Early COVID-19 Deaths May Be Understated

More Australians likely died from COVID-19 during the first weeks of the virus outbreak in Australia than has been reported, with deaths attributed to other causes because testing was limited.

An Actuaries Institute research paper found a spike in deaths from pneumonia, stroke and diabetes, all causes of death related to COVID-19 in some way, during March and April 2020. At that time, testing for the virus was not widespread.

“The last week of March and the first week of April each had much higher deaths than predicted,” said Jennifer Lang, Convener of the Actuaries Institute’s COVID-19 Working Group.

The Working Group’s actuarial modelling allowed for improved mortality trends, the ageing of the population and a growing population. It was based on Australian Bureau of Statistics data on doctor certified deaths. The modelling predicted that death rates in 2020 would be lower than the 2015-19 average. “Actual deaths this year have been broadly as expected based on our modelling except for the period mid-March to mid-April,” Ms Lang said.

 

 

In that period, coinciding with the first peak of infections and deaths from COVID-19 in Australia:

• the week ending March 24 had considerably higher deaths than expected (by around 100);
• the last week of March and the first week of April each had much higher deaths than expected (by around 200 each week); and
• the second week of April also had higher deaths than expected (by around 75).

These higher than expected deaths are not explained by official COVID-19 deaths. There were only 56 such deaths over this four-week period. Deaths from influenza and pneumonia were within a reasonable range of predicted numbers up to the week ending March 17, the paper states. “For the next four weeks, deaths from influenza and pneumonia were significantly higher than predicted.” COVID-19 often presents as similar to pneumonia.

For six weeks from March 24, deaths from diabetes were significantly higher than predicted. Diabetes is a known comorbidity of COVID-19. Deaths from strokes and brain haemorrhage were fairly close to predicted numbers except for the three-week period from March 31, when fatalities rose.

This followed a period when brain scans for stroke fell sharply, possibly reflecting people’s reluctance to visit hospitals. Quick treatment is important in the event of a stroke and reduced scan activity may have directly led to more deaths. However, stroke is also a known complication of COVID-19.

Actuaries Institute President Hoa Bui said the COVID-19 Working Group had provided significant guidance to business and the community in the months since the WHO declared the virus a global pandemic. “Actuaries have the skills to look at large data sets, model outcomes and advise Boards and management on what it means for their business,” Ms Bui said. “Research can help look back at what actually happened, highlight deviations that may not be apparent at the time, which in turn can help identify what we might do differently.”

The COVID-19 Working Group, of up to 80 volunteer actuaries, have produced 17 pandemic briefings and over 70 papers.

Some of the few positive outcomes of the pandemic in terms of death rates include:

• lower numbers of deaths from motor vehicle accidents during the lockdown period, and
• lower levels of respiratory disease in Australia since early April. This is likely to result in fewer deaths from respiratory illness during winter 2020.

Ms Lang said it was pleasing to see no increase in the number of suicides in Victoria, the only state subject to a lockdown in the second wave. Victoria’s Coroners Court released suicide data to 26 August. However, she said experts consider suicide risk reflects cumulative effects of stressors over time, and the ultimate impact of the pandemic on suicide rates may yet be seen.

Ms Lang also said future deaths from some causes, such as cancer, may be higher than usual due to delayed diagnoses or missed treatments. She said examining data on deaths provides an extra view on the effect of COVID-19 and lockdowns, and helps policymakers understand the impact on public health and whether officials may do things differently in future.