The Impact of COVID-19 on Mortality in Spain: Monitoring Excess Mortality (MoMo) and the Surveillance of Confirmed COVID-19 Deaths.

Inmaculada León-Gómez,Luz Frías,Lorena Vega-Piris,Concepción Delgado-Sanz,Ayelén Rojas-Benedicto,Clara Mazagatos,Amparo Larrauri

doi:10.3390/v13122423

Abstract

Measuring mortality has been a challenge during the COVID-19 pandemic. Here, we compared the results from the Spanish daily mortality surveillance system (MoMo) of excess mortality estimates, using a time series analysis, with those obtained for the confirmed COVID-19 deaths reported to the National Epidemiological Surveillance Network (RENAVE). The excess mortality estimated at the beginning of March 2020 was much greater than what has been observed in previous years, and clustered in a very short time. The cumulated excess mortality increased with age. In the first epidemic wave, the excess mortality estimated by MoMo was 1.5 times higher than the confirmed COVID-19 deaths reported to RENAVE, but both estimates were similar in the following pandemic waves. Estimated excess mortality and confirmed COVID-19 mortality rates were geographically distributed in a very heterogeneous way. The greatest increase in mortality that has taken place in Spain in recent years was detected early by MoMo, coinciding with the spread of the COVID-19 pandemic. MoMo is able to identify risk situations for public health in a timely manner, relying on mortality in general as an indirect indicator of various important public health problems.

Highlights

The emergence of the coronavirus disease 2019 (COVID-19) pandemic was followed by a period of excess mortality in Europe and the UK, beginning in March until midMay 2020 [1]
Deaths arising from untreated underlying health conditions due to limited access to the healthcare system, or those related with the indirect health effect or socioeconomic impact of the pandemic, such as unemployment or social isolation, are difficult to estimate in a timely manner and are frequently not recorded as part of the official COVID-19 mortality figures, even though they are a direct consequence of the pandemic’s impact on society and the pressure on the healthcare system [7]
COVID-19 mortality data were obtained from notifications of death in confirmed COVID-19 cases reported by Autonomous Communities, within the exhaustive national COVID-19 surveillance of the National Epidemiological Surveillance Network (RENAVE) through the Web platform SiViES (Spanish Surveillance System), which is managed by the National Center of Epidemiology

Summary

Introduction

The emergence of the coronavirus disease 2019 (COVID-19) pandemic was followed by a period of excess mortality in Europe and the UK, beginning in March until midMay 2020 [1]. Measuring the real impact of the COVID-19 pandemic on population mortality represents a great challenge, and it is known that the number of reported confirmed COVID-19 deaths in most countries greatly underestimates the total COVID-19-related mortality, during the first months of the pandemic when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing capacity was still limited [5]. Deaths arising from untreated underlying health conditions due to limited access to the healthcare system, or those related with the indirect health effect or socioeconomic impact of the pandemic, such as unemployment or social isolation, are difficult to estimate in a timely manner and are frequently not recorded as part of the official COVID-19 mortality figures, even though they are a direct consequence of the pandemic’s impact on society and the pressure on the healthcare system [7]

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