Spain’s civil registries detect 10% excess mortality during second coronavirus wave

With Spain already immersed in a second wave of the coronavirus, the country’s systems for detecting excess mortality rates have already identified a 10% rise in unexpected deaths over two periods: the month of August, and the second week of September.

The latest report from the Mortality Monitoring System, known as MoMo, was published on Wednesday, and shows that between July 27 and August 29 there were 3,466 more deaths in Spain than were expected, and that over the last week – September 8 to 13 – there were an extra 533 compared to the average.

The MoMo uses information about deaths from all causes supplied by the nearly 4,000 civil registries in Spain that have digitalized systems, covering 93% of the Spanish population from all of the country’s provinces. The reports estimate the expected mortality rates based on models that use historical averages based on deaths over the last 10 years.

You cannot establish that this excess is due to the coronavirus, but it is plausible that it is in part

Epidemiologist José Jonay Ojeda

In the MoMo’s latest report, there are three “periods of excess” mortality this year: during the first wave of the coronavirus, which ran from March 10 and May 9, and saw 43,068 more deaths than expected; in August; and last week.

The rate of excess deaths during the first wave was 63% of the average in all of Spain; in August it was 10%; and in September, 9.1%. Over the latter week there was a difference in genders, with 7.6% excess mortality for men, and 12.% for women – the experts consulted for this article have not so far been able to explain this difference.

The MoMo has not detected excess mortality in the majority of Spain’s 17 regions since the first wave of the epidemic between March and May. This is the case for Asturias, the Canary Islands, Cantabria, Castilla-La Mancha, Catalonia, Galicia, Navarre, the Basque Country and La Rioja. In contrast, excess mortality in the Madrid region between September 1 and 13 came in at 29.3%.

The MoMo also detected three periods of excess mortality in Andalusia: the first wave, August and September. In other regions two were noted. Aragón and the Valencia region saw periods in the first wave and the first half of August; Extremadura in the second half of July; Castilla y León from August 26 to 28; and Murcia August 31 to September 6. In the Balearic Islands, the two periods of excess mortality correspond to the months of April and May.

The profile of coronavirus cases has changed radically since the first wave – one in four is now aged between 15 and 29

Experts such as Diego Ramiro, a demographer and the director of the Institute of Economy, Geography and Demography at the CSIC public research institute, point out that the MoMo “is not designed to identify the causes of death, just excess mortality.” As such, it is still early to know whether these victims can be attributed directly or indirectly to the coronavirus.

What’s more, they took place during the summer, meaning that some of these excess deaths in areas of Spain that suffered a heatwave could be attributed to related causes. Epidemiologist José Jonay Ojeda, the spokesperson for the Spanish Society for Public Health and Health Administration (Sespas), agrees: “You cannot establish that this excess is due to the coronavirus, but it is plausible that it is in part,” he says.

Ojeda points out that now, unlike in March and April, the Spanish health system is detecting many cases of Covid-19, the majority of which are asymptomatic or with very mild symptoms. “With regard to the first wave, it’s less likely that we are missing mortality due to the coronavirus,” he says, in reference to the fact that many thousands of people are thought to have died from Covid-19 during the first wave without having been given a PCR test.

Between July 27 and August 29, the second period of excess mortality identified by the MoMo, 821 people with the coronavirus died, according to statistics from the Carlos III health institute. Between September 8 and 13, the third phase with the highest excess mortality in 2020, the same institution detected 368 Covid-19 victims – although it is possible that this figure could rise in the coming days given reporting delays. The data from the MoMo could similarly be adjusted, Ojeda points out.

According to the latest MoMo report, between September 8 and 13, there were an extra 533 compared to the average

Improvements in diagnostic capacity in Spain make comparing the infection data from the first wave with that of the second practically impossible, Ojeda adds. In March and April the healthcare system was unable to detect the majority of infections, including those that were very serious or that caused deaths. “The confirmation of cases was limited to very specific circumstances,” the epidemiologist explains. Now, however, while there are some differences between regions, the majority “are seeing nearly all of them,” he adds. The majority of cases are currently either asymptomatic or mild. That was seen in a report dated September 9 from the Covid-19 Team from the National Epidemiological Monitoring Network: just 4.7% of the more than 300,000 cases registered between May 10 and the date of the report required hospitalization, while 0.4% were admitted to an intensive care unit (ICU) and 0.5% died.

The profile of those being infected with the coronavirus has changed radically since the first wave. Now, one in every four cases is aged between 15 and 29. In the report from April 1, 49% of the cases notified to the network were hospitalized and 5.1% admitted to an ICU. The percentage of victims was 5.9%. More than half of the cases detected at that time – 54% – were aged over 60.

English version by Simon Hunter.