Ad hoc surveillance of COVID-19 mortality, 2020-2022

1. Key messages

2. COVID-19 mortality

The COVID-19 mortality is monitored continuously

Since the situation is in constant evolution, values are updated regularly on the Sciensano website. More specifically, the following resources are available:

1. Dynamic dashboard Epistat
2. Weekly epidemiological bulletin: Published on Friday, present indicators by region and province for COVID-19 mortality and indicators around all-cause mortality monitoring.
3. Open data are available. 
4. Frequently asked questions are answered in a specific document.

33 382 deaths due to COVID-19 were reported between 2020 and 2022

The first COVID-19 death in Belgium occurred on 7th March 2020. On the 31st of December 2020, 19 840 deaths were notified in Belgium, representing a crude cumulative COVID-19 death rate of 1 725 per million inhabitants. During the year 2021, a total of 8 560 COVID-19 deaths were reported, representing a crude cumulative death rate of 743 per million inhabitants. In 2022, a total of 4 977 COVID-19 deaths have been reported which represents a crude cumulative death rate of 430 per million inhabitants.

The first wave of the epidemic took place in Belgium from 1st March to 21st June 2020 and the daily number of COVID-19 deaths reached a peak of 324 on 8th April 2020.

The second wave of the epidemic started on 31st August 2020 to 14th February 2021. During this wave, the highest recorded number of daily COVID-19 deaths was 219 on 10th November 2020. The period between the two first waves has been defined as an "interwave" period.

The third wave occurred from 15th February to 27th June 2021 with a peak of daily COVID-19 deaths equal to 50 on 19th April 2021. 

The fourth wave started on 4th October 2021 and ended on 26th December 2021. The 30th of November 2021 registered the highest daily number of COVID-19 deaths with 61 deaths on that day. The period between waves 3 and 4 has been defined as an “interwave” period.

The fifth wave has been defined as the period starting on 27th December 2021 and ending on 27th February 2022, the peak of registered deaths with 66 deaths was reached on the 10th of February. 

The sixth wave took place from 28th February 2022 to 29th May 2022, the highest number of registered COVID-19 deaths was on the 8th of April with 36 deaths. 

The seventh wave started on 30th May 2022 and ended on the 11th of September 2022, the highest registered number of COVID-19 deaths was on the 24th of July, and on the 16th of August with 18 deaths.

The eighth wave is the period going from 12th September 2022 to 20th November 2022, the peak of daily registered COVID-19 deaths with 15 deaths per day was reached on 11th and 20th October. 

The ninth wave started on 21st November 2022, the end date has not yet been observed.

No interwave periods after the 3rd wave (from the 4th to the 9th wave) have been clearly observed.

Most COVID-19 deaths take place in people aged 75 years old and over

In 2020, more than half of the deceased people were aged over 85 years old, it decreased to 37% in 2021. It increased again to 47% in 2022.

The age-adjusted COVID-19 mortality rate is higher in the Brussels Capital Region

In 2020, the COVID-19 age-standardized mortality rate per region of residence was higher in the Brussels Capital Region (269 per 100 000 inhabitants) than in the Walloon Region (83) and the Flemish Region (51). The higher COVID-19 mortality rate in the Brussels Capital Region can be explained by several reasons. One of them can be a high density of the population which is known to enable the circulation of the virus.

In 2021, the COVID-19 age-standardized mortality rates were lower than in 2020. The mortality rate was higher in the Brussels Capital Region (103 per 100 000 inhabitants) than in the Walloon Region (35) and in the Flemish Region (24).

In 2022, the COVID-19 age-standardized mortality rates continued to decrease. The mortality rate was higher in the Brussels Capital Region (47 per 100 000 inhabitants) than in the Walloon Region (19) and in the Flemish Region (15).

International comparisons of COVID-19 mortality are misleading

Belgium has attracted attention internationally due to a high COVID-19-related mortality during the first wave. Belgium’s cumulated death rate was among the highest in Europe in the period 2020-2021. However, due to the methodological limitations mentioned in the background section, those figures have to be interpreted with caution. Excess mortality indicators are better suited for cross-country comparison [1].

3. Read more

COVID-19 Sciensano dashboard

Open data

Background

COVID-19 disease is caused by the SARS-CoV-2 virus. The most frequent symptoms are fever, cough, loss of taste and smell, and shortness of breath. In 80% of cases the infections are mild. The risk of developing a severe infection increases markedly with age and with underlying conditions such as heart, lung or kidney disease, diabetes, immunosuppression, or an active malignant disease.

In pandemic times, almost real-time monitoring of mortality is essential. In Belgium, the cause-specific mortality registration through death certificates is a two-year process, making it unsuitable for operational surveillance. For this reason, an ad-hoc registration in nearly real-time of COVID-19 mortality was set up for this emergency [3,4].

In accordance with the definition of the WHO [5] and the ECDC [6], Belgium has adopted a broad inclusion strategy for the surveillance of COVID-19 deaths, reporting also deaths in radiologically-confirmed cases and in possible cases based on clinical symptoms. Based on the pre-existing networks and collaborations set up for different health topics in long-term care facilities (LTCF), it was possible to rapidly start up the COVID-19 surveillance in LTCFs. It later highlighted the severity of the epidemic in LTCFs where the testing capacity was unable to follow the increase in cases during the first 6 weeks of the first wave.

As the situation is continuously evolving, this page provides links towards the continuous monitoring of the COVID-19 mortality on the Sciensano website. The page also presents the situation during the year 2020 (7th March – 31st December 2020), the year 2021, and 2022 of the COVID-19 epidemic in Belgium.

There are important limitations in the international comparability of COVID-19 mortality rates. Because of the differences in death notification methods between countries [7,8], COVID-19 mortality comparisons are not well suited for international comparisons. Indeed, in Belgium, as mentioned previously, deaths in patients with a positive laboratory test, a suggestive chest CT scan, or clinical symptoms are notified as COVID-19 death, while many other countries are much more restrictive. In addition to that, deaths occurring in nursing homes, long-term care facilities, and at home were included. Here we present the crude COVID-19 cumulated mortality rate per million of inhabitants in EU-14 for international comparisons [2]. Excess mortality indicators are better suited for cross-country comparison [1]. More information on excess mortality can be found on the website of the Belgian mortality monitoring project, in the press releases of Sciensano (Analysis of excess mortality linked to COVID-19 in 2020, Analysis of excess mortality in 2021, Analysis of excess mortality in 2022), and in the factsheet on excess mortality during the COVID-19 crisis.

References

1. Lagasse R, Deboosere P. Évaluation épidémiologique de l’impact du Covid-19 en Belgique à la date du 15 juillet 2020. Brussels; 2020. https://esp.ulb.be/fr/les-actus/les-actualites-de-lesp/rapport-d-analyse-de-l-epidemie-covid-19-n-ii
2. Ritchie H, Mathieu E, Rodés-Guirao L, Appel C, Giattino C, Ortiz-Ospina E, et al. Coronavirus Pandemic (COVID-19). Our World in Data. [cited 2022 Apr 28]; Available from: https://ourworldindata.org/covid-deaths
3. Renard F, Scohy A, Van der Heyden J, Peeters I, Dequeker S, Vandael E, et al. Establishing an ad hoc COVID-19 mortality surveillance during the first epidemic wave in Belgium, 1 March to 21 June 2020. 2021.https://doi.org/10.2807/1560-7917.ES.2021.26.48.2001402
4. Peeters I, Vermeulen M, Bustos Sierra N, Renard F, Van der Heyden J, Scohy A, et al. Surveillance of COVID-19 mortality in Belgium, epidemiology and methodology during 1st and 2nd wave (March 2020 - 14 February 2021). Brussels: Sciensano; 2021. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_THEMATIC%20REPORT_SURVEILLANCE%20OF%20COVID-19%20MORTALITY%20IN%20BELGIUM_2.pdf 
5. WHO. International guidelines for certification and classification (coding) of COVID-19 as cause of death. WHO; 2020 Apr. Report No.: WHO/HQ/DDI/DNA/CAT.
6. ECDC. Case definition for coronavirus disease 2019 (COVID-19), as of 5 May 2020. European Centre for Disease Prevention and Control. https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition
7. European Centre for Disease Prevention and Control (ECDC). Weekly surveillance report on COVID-19, Week 24, 2020. https://covid19-surveillance-report.ecdc.europa.eu/#4_severity
8. Institut national d’études démographiques (Ined). The demography of COVID-19 deaths - Seven data-related key issues. Ined - Institut national d’études démographiques. https://dc-covid.site.ined.fr/en/presentation/

Please cite this page as: Sciensano. Factsheets: Ad-hoc surveillance of COVID-19, 2020-2022, Health Status Report, 22 Feb 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/factsheets/ad-hoc-surveillance-of-covid-19-2020-2022