France had 60 percent more deaths than usual at height of coronavirus epidemic

The number of people dying in France was 60 percent over its average at the height of the Covid-19 epidemic earlier this year, according to a report by public health services on Wednesday.

A patient suffering from Covid-19 is treated at the intensive care unit at the Institut Mutualiste Montsouris hospital in Paris at the height of France's coronavirus epidemic in early April, when health officials say the country suffered an 60 percent rise in mortality. REUTERS - Benoit Tessier

A report by public health agency Santé publique France (SPF) published Wednesday showed between 25,000 and 30,000 more people died between 2 March and 31 May 2020 than in an average year.

The calculations were based on demographic data on mortality by any cause available from national statistics office Insee, Covid-specific mortality reported in hospitals and care homes for the elderly and electronic death certificates.

[#Coronavirus] Santé publique France publie le bilan de la surveillance de la #mortalité du 2 mars au 31 mai 2020. Pour le consulter 👉https://t.co/PlqsPfi1MO pic.twitter.com/r41JENSUQN

— SantépubliqueFrance (@santeprevention) July 22, 2020

According to SPF, the year 2020 had mortality comparable previous years until 9 March, when the number of deaths be any cause rose by 7 percent over the average.

Excess mortality peaked at 60 percent over  average in the first week of April, which was the height of the epidemic and came two to three weeks after the French government imposed a home confinement and economic lockdown to slow the spread of the virus.

The lockdown began on 17 March and started to be lifted on 11 May. Mortality had returned to its normal level by late April and early May.

SPF notes 175,800 people died in France between 2 March and 31 May, an overall excess mortality of 16.6 percent compared with the average.

More data to come

The official Covid-19 death toll from hospitals and care homes on 31 May was 28,802, suggesting the vast majority of deaths to the new coronavirus happened within the health system and that there no massive phenomenon of deaths at home.

The hypothesis will only be confirmed at the end of the year, when death certificates indicating the cause of death are included in the available data.

This data will also clarify the effect of the epidemic on mortality in general, including the extent to which people were dying as much or less from other causes.

For example, reduced activity and movement due to lockdown may have made for fewer workplace and road accidents. On the other hand, the disease caused by the new coronavirus “may have accelerated the deaths of the most fragile persons”, the report notes.

“These rises and declines in mortality, which can happen simultaneously and balance each other out, are very difficult to dissociate and measure if the precise cause of death is unknown,” the authors said.

Electronic death certificates

The authors of the report put forth a recommendation to expand the electronic filing of death certificates, available to doctors since 2007, in order to create a promptly updated database showing causes and sites of death.

“This report underlines the urgent need to generalise electronic death certification at a national level,” the authors wrote.

“This system would allow a single and sustainable data source for reactive mortality surveillance, regardless the nature of the health threat (infectious, environmental, bioterrorism, industrial accident…) and the location of the impacted population,” whether the death is at home, in a care home or in hospital.

About 20 percent of deaths are currently reported electronically. The report’s authors found that for the period in question, two thirds of death certificates “contained at least one mention of another cause of death” than Covid-19, suggesting many people who passed away had other serious health conditions.

As shown in electronic certificates, deaths due to other causes than Covid-19 decreased 15 percent in March compared with the same period in 2018 and 2019, while deaths in care homes, whose residents were not taken to hospitals, increased 91 percent.