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The proportion of COVID-19 deaths in Central Europe in 2020 and 2021 would have been up to 18-27% higher if the virus had been listed as the cause of death on the death certificate, a new study estimates. study Published in PLOS One.

Researchers led by the University of Warsaw examined 187,300 death certificates from Austria, Bavaria (Germany), the Czech Republic, Lithuania and Poland that mentioned COVID-19 in 2020 and 2021. They conducted a two-stage analysis of the cause of death associated index (CDAI) and attributable CDAI to estimate the statistical strength of the association between COVID-19 and other medical conditions.

“Excess deaths reported from causes other than COVID-19 could be due to unrecognized coronavirus infections, interruptions in treatment due to overcrowding in health facilities, or the socio-economic effects of the pandemic and lockdown,” the authors note. “Death certificates provide comprehensive medical information and make it possible to assess the extent of unrecognized COVID-19 deaths.”

There are many possible reasons for the undercount

A total of 15,700 death certificates listed COVID-19 as the cause, and three out of four deaths had a statistically significant COVID-19 complication or pre-existing condition recorded as the cause.

In Austria and the Czech Republic, unrecognized coronavirus deaths amounted to the entire excess deaths over registered COVID-19 deaths, and also accounted for a large proportion (25-31%) in Lithuania and Bavaria.

“In Austria, Bavaria, the Czech Republic, and Lithuania, COVID-19 mortality would have been up to 18-27% higher if COVID-19 had been classified as a cause of death,” the researchers wrote. “Unrecognized coronavirus deaths represented the entire excess mortality over registered COVID-19 deaths in Austria and the Czech Republic, and a large proportion of them (25-31%) in Lithuania and Bavaria.”

This undercount could be due to a shortage of COVID-19 tests, atypical disease courses, misclassification, or an increase in deaths from other causes such as cardiovascular disease and cancer as health systems were overwhelmed and COVID-19 patients were prioritized, or a decrease due to reduced risk factors such as air pollution, traffic congestion, and other infectious diseases.

“Finally, adverse behaviors typical of the socio-economic instability experienced by some groups during the pandemic, lockdowns and economic slowdown, such as substance abuse, suicide and accidents, may have led to increased mortality,” the researchers wrote.

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