Excess deaths in Ireland and beyond: what is behind the surge in mortality rates?

Mayo solicitor Pat O’Connor says he has never seen so many deaths in 30 years as a coroner as in the past few months.

He has just filed his figures for last month to the Department of Justice – 89 deaths were reported to him in January, up from 56 in January 2022, an increase of almost 60 per cent. The 1,008 deaths recorded in all of last year is almost double the 541 deaths recorded before the Covid pandemic, in 2018.

A similar picture is emerging nationally. Though the data can be sketchy at times, Ireland is experiencing a prolonged period of excess mortality.

The number of deaths across Europe last December was 27 per cent higher than expected, according to monitoring by the Economist, which also found excess deaths every month last year except January. A separate analysis by Eurostat for the first 11 months of 2022 also recorded excess deaths every month except January, peaking at 19.2 per cent in April.

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Economist Seamus Coffey, the first person to use online death notices to track trends in mortality, estimates excess death rates, before adjusting for population growth, at more than 10 per cent for the second half of last year, rising to about 23 per cent in December and 20 per cent in January.

An upcoming report from the Central Statistics Office is likely to confirm these estimates, while providing more detail, but for now it seems everyone has a story about the number of funerals they have been attending recently.

A similar trend has been observed in other countries. Last year there were nearly 40,000 excess deaths in the UK and, in the last two weeks of 2022, deaths were a fifth higher than the average from before the pandemic. Deaths in both Germany and Switzerland were up about 10 per cent on previous averages.

Excess mortality is the number of deaths beyond what would be normally expected. Because it looks at deaths from all causes, it can help show the true impact of an event, be it a pandemic or a war. It is one of the most important health statistics because it can show that something is wrong

According to the European Mortality Monitoring project (Euromomo) the number of deaths in the region has been larger than usual every month since June 2022.

The trend has surprised many scientists and led to some wild speculation. After all, shouldn’t death rates be falling in the wake of the Covid pandemic, which was particularly lethal for older age groups?

Excess mortality is the number of deaths beyond what would be normally expected. Because it looks at deaths from all causes, it can help show the true impact of an event, be it a pandemic or a war. It is one of the most important health statistics because it can show that something is wrong.

In trying to understand what is going on, it is important to remember that the surges in deaths now being seen in Ireland and other countries are a fraction of those that occurred at the height of the pandemic. In April 2020, for example, deaths jumped 37 per cent above expected levels.

The first and most obvious cause for the rise in mortality is the continuing circulation of Covid, a disease that did not exist before late 2019. Though vaccination and mutation has blunted its threat, the virus is still a significant cause of death in Ireland – there were 132 Covid-related deaths last November, 170 in December and at least 118 in January.

[ Varadkar to seek advice over number of excess deaths reported in recent weeks ]

However, Covid can only explain a fraction of the additional number of people dying. The rest arises from a wide variety of factors that may vary from country to country.

Across continental Europe, for example, last summer’s record heatwaves was blamed for an estimated 20,000 deaths. Deaths in Europe last July were 16 per cent above the expected average, according to Eurostat. Yet hot weather has never been a big contributor to deaths in Ireland and no spike was seen during last summer.

In Mayo, O’Connor is keeping an open mind about what is causing the extra deaths reported to his office. “The population in the county is getting bigger, and also older, and these are factors. But we’ve also seen the return of flu and other bugs, and I don’t think people are as hyper-conscious about hygiene as they were during the pandemic.”

As we have been learning, the pandemic’s malign influence spread far and wide. Not every death with Covid is a death from Covid. But equally, many non-Covid deaths arose from the pandemic and its impact on our wider physical and mental health.

In the US, for example, almost 100,000 more people a year died from non-Covid causes during the pandemic up to the end of 2021. High blood pressure and heart disease accounted for a third of these deaths. Alcohol-related deaths were up 12,000-15,000 on previous trends; homicide and road deaths combined were up 10,000; and drug deaths also rose.

When someone in their 70s or 80s dies, no one asks was there a delay in their treatment. It is only when they are young that it gets attention

—  Dr Fergal Hickey of the Irish Association of Emergency Medicine

Ireland experienced relatively low excess deaths during the height of the pandemic as the country locked down for long periods. Now, we may be reaping the whirlwind of all those missed medical appointments and lack of exercise. We are certainly running above average in the international rankings.

This winter, simultaneous waves of flu, Covid and other respiratory ailments have put health services across Europe under extreme pressure, leading to record attendances at emergency departments and record levels of hospital overcrowding. Flu has accounted for 127 deaths so far this winter, but we do not have official figures for other respiratory deaths.

Ireland is used to trolley crises, so delays in treatment have long been a factor in our death rates. For other countries this winter, hospital overcrowding was a relatively novel experience that many blamed, at least in part, for the rise in deaths.

In Britain, the Royal College of Emergency Medicine estimated that delays in emergency departments were leading to 300-500 additional deaths a week. Officials in the National Health Service rejected the estimate but the Economist estimated deaths due to healthcare delays at 260 a week, or a quarter of all excess deaths.

By a similar yardstick, hundreds of Irish patients have died this winter as a result of delays in receiving treatment, being infected while in a healthcare setting or missed diagnoses.

“There is silence around these patients,” says Dr Fergal Hickey of the Irish Association of Emergency Medicine. “They don’t have a voice. They already have medical conditions so the role of delays in treatment in their death seldom features in coroners’ investigations.”

“When someone in their 70s or 80s dies, no one asks was there a delay in their treatment,” he says. “It is only when they are young that it gets attention.”

The recent rise in deaths has been attributed by some online to Covid vaccines. Hashtags such as #DiedSuddenly trend on Twitter whenever a well-known person dies unexpectedly, despite the lack of any supporting evidence

Covid, though no longer directly responsible for large numbers of deaths, continues to cast a long shadow. One large US study found people who had been admitted to intensive care with acute Covid had a drastically higher risk of cardiovascular problems over the next year. But even people who had not been hospitalised showed an 8 per cent increase in the rate of heart attack and a 247 per cent rise in the rate of heart inflammation. Evidence points to Covid, also linked to lung and brain damage, permanently damaging some people’s health.

We also know that many people did not come in for screening or non-urgent treatment when the pandemic was at its worst, leading to conditions being missed. One in 10 expected cancers were undiagnosed in 2020, when many screening programmes were suspended.

The recent rise in deaths has been attributed by some online to Covid vaccines. Hashtags such as #DiedSuddenly trend on Twitter whenever a well-known person dies unexpectedly, despite the lack of any supporting evidence.

Some Covid vaccines have been linked to a small rise in cases of heart inflammation (myocarditis and pericarditis), mostly among young men. In Ireland, 133 cases of heart inflammation following vaccination have been reported to the Health Products Regulatory Authority, five of them involving adolescents (this doesn’t mean the vaccine cause the side effect). Fewer than five deaths have been reported.

Even allowing for imperfect reporting mechanisms, these numbers are too small to have any impact on the overall number of excess deaths.

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In the US, health authorities are investigating a potential link between Pfizer’s updated Covid vaccine and a type of stroke in older adults, but say such a link has not been observed in other countries, and have not recommended any change to vaccination practices for now. It is worth noting that there was no rise in the rate of excess deaths in Ireland after boosters began to be rolled out.

Data from the UK shows unvaccinated people were more likely to figure in excess deaths than vaccinated people. And if vaccines did have a role in pushing up excess deaths, you might expect the countries with the highest vaccination rates (such as Ireland) to have the highest excess deaths, but this is not the case.

To test claims of excess death, particularly among younger people, The Irish Times asked the CSO for figures for deaths of people aged under 45 years in recent years. This limited data does not appear to support claims of a vaccine-related rise in deaths in this age cohort. Since 2019, the number of deaths among under-45s has remained relatively stable, aside from the expected peaks during winter (see graph above).

While the vast majority of medical specialists we asked in recent months about claims of vaccine-induced harm say they have no cause of concern, it is fair to say a small number of doctors do, though for now they are reluctant to speak publicly. The issue is likely to receive an airing at a number of forthcoming inquests into the deaths of people shortly after being vaccinated against Covid.

The CSO has been forced to rely on online death notices to arrive at some assessment of the level of excess mortality

The pandemic exposed Ireland’s woeful deficiencies in health data, and nowhere more so than in the registration of deaths. We were left out of many international initiatives for calculating excess deaths because of delays arising from the 90-day period allowed for registering deaths. Then the HSE, which is responsible for this work, was hit by a cyberattack in mid-2021, leading to further delays in registering deaths and consequent distortion of the figures for a period.

As a result, the CSO has been forced to rely on online death notices to arrive at some assessment of the level of excess mortality. Although rip.ie notices are regarded as a good proxy, they give little indication of the age of those dying, or the cause of death. As a result, it is impossible to be certain about the causes of the current rise in deaths.

Thankfully, the number of excess deaths has begun to abate now, as flu and other infections decline. An update by the CSO will be published by the end of next month.