Nearly 11 thousand more deaths than expected during second wave

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© Hollandse Hoogte / Ramon van Flymen
Between mid-September 2020, the start of the second wave of coronavirus, and the end of June 2021, there were close to 11 thousand more deaths (9 percent) than expected. Mortality was higher than usual mainly in the first few months. It was elevated the most in the age group 65 to 79 years, and in total more among men than among women. Statistics Netherlands (CBS) reports this based on the latest provisional weekly mortality figures.

Four phases can be distinguished in the mortality figures when looking at the second wave of the coronavirus epidemic. During the first and second phase, there were several weeks of excess mortality, whereby mortality rose outside the range of usual fluctuations. In the third phase, mortality was below the expected level for several weeks (but within the interval, meaning there was no undermortality). During the last phase (up to week 24 inclusive), mortality was higher than expected (but within the interval), with excess mortality in one single week. In week 25, mortality was lower than expected, and in the following week as expected again.

At the beginning of January, the Netherlands started its vaccination programme. Elderly people and people in long-term care institutions were the first to be vaccinated.

Weekly mortality*
   DeathsExpected mortalityExpected mortality (95% interval)
20201310332772908 – 3645
20202336433112930 – 3692
20203315733442945 – 3742
20204304633923008 – 3776
20205316434073027 – 3788
20206319634012979 – 3823
20207319834082916 – 3901
20208295933872851 – 3922
20209309833522805 – 3898
202010310733152785 – 3845
202011321832532756 – 3751
202012361431742711 – 3637
202013445831042703 – 3505
202014508530242712 – 3337
202015498229572719 – 3195
202016430829152711 – 3120
202017391028692677 – 3060
202018338328412650 – 3032
202019298928212633 – 3009
202020277727942626 – 2962
202021277027702620 – 2920
202022273227532608 – 2898
202023268227352591 – 2880
202024268927372600 – 2875
202025269627252594 – 2855
202026265927172577 – 2857
202027263827232544 – 2902
202028261927192515 – 2923
202029252827202507 – 2934
202030267327072515 – 2900
202031266626872492 – 2882
202032264226822483 – 2881
202033320926692481 – 2857
202034285626632510 – 2815
202035273526672526 – 2807
202036269226762549 – 2804
202037274226982564 – 2832
202038272127292585 – 2873
202039289127522618 – 2886
202040300227862628 – 2943
202041302228072655 – 2960
202042322228392677 – 3001
202043344828622661 – 3063
202044368728892683 – 3095
202045358929022692 – 3111
202046358029322710 – 3155
202047333529722742 – 3202
202048340530122762 – 3263
202049353030372742 – 3332
202050361531002800 – 3399
202051390931662830 – 3501
202052386732222871 – 3573
202053410332662906 – 3625
20211414233092940 – 3677
20212385033432962 – 3724
20213386033762978 – 3775
20214371434253040 – 3809
20215365134403060 – 3821
20216354834343012 – 3856
20217352534412949 – 3934
20218320634202884 – 3955
20219310533842838 – 3931
202110324333472817 – 3877
202111303932852787 – 3782
202112304232052742 – 3668
202113317331342733 – 3535
202114315730542741 – 3366
202115313329862748 – 3224
202116313929442739 – 3148
202117311528972705 – 3088
202118299228692677 – 3060
202119300728492660 – 3037
202120297928212653 – 2989
202121279927972646 – 2947
202122300027802635 – 2925
202123286927622617 – 2906
202124284827642627 – 2901
202125262627512620 – 2882
202126275527432603 – 2883
20212727502571 – 2929
20212827452541 – 2949
20212927472534 – 2960
20213027342541 – 2926
202131
202132
202133
202134
202135
202136
202137
202138
202139
202140
202141
202142
202143
202144
202145
202146
202147
202148
202149
202150
202151
202152
* Provisional figures. Week 26 in 2021 is an estimate.

Higher mortality caused by COVID-19

The higher mortality figures during the second wave are entirely due to COVID-19. Between mid-September and the end of March (the period for which the figures on causes of death are known), 18.0 thousand people died of COVID-19. The total number of deaths in that period was 9.2 thousand higher than expected. The fact that the number of COVID-19 deaths was higher than excess mortality up to the end of March is related to the absence of a flu epidemic in the winter of 2020/'21. In an average year, relatively many people die during a flu epidemic in the winter. During the first wave of the coronavirus epidemic, mortality from COVID-19 was more or less the same as excess mortality.

Elevated mortality among long-term care users, but to a lesser extent than during the first wave

During the second epidemic wave, there were 3.7 thousand more deaths (8 percent) among people receiving care under the Long-term Care Act (Wlz) than expected. At 9 percent, this was slightly higher among the rest of the population (7.0 thousand more deaths). During the first wave, there were 5.2 thousand more deaths among long-term care recipients than expected, and 3.8 thousand more deaths among the rest of the population.

Among long-term care users, more people than expected died during the first and second phase of the second wave. At 22 percent, excess mortality was slightly higher in the second phase than in the first phase (20 percent more deaths). There were also more deaths among the rest of population during these two phases, but excess mortality was lower than among long-term care users (13 percent during the first phase, 12 percent during the second).

Mortality declined in the third phase, with 11 percent fewer deaths among long-term care users than expected. Among the rest of the population, the death rate was approximately at the expected level. The fourth phase saw an increase in mortality among the rest of the population; there were 10 percent more deaths than expected. The mortality rate among long-term care recipients was 5 percent lower than expected.

Mortality relative to expectation, long-term care use*
 Total (%)Long-term care users (%)Rest of the population (%)
1st wave33.352.122.3
2nd wave, total9.08.39.4
2nd wave, phase 115.720.113.1
2nd wave, phase 215.521.811.6
2nd wave, phase 3-4.6-10.7-0.8
2nd wave, phase 44.5-4.910.0
*Provisional figures
1st wave: week 11 through 13 2020, 2nd wave, phase 1: week 39 through 47, phase 2: week 48 through 6 2021, phase 3: week 7 through 12, phase 4: week 13 through 24

Higher mortality among men

Although there are more elderly women than men, more men died during the second wave of the coronavirus epidemic (65.8 thousand men against 64.5 thousand women). There were 6.9 thousand more deaths among men (12 percent) and 3.9 thousand more deaths among women (6 percent) than expected. During the first wave, mortality among men was also more elevated.

Mainly more deaths among 65 to 79-year-olds

During the second wave of coronavirus, there were 4.9 thousand more deaths (7 percent) among the over-80s than expected. In the age group 65 to 79 years, there were 4.9 thousand more deaths (14 percent) than expected. Among people under 65, this number stood at 0.9 thousand (6 percent). During the first wave, excess mortality amounted to 5.7 thousand among people aged 80 and over, 2.7 thousand among 65 to 79-year-olds and 0.5 thousand among people under 65.

Higher mortality during the second wave of coronavirus was first seen among people aged 80 and over. Not much later, the number of deaths also increased among 65 to 79-year-olds. Mortality remained above the expected level for a longer time in this age group. Among people under 65, there were a few weeks with elevated mortality during this period.

During the third phase (in early 2021), mortality among the over-80s fell rapidly and has since remained below or around the expected level. There were 10 percent fewer people aged 80 and over than expected in this phase. Mortality among people under 80 was also lower in this phase than in the first two phases. In the fourth phase, however, the number of deaths in this age group rose again resulting in excess mortality.

Weekly mortality relative to expectation, age*
 0 to 64 yrs (%)65 to 79 yrs (%)80 yrs and over (%)
1st wave14.134.437.1
2nd wave, total5.913.87.1
2nd wave, phase 13.517.018.2
2nd wave, phase 24.418.316.3
2nd wave, phase 31.42.8-9.6
2nd wave, phase 411.812.5-1.5
*Provisional figures
1st wave: week 11 through 13 2020, 2nd wave, phase 1: week 39 through 47, phase 2: week 48 through 6 2021, phase 3: week 7 through 12, phase 4: week 13 through 24

Data sources for RIVM

To date, the National Institute for Public Health and the Environment (RIVM) has registered 17,757 COVID-19 deaths. These include 11,376 recorded since mid-September (as at 6 July 2021). RIVM receives data on confirmed COVID-19 deaths from municipal health services (GGD) around the country on a daily basis. The actual COVID-19-related death count in the Netherlands is higher because of the following reasons: it is possible that not all people with COVID-19 have themselves tested, there is no reporting obligation for COVID-19 and registration sometimes takes a little longer.