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Factfind: Has Ireland experienced 'excess mortality' since the start of the Covid-19 pandemic?

Several posts on social media have tried to play down the need for lockdowns by pointing to excess deaths.

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IN THE ONGOING discussion about the impact the Covid-19 pandemic has had on Ireland, one question raised is whether we have seen excess deaths due to the virus.

The question can be part of discussions or debates around the impact of or need for measures such as lockdowns. But the answer to this question – whether Ireland has experienced an excess death rate over the pandemic – is not without complications.

However, that has not stopped people assuming it’s already been answered, or that it is possible to make a definitive statement about excess deaths during certain periods over the past twelve months.

For example, a post shared recently on Twitter claimed that Ireland did not experience an excess number of deaths during the winter months despite the effects of the Covid-19 pandemic.

The post stated: “Irish Covid deaths in the winter have been substantial and yet no excess deaths.”

The claim was accompanied by two graphs shared as part of the post, one of which was taken from a Danish-based statistics website which estimates Europe’s excess mortality. 

The graph appeared to show that deaths in Ireland over the winter were within what the website’s algorithm described as a “normal range”.

However, this tweet is an example of how it is difficult to make definitive claims. An updated version of the chart – seen on the same website just two weeks after the claim was made – shows a spike in deaths outside the “normal range” early in 2021.

The post on Twitter was not the first time since the beginning of the pandemic that someone has claimed that Covid-19 is not causing excess mortality – that is, a higher number of deaths than could be expected in a ‘normal’ year – in Ireland.

Yesterday marked the one-year anniversary of the first death in a person who was diagnosed with the virus, and thousands of other deaths have been reported in the twelve months since.  

As part of this series, we have previously looked at claims about whether these deaths have contributed to excess mortality in Ireland herehere and here.

Often, such claims seek to downplay concerns about the virus by suggesting that it is less dangerous than the government, health officials and the media are making out.

That suggestion could then be used to bolster arguments that public health restrictions – including shutting down parts of the economy – are unnecessary.

But claims which rely on this logic fundamentally misunderstand the effect of national lockdowns on mortality rates and ignore what would happen if no restrictions, or less stringent restrictions, were in place and the spread of Covid-19 went unchecked. 

And like the poster on Twitter, claimants occasionally use incomplete data on registered deaths in Ireland to suggest that Covid-19 is not leading to excess mortality here.

The topic is complicated and one that is likely to continue cropping up, so let’s look at:

  • How excess mortality is calculated;
  • What impact Covid-19 and lockdowns are having on mortality in Ireland, and;
  • Whether it is fair to use excess mortality to argue against restrictions.

Counting excess deaths

Although its use has featured in a number of claims about the Covid-19 pandemic, the term ‘excess mortality’ is not a new one. 

It has long been used by epidemiologists and public health experts to examine whether the number of deaths from all causes during a period of crisis is above what would have been expected if that crisis had not occurred.

Crucially, this means that one should not see attempts to measure excess mortality during the pandemic as counting the excess number of deaths solely due to Covid-19.

Excess mortality does not distinguish why there are more deaths, so could theoretically include things like a higher number of road traffic accidents or more instances of people having accidents at home.  

In Ireland, where there are generally between 2,000 and 4,000 deaths each month, hundreds of additional deaths due to Covid-19 were reported at various stages of the pandemic.

One might imagine you could reasonably assume that these deaths would not have occurred if there was no Covid-19, and therefore say that the pandemic led to an excess number of deaths.

But this is not how measuring excess mortality works, particularly as the number of people who die each year – or at certain points within each year – is not stable.

Deaths from other causes may actually decrease as a result of public health measures implemented to stop the spread of Covid-19; for example, if fewer workplaces are allowed to open, there may be a reduction in workplace accidents.

Estimating excess mortality is also complicated because looking at the number of deaths that would have occurred if there was no crisis is an attempt to examine what would have happened in a hypothetical scenario. In other words, the true figure cannot be known.

However, there are still several ways of examining whether the number of deaths in a crisis is significantly above what would have been expected in ‘normal’ circumstances.

One approach is to count the number of deaths over a certain length of time during the crisis and to compare it to the average number of deaths during the same length of time over previous years.

For example, one could look at the total number of deaths in Ireland in April 2020 and compare the figure to the average number of deaths in April each year from 2015 to 2019. 

All methods have their limits, and there are some general statistical pitfalls that should be avoided when looking to measure excess mortality.

These include measuring a length of time that is too short, too long, or which gives a snapshot of one period of the crisis that misrepresents the bigger picture.

Comparing deaths in Ireland during June 2020 to those in June each year from 2015 to 2019 likely won’t reveal much about excess mortality due to Covid-19, given that deaths caused by the virus were at a low point that month.

In contrast, a comparison of deaths in Ireland between January 2018 and December 2020 to those from January 2015 to December 2017 won’t reveal much about excess mortality as a result of the Covid-19 pandemic alone.

Registration of deaths

There are further issues associated with counting excess mortality in Ireland due to how deaths are registered.

The date associated with a death – from any cause – can refer to when a death occurred or when it was registered, but this could be impacted by things like the closure of registration offices on weekends or bank holidays.

The registration of deaths is a particularly problematic issue in Ireland – where a person’s death can be registered up to three months after they have died. In rare cases, it can take even longer if a coroner has to investigate a person’s cause of death. 

In a FactCheck carried out last September about the total number of deaths in Ireland last year, a government spokesperson told TheJournal.ie that deaths registered with the General Registration Office up to that point “do not represent the number of deaths which have actually occurred”.

The spokesperson explained that in a normal year, around 80% of deaths are registered within three months of the death occurring – so approximately 20% of deaths take longer to be officially notified.

Many people also experienced delays in registering the death of a loved one due to the Covid-19 pandemic. As a result, the measurement of excess deaths in Ireland during the pandemic is not a straightforward process.

Official counts

Despite these issues, initial attempts to gauge Ireland’s excess mortality as a result of the pandemic have been made at an official level.

Last November, the Central Statistics Office (CSO) – Ireland’s official statistics agency – estimated excess mortality during the pandemic using data from the website RIP.ie.

The website is dedicated to publishing death notices and funeral details in Ireland, and contains details about people’s deaths before they are officially registered. Given that the website partly functions as a way of notifying people about funeral details, it allows deaths to be monitored close to the time they occurred.

It’s important to clarify that the website has never previously been used as an official source to count deaths in Ireland, and the CSO explained that it used the website “experimentally” as part of attempts to monitor excess mortality in Ireland last year.

Issues around the length of time it takes for deaths to be officially reported in Ireland and other delays as a result of the Covid-19 pandemic caused the CSO to use it as a source. 

The statistics agency used the RIP.ie website to compare mortality figures on a monthly basis from October 2019 to September 2020 with figures from the same months from 2014 to 2019.

It found that there were between 876 and 1,192 excess deaths between March and September 2020. 

figure-1-analysis-of-mor Source: CSO

Similarly, the Health and Information Quality Authority (HIQA) also estimated last July that between 11 March and 16 June 2020, there were 13% more deaths in Ireland than there would have been if the pandemic had not occurred.

At the time, HIQA’s chief scientist Dr Conor Teljeur explained that the authority’s analysis was also based on death notices reported on RIP.ie since 2010.

He noted “clear evidence” showing excess mortality since the first reported death due to Covid-19.

“There were about 1,100 to 1,200 more deaths than we would expect based on historical patterns; a 13% increase between 11 March to 16 June,” Teljeur said.

HIQA also noted that it was possible that mortality “may have decreased for certain causes of death” during Covid-19 – which we will return to – but that it was not possible to examine that using the data from RIP.ie.

These are the only attempts by Irish authorities which have sought to count excess deaths as a result of Covid-19 to date. Unfortunately, they only deal with deaths in the initial stages of the pandemic and are based on an unconventional source of data.

The majority of deaths which have occurred in Ireland in people who have been diagnosed with Covid-19 have also happened since the CSO and HIQA and counts took place.

Since 1 August 2020, there have been almost 2,700 deaths in Ireland among people who have been diagnosed with Covid-19, compared to 1,763 deaths before that date.

While the CSO and HIQA have made initial attempts to estimate excess mortality due to the pandemic, these estimates have not yet been confirmed with the General Registry Office.

And with deaths still occurring as a result of Covid-19, it could be a number of years before it is possible to gauge whether the pandemic has caused excess mortality in Ireland.  

Unofficial sources

But one person has sought to provide more up-to-date data using the same source material as the CSO and HIQA.

UCC economist Seamus Coffey recently tweeted graphs which showed the level of notices being posted on RIP.ie from mid-October to late February, comparing the figure to averages during the same months from 2016/2017 to 2019/2020.

Coffey estimated that “excess postings” occurred from the middle of January onwards compared with those in 2017, 2018, 2019 and 2020:

EvJ9lg2XcAg8QG2 Source: Twitter/Seamus Coffey

This tallies somewhat with the increase in deaths as a result of Covid-19 during the first two months of the year.

The total number of deaths in Ireland due to the virus began to increase significantly from 11 January onwards, rising by 40% from 2,352 to 3,307 by 31 January alone.

Again, neither Coffey or RIP.ie are official sources and this estimate cannot be treated as such, but it does suggest a level of mortality higher than was seen here in previous years at the peak of the third wave of the pandemic.

Outside of Ireland, another source has also estimated levels of excess mortality here. 

EuroMOMO is a statistical project which regularly monitors mortality across Europe as part of attempts to measure excess deaths related to “seasonal influenza, pandemics and other public health threats”.

The project is run by the Statens Serum Institut, a state-owned research institute based in Copenhagen, which was founded with some funding from the European Commission.

EuroMOMO’s data is based on national mortality information registered in European countries which participate in its network, including Ireland. Its website features graphs for individual countries which show rates of mortality over time.

The graphs are presented as an index, where 0 represents an average and one can see whether mortality at a given time is above average (if the score is above 0) or lower (if the score is below 0).

One graph from EuroMOMO, mentioned at the top of this piece, was recently shared on Twitter, along with a question about whether there was any excess mortality in Ireland during the winter months.

Here is the graph that was shared in the tweet:

EuxGJDrXEAs-L1n Source: EuroMomo

A light blue bar on the graph, either side of the zero, indicates what is deemed to be the “normal range” (because the number of people who die at certain points in each year is not constant).

The graph does show a substantial spike in deaths during the first third of 2020 for Ireland. This tallies with the number of deaths in Ireland as a result of Covid-19 during the first wave of the pandemic.

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Yet no such increase is seen from the end of 2020 into 2021, despite the number of deaths as a result of Covid-19 more than doubling between December and the end of February.

But now, just over two weeks after it was shared, the version of the chart posted on Twitter is out of date.

An updated version of the graph, which we screen-grabbed on 9 March and which relies on data from the exact same period as the graph shared on Twitter, does show an increase in mortality above the ‘normal range’ in Ireland over the winter months.

This is particularly evident at the start of the year (to the right of the graph):

Grpahs2 Source: Euromomo

The number of excess deaths recorded on sections of the graph may yet climb higher, due to the way in which deaths are recorded in Ireland, which can take up to three months.

So claims which rely on this website – which do show high levels of excess mortality when deaths as a result of Covid-19 spike in Ireland – should also be treated with caution.

Fewer deaths

There are also several reasons why the pandemic may have caused fewer deaths from other types of mortality than in ‘normal’ years.

Public health measures at various stages of the pandemic have led to the closure of large sections of the economy at different times. This could lead to fewer workplace accidents, or fewer deaths as a result of night-time street assaults.

Here is a CSO comparison of mortality during the winter months in recent years (which it should be noted is also partly based on notices from RIP.ie):  

figure-3-comparing-morta Source: CSO

The figures compiled show that deaths in Ireland usually tend to peak in January, partly due to an increase in the spread of seasonal viruses at this time of year.

However, although a significant spike in deaths occurred due to Covid-19 in January this year, Ireland may see a fall in the number of other illnesses due to social distancing rules.

The HSE recorded no cases of seasonal influenza between last year and the end of February (the latest point for which data is available), noting that the pandemic has disrupted its transmission because public health guidelines are preventing its spread.

By way of comparison, almost 100 deaths were recorded as being due to the flu at the same point last year.

Other causes of death may also fall for similar reasons: vulnerable citizens were less exposed to all illnesses this winter, not just Covid-19.

So even though thousands of people may have died because of the coronavirus, the overall level of mortality may remain within a ‘normal’ range if social distancing has prevented deaths for other reasons.

This raises a further point about the effect of all lockdowns that have occurred since last year.

It is important to note that although more than 2,000 people died between December and February due to Covid-19, the number of deaths was likely lower than if there had been no lockdown at all.

Due to avoiding contact with others, the vast majority of people did not catch the virus. Therefore they did not become seriously ill with Covid-19 or pass it on to someone else who could become seriously ill themselves.

As the effects of the post-Christmas lockdown took hold, case numbers began to drop. In the months since, the number of confirmed cases and deaths have continued to fall.

This is how viruses work: they spread in wider society when more people are in contact with each other. Case numbers fall when people are not in contact with each other.

The same pattern was evident last year, when cases and then deaths began to fall between March and May (during the first national lockdown) and between late October and December (during the second national lockdown). 

When Covid-19 spreads unchecked, it passes on to a significantly greater proportion of the population, some of whom get seriously ill and die. In such a scenario, hospitals and intensive care units approach or reach capacity,

The surge that Ireland experienced after Christmas showed this: as people socialised over Christmas – when restrictions were eased – they spread Covid-19 to others, sometimes dozens of people. This led to case numbers here not seen since the start of the pandemic.

The knock-on effect was high case numbers, more deaths, and hospitals and ICU wards approaching capacity.

Ultimately, lockdowns have played a part in keeping the total number of deaths last year lower than they would be had they not been implemented.

With case numbers now falling – as they did in the latter part of previous lockdowns – this is now evident again.

Contains reporting from previous FactChecks by Órla Ryan and Lauren Boland.

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There is a lot of false news and scaremongering being spread in Ireland at the moment about coronavirus. Here are some practical ways for you to assess whether the messages that you’re seeing – especially on WhatsApp – are true or not. 

STOP, THINK AND CHECK 

Look at where it’s coming from. Is it someone you know? Do they have a source for the information (e.g. the HSE website) or are they just saying that the information comes from someone they know? A lot of the false news being spread right now is from people claiming that messages from ‘a friend’ of theirs. Have a look yourself – do a quick Google search and see if the information is being reported elsewhere. 

Secondly, get the whole story, not just a headline. A lot of these messages have got vague information (“all the doctors at this hospital are panicking”) and don’t mention specific details. This is often – but not always a sign – that it may not be accurate. 

Finally, see how you feel after reading it. A lot of these false messages are designed to make people feel panicked. They’re deliberately manipulating your feelings to make you more likely to share it. If you feel panicked after reading something, check it out and see if it really is true.

TheJournal.ie’s FactCheck is a signatory to the International Fact-Checking Network’s Code of Principles. You can read it here. For information on how FactCheck works, what the verdicts mean, and how you can take part, check out our Reader’s Guide here. You can read about the team of editors and reporters who work on the factchecks here

Have you gotten a message on WhatsApp or Facebook or Twitter about coronavirus that you’re not sure about and want us to check it out? Message or mail us and we’ll look into debunking it. WhatsApp: 085 221 4696 or Email: answers@thejournal.ie

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