Five times higher mortality in July than expected for that month

by Lorraine Williamson
higher mortality rate

MADRID – The Carlos III health institute calculates nearly 10,000 more deaths than expected in July. Of these, 2,124 deaths are due to high temperatures.  Moreover, this is a far higher mortality rate then previous statistics

In July 9,687 more people died than expected in Spain. That is the ‘excess mortality’, an estimate of the total number of deaths in a given period above the expected number of deaths. This is five times the July average (1,844) since the institute ISCIII collected the data in MoMo (the daily all-cause mortality monitoring system) statistics. 

In other words, nearly 41,000 deaths were recorded in July, 20% more than the average for that month. Some of the additional deaths are explained directly or indirectly by the heat (2,124), others are caused by the seventh wave of Covid (1,872 based on preliminary data). That means there are thousands more unforeseen deaths for other reasons. About what those reasons might be, there are more hypotheses than certainties. 

The vast majority of deaths are attributed to very old people 

ISCIII sources acknowledge to El País that the calculations are above expectations. They explain that the vast majority are attributed to very old people, especially those over 85 years of age. But also between those 75 and 85 years of age. However, the exact causes may not be known or be attributed to a single specific reason. 

The heat of these weeks, the covid, the indirect effects of the pandemic such as social health, less access to the health system due to health problems or anxiety, and the isolation that many elderly people have suffered affect the vulnerability of people about all of the above. Estimates like these should be “handled with caution and data studied,” according to the same sources. 

Unrivalled in other European countries 

Today it is not possible to pinpoint the exact causes of these deaths. More about this will be published next year by the national statistical office INE. Epidemiologists consulted by El País do agree that this is a very striking figure. Moreover, it is unparalleled in other European countries.  

Heat and covid clear factors 

The two most obvious differential factors compared to other summers are extreme heat and covid. But their sum doesn’t explain the 10 times more deaths than in 2019, to give an example. Despite the impact of heat waves, the vast majority of temperature-related deaths throughout the year are related to the cold. In July, however, the excess mortality was at the same level as the worst winters, not counting the very exceptional months of March and April 2020, when the coronavirus caused excess deaths of 25,000. 

nederlandse orthopeed

Heat explains only a fifth of excess mortality 

Hicham Achebak, a researcher specialising in climate and health at ISGlobal, as other specialists consulted, is surprised that the excess mortality is now so high and that the heat explains only a fifth of it. “These are estimates that need to be consolidated. Maybe the system isn’t as robust or it doesn’t properly measure deaths from temperatures,” he reflects. 

Covid as a co-cause of excess mortality 

The other suspected cause of death, covid, also doesn’t explain so many deaths. Preliminary data from the ISCIII currently records 1,872 deaths from coronavirus in July. Although the month is over, the institute will continue to add deaths due to delays in notifications for weeks to come. Yet it would then be hundreds and not the thousands that would be needed to explain this excess mortality. 

Five hypotheses to explain excess mortality 

Salvador Peiró, research director at the Fisabio foundation, has been thinking about these figures for some time, which were already above expectations with 4,404 deaths in June. More than 10 times higher than the monthly average. 

He sees five hypotheses. The first is that many covid deaths have not been counted, something that seems “highly unlikely”. On the contrary, deaths of people entering the statistics due to covid had a positive PCR, but the disease was not the sole or leading cause of death. 

Deferred care 

Peiró’s second hypothesis is that people are dying as a result of the long-term lack of control in the treatment of chronic diseases and the low detection rate of cancer in the past two years. “It could explain some of the excess mortality, but not all. And it should be accompanied by an uptick in emergency hospitalisations due to chronic conditions,” he says. 

Models may not suffice 

The third and fourth hypotheses have to do with the fact that the MoMo does not measure the excesses well. “They are models and they are probably not built for such a prolonged heat wave,” says the epidemiologist. He also thinks it might be underestimating mortality in general, beyond temperatures. “But I checked the model and it seemed correct. I don’t know if it could have any effect, but not that much,” he says. 

A mix of previous factors 

The fifth hypothesis, which is perhaps the most plausible to him, is a mixture of all the previous ones. “But a lot of people have died in two years. Sick people, very old people who, without covid, would probably have died of non-covid causes in the months after their death anyway. 

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