The Belgian Model for Tracking Coronavirus Deaths

Belgium, one of the hardest hit countries by coronavirus, may also have a more accurate count of coronavirus deaths than other nations with high infection rates according to Belgian health officials.

Countries around the world have been affected by the coronavirus to varying degrees, and in Europe, one of the hardest hit countries is Belgium. However, making comparisons between countries is difficult due to differences in the way that countries keep statistics, but when compared to increases in excess deaths, Belgium’s coronavirus deaths matches the increase in excess deaths.

According to Johns Hopkins’ Coronavirus Resource Center, Belgium has the highest number of deaths per capita, with 83 per 100,000 residents, the most of any country except for San Marino (the tiny enclave republic is surrounded by hard-hit Italy). Additionally, Belgium has a high case fatality rate of 16.2%, which is higher than any country except Yemen. To put these numbers in perspective, two of Belgium’s neighbors, Germany and the Netherlands, have significantly lower deaths per 100,000 and lower case fatality rates. Germany has a coronavirus case fatality rate of 4.7% and only 10.3 deaths per 100,000 residents, and the Netherlands has a case fatality rate of 12.8% and 34.68 deaths per 100,000 residents. 

There are several reasons why Belgium has a high death rate. Belgium is one of the most densely populated countries in Europe, with a density of 378 people per square kilometer, and this could have played a factor in spreading the virus initially, but it does not explain the high death rate. The U.K. and the U.S. have a population density of 275 and 36 people per square kilometer, respectively. Some areas of Belgium have been more adversely affected than others, but there is no clear reason for these differences other than when coronavirus cases were first introduced to these areas, according to Professor Doctor Brecht Devleesschauwer, a senior epidemiologist at Sciensano, which is the public health institute of Belgium. Additionally, the death rate and the infection rate are not well correlated with socioeconomic status according to Devleesschauwer.

Belgium’s elderly population and nursing home residents have been highly affected by the coronavirus. According to Devleesschauwer, over half of all deaths due to the coronavirus in Belgium have occurred in nursing homes, and the average age of people who die from coronavirus in Belgium is 82, which is similar to other countries which have also seen their elderly populations hit hard by the virus. Devleesschauwer said that Belgium is counting deaths not only at hospitals, but also in nursing homes and other places such as asylum seeking centers and psychiatric institutes. Belgium also counts suspected coronavirus deaths, in cases where a test was not performed but a physician thought it was very likely that the patient died from the coronavirus.

Belgium’s strategy of counting deaths in suspected cases and in places other than in hospitals may explain their high death rate. There have been reports from the U.S. and the U.K. that nursing home deaths may be undercounted. About 40% of the 9,505 covid deaths reported in Belgium are possible deaths, and the vast majority of possible deaths are deaths that occurred outside of hospitals, in places such as nursing homes. Last month Dr. Anthony Fauci said in a Senate hearing that the number of U.S. coronavirus deaths is probably underreported because there are deaths occurring outside of hospitals that are not counted in the official numbers.

Recently, some statisticians and epidemiologists have stated that the rate of coronavirus infections could be significantly higher than the official numbers indicate, and this could be because there are many asymptomatic carriers and people who have become sick but were never tested. A recent study in the journal Thorax, found that around 80% of people who tested positive for coronavirus on a cruise ship showed no symptoms, meaning the rate of infection could be much higher than previously thought. Therefore, the number of deaths from coronavirus in the U.S. could be much higher because there are likely people who became infected and died from coronavirus but were not tested before they died.

Devleesschauwer said that there is not a standard way of counting coronavirus deaths, as different countries use different methods, and systems to count coronavirus deaths needed to be set up quickly after the pandemic began. Additionally, it is difficult to determine exactly how many have died due to coronavirus because people are dying outside of hospitals, in places such as nursing homes, and they may not be tested before they die there.

The official numbers collected by countries so far may not be accurate and may not provide the complete picture. Due to the limitations of official figures, a more accurate measure may be excess death statistics, which calculates the difference between the expected number of deaths, which is based on the past average number of deaths for that time of year, and the current number. The excess deaths statistic includes all deaths, not just those caused by coronavirus, but it can be a useful tool for calculating the impact of a pandemic over a short period of time. 

EuroMOMO, the European mortality monitoring network, is an organization based in Denmark that collects data on mortality rates of EU countries and calculates excess mortality. Based on their data, England and Spain had higher excess death rates than Belgium. The deaths tended to peak between March 30 and April 12, and excess death rates are decreasing throughout the EU and the U.S.

Based on data from Sciensano, the number of daily deaths exceeded the number of expected deaths by roughly 100% at the peak of the pandemic.

“We look at excess deaths and all-cause mortality,” said Devleesschauwer. “We actually see a very close approximation of the curves of excess deaths with the curves that we get for the total covid related deaths, which is a strong indication that what we are counting matches very well with the reality of this crisis.”

According to Devleesschauwer, Belgium has a robust system to track all-cause mortality, and that allows them to effectively track excess mortality rates. 

 In England and Wales, in the third week of April, the number of deaths exceeded the number of average deaths for that week over the past five years by about 113% according to data from data from the Office for National Statistics. The U.S. witnessed about a 38% increase in deaths compared to expected deaths during the second week in April, the peak of excess deaths in the U.S., according to data from the Centers for Disease Control.

In Spain, the number of deaths per week exceeded the expected number of deaths by 142% during the last week in March, according to data from the National Center of Epidemiology at Carlos III Health Institute. These excess death numbers indicate that Spain was one of the most severely impacted countries during the peak of the coronavirus outbreak, but according to Johns Hopkins’ Mortality Analysis, Spain has a coronavirus death rate of about 58 per 100,000, which is less than Belgium’s death rate.