In epidemiology, the excess deaths or excess mortality is a measure of the increase in the number of deaths during a time period and/or in a certain group, as compared to the expected value or statistical trend during a reference period (typically of five years) or in a reference population. It may typically be measured in percentage points, or in number of deaths per time unit.
A short period of excess mortality that is followed by a compensating period of mortality deficit (i.e., fewer deaths than expected, because those people have died at a younger age) is quite common, and is also known as "harvesting". Mortality deficit in a particular time period can be caused by deaths displaced to an earlier time (due to harvesting by an event in the past) or deaths displaced to a future time (due to lives being saved, also called "avoided mortality"). [1] [2]
Mortality displacement is the occurrence of deaths at an earlier time than they would have otherwise occurred, meaning the deaths are displaced from the future into the present, resulting in a changed life expectancy.
As opposed to number of registered fatalities of a certain death cause, such as a specific virus, a temporary excess mortality, and the mortality displacement, are measures that reflect many combined causes. The dominant reason may be events such as heat waves, cold spells, epidemics and pandemics (especially influenza pandemics), famine or war, and allows for estimates of the mortality caused by those events combined with other indirect health effects. Excess mortality is also studied for certain groups of people, such as elder, men, unemployed, etcetera.
During heat waves, for instance, there are often additional deaths observed in the population, affecting especially older adults and those who are sick. After some periods with excess mortality, however, there has also been observed a decrease in overall mortality during the subsequent weeks. Such short-term forward shift in mortality rate is also referred to as harvesting effect. The subsequent, compensatory reduction in mortality suggests that the heat wave especially affected those whose health was already so compromised that they "would have died in the short-term anyway" due to other causes, meaning that not all the deaths caused by the heat wave could have been avoided by addressing the effects of heat waves. [3]
A Dutch research group analyzed data from 47 Western countries and found that excess mortality “remained high” since 2020, despite the widespread rollout of COVID vaccines and various containment measures. The study found there had been more than 3 million excess deaths across the US, Europe and Australia since 2020. While the study does not establish a link between COVID vaccinations and excess mortality, it argues that more research is needed in order to help better dictate future health policy. [4] Insurers link continued excess deaths to the continued damaging effects of covid infections on the population. [5]
Different institutions and initiatives offer weekly data to monitor excess mortality. Significant efforts to capture short term mortality data have been made along 2020 due to the pandemic of the coronavirus disease 2019 (COVID-19) and its worldwide effects. Eurostat launched in April 2020 a collection of weekly death data that provide for most of the EU countries weekly death data series by 5-year age groups and sex in NUTS3 regions within the countries starting from the year 2000. [6] This temporary data collection was established in order to support the policy and research efforts related to the COVID-19 pandemic. Data are transmitted by the National Statistical Institutes on voluntary basis and it is being updated, depending on the country, weekly. [7]
In May 2020, the Human Mortality Database project launched a new data series, the Short-term Mortality Fluctuation series (STMF), offering freely available weekly death counts by age and sex for a growing number of countries (34 in October 2020), as well as a visualization tool that captures the excess mortality on a weekly basis. The STMF was established to provide data for scientific analysis of all-cause mortality fluctuations by week within each calendar year in standard formats. Part of the Human Mortality Database use a joint project of two teams based in the Laboratory of Demographic Data at the Max Planck Institute for Demographic Research (MPIDR) and at the Department of Demography of the University of California, Berkeley (UCB).
The collaborative network EuroMOMO (European mortality monitoring activity), monitors mortality across 24 European countries in order to detect and measure excess deaths related to seasonal influenza, pandemics, and other public health threats. EuroMOMO is hosted and maintained by the Department of Infectious Disease Epidemiology and Prevention of Copenhagen, Denmark. They offer regular reports (weekly bulletins), graphs and maps showing the present levels of mortality but the network does not publish openly data. Individual partners may decide to share openly some selected national data, like for instance, MoMo-Spain. The study centre at the Statens Serum Institut in Copenhagen publishes a weekly situation report and regular scientific articles. Periods of high excess mortality have also been described for the United States. [8]
A pandemic is an epidemic of an infectious disease that has a sudden increase in cases and spreads across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. Widespread endemic diseases with a stable number of infected individuals such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide.
An epidemic is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.
The 1918–1920 flu pandemic, also known as the Great Influenza epidemic or by the common misnomer Spanish flu, was an exceptionally deadly global influenza pandemic caused by the H1N1 subtype of the influenza A virus. The earliest documented case was March 1918 in the state of Kansas in the United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in history.
The Hong Kong flu, also known as the 1968 flu pandemic, was an influenza pandemic that occurred between 1968 and 1970 and which killed between one and four million people globally. It is among the deadliest pandemics in history, and was caused by an H3N2 strain of the influenza A virus. The virus was descended from H2N2 through antigenic shift, a genetic process in which genes from multiple subtypes are reassorted to form a new virus.
Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemisphere. It takes approximately two days to show symptoms. Influenza activity can sometimes be predicted and even tracked geographically. While the beginning of major flu activity in each season varies by location, in any specific location these minor epidemics usually take about three weeks to reach its pinnacle, and another three weeks to significantly diminish.
An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been five major influenza pandemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.
In epidemiology, case fatality rate (CFR) – or sometimes more accurately case-fatality risk – is the proportion of people who have been diagnosed with a certain disease and end up dying of it. Unlike a disease's mortality rate, the CFR does not take into account the time period between disease onset and death. A CFR is generally expressed as a percentage. It is a measure of disease lethality, and thus may change with different treatments. CFRs are most often used for with discrete, limited-time courses, such as acute infections.
The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus. The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".
In public health, social distancing, also called physical distancing, is a set of non-pharmaceutical interventions or measures intended to prevent the spread of a contagious disease by maintaining a physical distance between people and reducing the number of times people come into close contact with each other. It usually involves keeping a certain distance from others and avoiding gathering together in large groups.
During the 1972–1973 flu season in the Northern Hemisphere, a new variant of influenza, dubbed the 'London flu' by the press in the United States, was responsible for epidemics in many countries. 'London flu' was caused by a variant of influenza A/H3N2 that was first isolated in India in mid-1971 but only identified as a distinct strain in England in January, 1972.
The 1889–1890 pandemic, often referred to as the "Asiatic flu" or "Russian flu", was a worldwide respiratory viral pandemic. It was the last great pandemic of the 19th century, and is among the deadliest pandemics in history. The pandemic killed about 1 million people out of a world population of about 1.5 billion. The most reported effects of the pandemic took place from October 1889 to December 1890, with recurrences in March to June 1891, November 1891 to June 1892, the northern winter of 1893–1894, and early 1895.
The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began with an outbreak of COVID-19 in Wuhan, China, in December 2019. It spread to other areas of Asia, and then worldwide in early 2020. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern (PHEIC) on 30 January 2020, and assessed the outbreak as having become a pandemic on 11 March.
The COVID-19 pandemic in Sweden is a part of the pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2. As of 22 March 2023, there have been 2,701,192 confirmed cumulative cases and 23,851 deaths with confirmed COVID-19 in Sweden. Sweden ranks 57th in per capita deaths worldwide, and out of 47 European countries, Sweden places 30th. A 2022 estimate of excess mortality during the pandemic using IHME COVID model estimated 18,300 excess deaths during 2020–2021 The Economist model value estimated 13,670 excess deaths between 16th 2020-Mar 6th 2022.
This article contains the monthly cumulative number of deaths from the pandemic of COVID-19 reported by each country, territory, and subnational area to the World Health Organization (WHO) and published in WHO reports, tables, and spreadsheets. There are also maps and timeline graphs of daily and weekly deaths worldwide.
The 1957–1958 Asian flu pandemic was a global pandemic of influenza A virus subtype H2N2 that originated in Guizhou in Southern China. The number of excess deaths caused by the pandemic is estimated to be 1–4 million around the world, making it one of the deadliest pandemics in history. A decade later, a reassorted viral strain H3N2 further caused the Hong Kong flu pandemic (1968–1969).
The Pandemic Severity Assessment Framework (PSAF) is an evaluation framework published by the Centers for Disease Control and Prevention in 2016 which uses quadrants to evaluate both the transmissibility and clinical severity of an influenza pandemic and to combine these into an overall impact estimate. Clinical severity is calculated via multiple measures including case fatality rate, case-hospitalization ratios, and deaths-hospitalizations ratios, while viral transmissibility is measured via available data among secondary household attack rates, school attack rates, workplace attack rates, community attack rates, rates of emergency department and outpatient visits for influenza-like illness.
This article contains the number of confirmed COVID-19 deaths per population as of 30 December 2024, by country. It also has cumulative death totals by country. For these numbers over time see the tables, graphs, and maps at COVID-19 pandemic deaths and COVID-19 pandemic by country and territory.
Part of managing an infectious disease outbreak is trying to delay and decrease the epidemic peak, known as flattening the epidemic curve. This decreases the risk of health services being overwhelmed and provides more time for vaccines and treatments to be developed. Non-pharmaceutical interventions that may manage the outbreak include personal preventive measures such as hand hygiene, wearing face masks, and self-quarantine; community measures aimed at physical distancing such as closing schools and cancelling mass gathering events; community engagement to encourage acceptance and participation in such interventions; as well as environmental measures such surface cleaning. It has also been suggested that improving ventilation and managing exposure duration can reduce transmission.
This article presents official statistics gathered during the COVID-19 pandemic in the United Kingdom.
Undercounting of COVID-19 pandemic deaths has been witnessed around the world. Global mortality excess estimates by the World Health Organization are significantly different from official figures, pointing to undercounting– "while 1,813,188 COVID-19 deaths were reported in 2020... WHO estimates suggest an excess mortality of at least 3,000,000." The global average for underreporting COVID-19 deaths in cities is 30%. The aim of arriving at a truer death count is ultimately linked to improving national and international abilities and responses to fighting the virus. Undercounting can cause a number of problems such as delay in vaccines to priority populations.