The real Covid-19 death toll in Spain: at least 44,868 victims

Covid-19, which is caused by the SARS-CoV-2 coronavirus first detected in Wuhan, China, in November 2019, has killed at least 44,868 people in Spain since February 13, when the first death from the disease was recorded. That is much higher than the official death toll of 28,432 reported by the Spanish Health Ministry based on cases that were tested and came back positive.

To arrive at this figure, EL PAÍS has included all the people who died either from confirmed or suspected Covid-19, using records from the 17 autonomous regions of Spain as well as excess death studies by two state-funded agencies and a trade association.

The figure, which makes Spain’s death toll second only to the UK’s in Europe, includes 16,436 additional deaths to those recorded by the Health Ministry, which currently still counts only people who test positive for the virus.

During the first month of the epidemic, between March 14 and April 14, hospitals were overwhelmed by the numbers being admitted, which led all too often to the neglect of the sick in nursing homes

The higher number of 44,868 is closer to the figures in studies carried out by the Carlos III Institute of Health (44,418), the National Statistics Institute (44,395) and the Spanish Association of Funeral Professionals and Services (43,985).

As part of the Ministry of Science and Innovation, the Carlos III Health Institute monitors the mortality rate daily with data provided by 3,800 civil registries. This monitoring is part of a year-round alert system that will flag up any circumstance relevant to public health, such as a heatwave or a pandemic. As a benchmark for its analyses, the institute uses the average number of deaths in the last 10 years and compares that figure with the current situation. The results for the period between March 14, when Spain entered a state of alarm, to May 22, when hospital deaths began to fall dramatically, show that deaths were up by 44,118 on the previous 10 year-average.

Meanwhile, the National Statistics Institute (INE), which is part of the Ministry of Economy, has launched a pilot study that shows an excess of 44,395 deaths between January 1 and May 24 of this year compared to the same period last year. The role of Covid-19 in this vertiginous rise becomes even more dramatic after observing that until March 14, there were almost 3,000 fewer deaths in Spain compared to the same period in 2019, according to INE data.

Both the INE and the Carlos III Institute of Health base their studies on data provided by the Directorate General of Registries, which answers to the Justice Ministry, via the Inforeg service, which includes data from 3,800 civil registries across Spain, covering 93.4% of the population.

The INE explains that, unlike the Carlos III Health Institute, its own data covers 100% of the population due to the application of a higher coefficient to the deaths recorded in Inforeg to compensate for data on the missing 6.4%. The coefficient is calculated on the basis of a historical comparison between Inforeg data and the number of deaths finally recorded by INE, which is invariably higher.

The difference between the data recorded by the 17 autonomous regions and the data from the Health Ministry is most glaring in the four most severely affected regions

Although no expert doubts that the excess mortality recorded by the two public bodies is mainly attributable to Covid-19, the Carlos III Institute stresses that it will be impossible to confirm whether all the deaths were due to the pandemic until the cause of death that appears in the medical certificates becomes available.

The difference between the data recorded by the 17 autonomous regions and the data from the Health Ministry is most glaring in the four most severely affected regions – Madrid, Catalonia, Castilla-La Mancha and Castilla y León – which account for 75% of mortality from Covid-19.

Thousands of deaths recorded in these regions occurred in nursing homes and, to a lesser extent, at home. The public health services in these regions believe that, in the vast majority of cases, Covid-19 was responsible, though the victims were never tested.

During the first month of the epidemic, between March 14 and April 14, hospitals were overwhelmed by the numbers being admitted, which led all too often to the neglect of the sick in nursing homes. This alone complicates estimates of actual mortality from the pandemic.

The Ministry of Health argued from the outset that its death count followed World Health Organization (WHO) criteria, which stipulated that only those who tested positive should be recorded as Covid deaths. But on June 6, the WHO changed its criteria to include those who are strongly suspected to be Covid-19 victims.

Statistics in Europe

Fernando Simón, director of Spain’s Center for the Coordination of Health Alerts and Emergencies, said more than a month ago that the Health Ministry should adjust the death count according to the new WHO criteria, although he did not specify when this would be done. “This puts us in a situation where every country is going to have to make adjustments to their data at some point so that we can compare it,” he said.

France, however, began to officially record those who died in nursing homes and residences on April 6, boosting the number of deaths on one single day by 1,000. The UK did likewise on April 29 and increased its total death count by 4,000.

Questionable death-free days

On June 1 and 2, Fernando Simón said that no Covid-19 deaths had been recorded for the first time since the beginning of the health crisis, according to the health statistics itemized as “Deaths reported in the last seven days.” However on June 1, seven regional governments reported 24 deaths in their hospitals; and on June 2, nine regions confirmed 34 further deaths from the virus. The Health Ministry added these figures to its lists of deaths many days later.

On June 2, the ministry stated that Madrid had not reported any deaths occurring in the last seven days. But, in fact, the Madrid region had reported 80 deaths in that period. Over the last week, the ministry has reported two deaths in Catalonia while the regional government’s department of health has reported 32 deaths in its hospitals in the same period.

Controversial data management

Since the beginning of the pandemic, Catalonia has generated data that does not coincide with that of the Health Ministry. According to officials in charge of the region’s data, the ministry asks for certain data published daily by the region and interprets it, but “only the Catalan government knows Catalonia’s epidemiological reality.”

This epidemiological reality has resulted in some impossible figures. On May 18, the Catalan health department counted 6,614 deaths in hospitals due to Covid-19. A day later, the number had fallen to 6,385 deaths. On May 23, Catalonia added 18 deaths, but the Health Ministry only noted seven, with the following explanation: “Catalonia has reported more deaths from previous days that are pending assignment by date of demise. The series is being reviewed.”

As recently as July 23, Catalonia had still recorded nine deaths for that day in May. However, when the number of deaths was counted according to location, it appeared that 13 more people had died that day in the region’s hospitals.

English version by Heather Galloway.