The first wave of Covid-19 resulted in an excess mortality of 206,000 deaths in 21 industrialized countries.

This is the conclusion of a large international study, published Wednesday, October 14 in the journal Nature, which attempts to establish an inventory of the real number of deaths during the health crisis between the end of January and the end of May 2020.

The study not only counts deaths from Covid-19, but tries to estimate the number of those, all causes combined, that would not have occurred had there not been a pandemic.

They may be people suffering from other serious illnesses who were unable to access adequate care for lack of space in the hospital, or victims of domestic violence during confinement, or even the increase in the number of suicides in frail people.

Better indicator than the number of deaths attributed to Covid-19

To reach their conclusions, this team of researchers, headed by scientists from Imperial College London, developed a mathematical model which, based on the annual number of deaths since 2015, made it possible to estimate how many people would be died during the first four months of this year if there had been no health crisis.

This number was then compared to the reality of the situation in the 21 countries analyzed (19 in Europe, plus Australia and New Zealand).

“Estimating excess mortality is a usual exercise to assess the real effects of influenza epidemics or extreme weather events, for example,” notes Kevin McConway, researcher in applied statistics at the Open University of Milton Keynes (UK), when interviewed by the British site Science Media Center.

It is above all, according to him, a much better indicator of the consequences of the pandemic than official statistics.

“First of all, it makes it possible to take into account the indirect consequences and, above all, it gives rise to more relevant comparisons between countries”, underlines Majid Ezzati, researcher in environmental health and principal author of the study, contacted by France 24. The way of counting deaths due directly to the coronavirus varies, in fact, from country to country.

Some states, such as Belgium, have thus taken into account the cases of people who were only suspected of having been infected, while others have had much more restrictive definitions for their count.

According to the study, the countries that experienced the highest excess mortality during the first wave are Spain (38% more deaths linked to the pandemic), England and Wales (37%).

“The case of England is particularly striking because it highlights the serious consequences, in times of pandemic, of the degradation of social protection and the lack of modernization of health infrastructures, which have been neglected by the government, too busy with the Brexit ”, estimates Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine and co-author of the study, contacted by France 24.

France, a case apart

France is, with Belgium, a special case.

These are the only two countries where the official total of Covid-19 victims is ... higher than the excess mortality calculated by researchers.

This apparent inconsistency is explained: “This may be due, in part, to the fact that a number of people counted as victims of the virus would probably have died anyway during this period, due to co-morbidities, and are therefore not not taken into account as excess deaths in our model ”, emphasizes Majid Ezzati.

In some countries, the first wave even resulted in fewer deaths than if there had been no pandemic.

Thus, the authors of the study came to the conclusion that in Bulgaria there were 1,110 fewer deaths than projected, based on trends over the past five years.

The findings are similar for Australia and the Czech Republic. 

Again, this is not a miscalculation: the health situation has prevented a certain number of deaths which occur in more normal times.

“In these countries, there has been a low rate of infection to which has been added the fact that social distancing measures have probably reduced the number of infections with other viruses, such as the flu.

In addition, travel restrictions could, for example, have a positive effect on the number of traffic accidents ”, analyzes Majid Ezzati.

However, we must be careful not to conclude that this pandemic would have been “beneficial” for these countries.

“We do not yet know what are the medium and long term effects of measures such as confinement, the economic cost of which [loss of jobs, income, etc., Editor's note] can have serious health consequences”, underlines the author principal of the study.

“Containment proves that other policies have failed”

This comparison work carried out nevertheless has its limits.

Thus, some important nations are missing, starting with the United States and Germany.

“Of course, we would have liked to have data for these countries, as well as for Greece or South Korea, which would have enabled us to refine our conclusions,” recognizes Majid Ezzati.

But for the United States, the country which has recorded the most deaths since the start of the pandemic, “the wide variety of health policies implemented and the way in which information was collected in the different states made it difficult to obtain data. unified ”, emphasizes Martin McKee.

Same problem for Germany with its 16 Länders.

“I don't think, however, that this fundamentally changes the picture that emerges from our study,” says Majid Ezzati.

Overall, the countries that fared best during the first wave were those that were able to quickly put in place an effective policy of testing and tracing contact cases, as “was the case in Denmark. ”, Note the authors of the study.

States with well-funded health systems also went through this period, recording far fewer deaths from all causes.

This is particularly the case with Austria, which has nearly three times as many hospital beds per capita than the United Kingdom.

The use of containment, if it was useful during the first wave, “must remain the solution of last resort,” says Martin McKee.

“This is a sign that other policies have failed,” adds Majid Ezzati.

For him, the lesson of the first months of the pandemic is that beyond the emergency measures to be taken to face the second wave, it is imperative to “focus on long-term investments in health systems. national ”.

And above all, to avoid trying to save money on the backs of hospitals when it comes to reducing deficits again.  

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