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Covid-19 deaths may have been overestimated, Hiqa report finds

Leo Varadkar said the findings are “interesting but not a surprise” because of how deaths related to the virus are counted.

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Updated Jul 3rd 2020, 2:13 PM

THERE WAS A 13% increase in deaths in Ireland between March and June but Covid-19 deaths may have been overestimated, a new report by the Health Information and Quality Authority (Hiqa) has found.

The report examined the number of excess deaths that occurred over a three-month period during the Covid-19 pandemic. 

The document, which can be read here, assessed the number of deaths that occurred in Ireland from 11 March to 16 June, relative to the expected number of deaths, using data from the death notices website RIP.ie.

It found that the official number of Covid-19 deaths reported may be an overestimate – something Tánaiste Leo Varadkar said was “not a surprise” given how deaths related to the virus are counted. 

There were about 1,100 to 1,200 more deaths than would be expected based on historical patterns – a 13% increase between 11 March and 16 June, the report notes.

Excess deaths peaked by 33% over a six-week period from 25 March to 5 May. During this period, there was an increase of 1,200 deaths from expected figures, with 1,332 Covid-19-related deaths officially reported.

‘Interesting but not a surprise’ 

Hiqa’s Chief Scientist, Dr Conor Teljeur, said the analysis shows “clear evidence of excess deaths occurring since the first reported death due to Covid-19 in Ireland”.

“However, the number of excess deaths is substantially less than the reported 1,709 Covid-19-related deaths over the same period.”

Hiqa found that the official number of reported Covid-19 deaths likely “overestimates the true burden of excess deaths caused by the virus”.

The report states that this could be due to the inclusion within official figures of people who were infected with the virus at the time of death whose cause of death may have been predominantly due to other factors.

Speaking to RTÉ’s News at One, Teljeur said the official figure of 1,709 is likely “an accurate estimate”.

“It may be a slight overestimate, but it is likely to be an accurate estimate. Excess mortality, it has a limitation that doesn’t necessarily fully state the burden of Covid-19 on mortality.

“So excess mortality is trying to contrast the number of deaths that were observed with the number that were expected. And as some of these people were expected to have died during that period, then they don’t count towards the excess mortality.

“But the reality is, they did die because of Covid-19, and it therefore contributes to the overall mortality and we need to count that correctly.”

Varadkar today said the report’s findings are “interesting but not a surprise“.

“In Ireland we counted all deaths, in all settings, suspected cases even when no lab test was done, and included people with underlying terminal illnesses who died with Covid but not of it.”

Varadkar added that this was the “right approach but skewed the numbers”, saying the priority was “to save lives, not look good in league tables”.

The number of Covid-19 deaths confirmed by the Department of Health every day are deaths “related to” the virus and other factors may have played a role in the person’s death. You can read exactly how Covid-19 deaths are counted in Ireland here

Lasting impact 

Teljeur said in the last four weeks of the analysis, there were fewer deaths than expected.

However, in a statement he added that the changes to healthcare delivery during the pandemic, such as the suspension of elective activity in public acute hospitals, “may have a lasting impact on health outcomes, the effect of which may take years to be seen”.

On the News at One, he elaborated on this and said: “It may be years before we see the impact of the deferred healthcare. And it may be quite difficult to determine the impact, unless we look back in maybe two, three or even five years’ time.”

Teljeur said Ireland ranks mid-table when it comes to mortality in the 23 countries that are part of EuroMOMO, a European mortality monitoring project.

“Ireland is roughly mid-table from the countries that are participating in that. But what’s very important to note is that our excess mortality is much closer to the lower mortality countries than the higher mortality countries.

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“So, it tends to suggest that our mortality, or excess mortality has not been particularly high, which is a reassurance because it suggests that all the control measures and all the efforts that have been put in place to try and minimise the impact of Covid-19 have been quite successful.

“As long as people continue to adhere to control measures such as wearing masks and social distancing, hopefully we can continue to suppress the disease and minimise the impact on mortality.”

Hiqa’s analysis has been provided to the National Public Health Emergency Team (NPHET) to inform the national response to the virus.

The report notes that while the data from RIP.ie “would appear to accurately represent true overall mortality patterns, there are limitations”.

“These include the lack of data on age and sex, and the lack of reliable information on county of residence. Monitoring of excess mortality would benefit immensely from more timely availability of official death registration data.”

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Órla Ryan

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