‘It’s all hands on deck’

From the beginning of December to Christmas, 9,294 people died in our country. That is an average of 19 percent more than in other December months, in years without corona that is. But unlike in previous years, corona has nothing to do with it this time. Then what? Flu, RSV or even particulate matter? Sciensano is helping to find the cause of the sudden excess mortality.

Marc Coppens

It has been remarkably busy at funeral directors and crematoriums in recent weeks. “The situation cannot of course be compared to the busiest periods during the corona pandemic, but it is still all hands on deck here and we have to work quite a bit of overtime to be of service to everyone,” says Jill De Ras of funerals De Ras in Lede and Berlare. “We are not the largest player in the market, but we still provide around 250 funerals a year on average and it is already busier in the winter months than in the summer. In recent months we have organized about 30 to 35 funerals, in 2020 it was often 40 or 45.”

That it is busy, can be read in black and white at the Belgian Statistical Office Statbel. There were 9,294 deaths from early December through Christmas. That is less than the 9,331 in 2021 and the 9,798 in 2020, but 17.6% more than in 2019 and even 18.6% more than in 2018. Compared to the December average measured between 2009 and 2018, 2022 even counts 19% more deaths. It is not due to corona, because between December 1 and Christmas Eve, according to Statbel, there were 222 deaths due to Covid-19. In 2021 there were 976 in the same period and a year earlier there were even 2,239. At that time, the corona virus was raging in full force and there were no vaccines yet.

If corona doesn’t explain the excess mortality, what does? At Sciensano they can’t quite put their finger on it. “The fact is that more people always die in the winter, January is the month with the most deaths,” it sounds. “It is also important to emphasize that the number of deaths in a certain period cannot be compared one-to-one between different years. To determine the real excess mortality, we therefore calculate the difference between the actual number of deaths in a certain period and the number of deaths that were expected in that period using a statistical model. It is therefore not entirely correct that there was almost 20% excess mortality in December. It is rather around 14%, with the excess mortality mainly concentrated in the penultimate week of the year. We do not yet have the full figures for the last week.”

Flu, RSV and Covid

Sciensano nevertheless cites the flu as a possible cause of the excess mortality. On average, half a million people in our country are affected by the flu every year. In the last weeks of December, an RSV epidemic and a flu epidemic raged at the same time. It is rather exceptional that people die directly from the flu. In 2013 there were 147, but in most other years it is between 50 and 100. “Influenza, but also other respiratory diseases such as Covid-19 and RSV, are known to be a risk factor for death, especially in the elderly,” says Sciensano .

Fine dust

In addition to the flu, the December cold sting may be an even more important explanation for the excess mortality. From December 8 to 18, freezing temperatures were recorded throughout the country and from December 15 to 18 there was an awful lot of particulate matter in the air. These high particulate matter concentrations arise because the air pollution from industry, agriculture, traffic and building heating is poorly diluted by low wind speeds. Due to the cold weather, emissions from wood-burning stoves are also higher. “Those elements may have played a role in the observed excess mortality,” Sciensano acknowledges. “The connection seems logical, but for December we cannot yet scientifically substantiate this because we do not yet have insight into the exact causes of death from the death certificates,” the spokesperson adds. The impact of particulate matter on health cannot be underestimated. The European Environment Agency published a report two years ago stating that pollution with particulate matter in our country is the cause of no fewer than 6,500 premature deaths.

Not only in our country is excess mortality reported in December, in the Netherlands there is even a quarter more deaths. “The population pyramid in Western European countries is quite similar,” says Sciensnao. “Belgium and the Netherlands both have an older population. The older age categories are more sensitive to the risk factors that promote excess mortality. At the end of December, most other Western European countries also had to contend with excess mortality to a greater or lesser extent.”

In Belgium, 6,500 people die prematurely every year from the consequences of particulate matter.Image Marc Baert

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