mid-February-mid-March, briefly dipped below the expected level. After a period of high mortality, this can be explained as the influence of undermortality. However, the lower mortality lasted only 1 month. In mid-March, the mortality rates went up again; The reduced mortality - which lasted remarkably short given the substantial excess mortality that preceded it - therefore became invisible.

As of April 2021, mortality remained structurally above the expected level for the rest of the year (yellow shading). The light blue area indicates the fluctuation margin within which mortality should fluctuate. The peaks and troughs should more or less compensate for each other. Especially in the spring and summer months, it is therefore very unusual for actual mortality to fluctuate structurally above expectations. The only exception was a small dip in mid-June.

From July 2021, mortality will even fluctuate above the fluctuation band

After that, mortality continued to rise. From the end of July 2021 (during the summer!), mortality even exceeded the upper limit that is used as the 'excess mortality limit' in a regular mortality pattern (blue shading). From mid-October, mortality suddenly started to rise even faster.

This could be due to the arrival of the autumn/winter season, were it not for the fact that the reported covid mortality also lags far behind the observed general mortality in this period. The period of excess mortality will last until the end of 2021. In the first weeks of 2022, mortality is lower than originally expected. This also indicates an influence of undermortality from the large mortality that took place shortly before.

After a period of persistent higher mortality, a period of lower mortality is common. This depends on the age of the deceased. If they are elderly people who would otherwise have died within six months to a year, this is quickly reflected in lower mortality rates in the following months and also in the flu wave of the following year. If, on the other hand, it is mainly people in their thirties, for example, there will be no clear undermortality during this period. Undermortality therefore only refers to the deceased elderly, while excess mortality relates to all age groups.

WLZ users

FromWLZGivesstraightcare for insured persons who are permanently dependent on 24-hour care in the vicinity or permanent supervision because of their condition(s) or limitation(s).

These are largely elderly and vulnerable. It is good to see that the undermortality there continues for longer, so it does not stop at the end of March. The fact that the total figures for the entire population can be presented as "normal" again from March onwards is therefore due to higher mortality in the other groups.

The undermortality among long-term care users masks what happened to the rest of society in the spring of 2021, starting with April.

Age groups 0-80

The line over eighty shows almost the same picture as that of long-term care users, both 'cohorts' overlap. Therefore, only the groups under 80 years of age are listed below. Traditional reporting uses cohorts 0-65 years, 65-80 and 80+. In a highly age-discriminatory disease such as Covid, 0-65 is defined too broadly: after all, interesting subgroups can be distinguished within that group. However, this would provide a more complex picture for the reader. For the sake of scientific consistency with previous reports, CBS also adheres to the usual generalisation.

In the 65-80 age group, mortality in the whole of 2021 was above expectations, with several peaks above the fluctuation margin. One exception in week 9: there were six(!) fewer deaths than the expected 975. In April-May, there is a clear excess mortality (above the fluctuation margin). The corona wave from October shows great similarities with that of 2020, despite the largely vaccinated population.

Mortality in the age group 0-65 years has also been structurally elevated since March 2021 and has not fallen to the expected value, even in the summer. An explanation for this could be found in the causes of death.

The earlier claim "In the weeks that followed [after mid-January 2021, ed.] there was no excess mortality" is misleading in that sense. There was indeed excess mortality in those weeks. This is not reflected in the averages because of the considerable undermortality in the 80+ group, which was previously severely affected.

Both compared to 2020 and compared to previous years, there was an extremely increased mortality in 2021. Even after deducting covid mortality and an occasional heat wave, a large part of that mortality remains unexplained in a year in which all kinds of things have happened to the population.

If COVID is still determined as the dominant cause of death, this indicates insufficient effectiveness of the vaccines. The decision to urge vaccination would then possibly be seen in a different light.
If, on the other hand, the vaccines did offer significant protection against Delta and we can therefore disregard them, it remains unknown which disease caused the death. To avoid further confusion about this, the causes of death will only be made available in plausibised reporting form, edited by RIVM and Statistics Netherlands, both under the auspices of the Ministry of Health, Welfare and Sport. The state interest prevails here over parliamentary questions, WOB requests and court rulings.

Editor's note: extremely increased mortality, no 'excess mortality' according to CBS

We consider it essential that the links between possible influences on health on the one hand and mortality rates on the other are thoroughly mapped. An interpretation such as that given by CBS does not help with this.

CBS, like the RIVM, seems to want to use the term "excess mortality" as "mortality that falls outside the fluctuation margin". However, this definition can only be used in the case of a regular fluctuation around the zero line of expected mortality. This is clearly not the case in 2021: mortality fluctuates around the upper limit for much of the year. As long as this is not explicitly established, we should not expect anything from statements from the government.

Increased mortality now appears to be re-emerging in week 11 of 2022. We are heading towards spring and summer again. There is no Covid, but there is some flu. In any case, this should not continue in April.