COVID-19 the Likeliest Explanation for Excess Mortality in 2022

From the night shift at the COVID-19 ward.

Chief Epidemiologist Guðrún Aspelund believes that COVID-19 is the only possible explanation for excess mortality in Iceland last year, RÚV reports. Guðrún emphasised that vaccinations had in all likelihood reduced mortality and that the number of deaths was to be explained by a large number of infections.

COVID-19 deaths on the rise again

After a significant decline last autumn, the number of deaths due to COVID-19 has begun to rise once again; thirteen individuals died from COVID-19 in Iceland in January 2023, compared to an average monthly mortality rate of three between the months of August and October last year.

Yesterday’s RÚV reported that there had been an inordinate number of excess deaths last year, which suggests that twice as many people – or about 400 – had died from COVID-19 last year than previously thought.

Chief Epidemiologist Guðrún Aspelund told RÚV that COVID-19 was really the only explanation: “There were excess deaths in 2022 at around the same time as the big omicron wave hit between February and March. And then there was another smaller wave in July, which was when the excess mortality rate rose again,” Guðrún remarked. “And there is no other explanation for these deaths other than COVID-19.”

As noted by RÚV, excess mortality also increased in other countries after waves of COVID-19 passed. Guðrún noted that the pandemic could also have had an indirect effect on mortality: “It could mean reduced access to the healthcare system in some countries, or some other societal trends,” Guðrún observed.

More deaths in January 2023 than in all of 2021

In 2020, there were 31 confirmed COVID-19 deaths, while in 2021, the number decreased to 8. Last year year, however, there were 211 confirmed COVID-19 deaths, but as previously mentioned, the deaths last year were probably closer to 400. The latest available data from the health authorities are from January, 2023, which indicate that thirteen individuals died from COVID-19 during the first month of the year. This number exceeds the total number of deaths for all of 2021.

As noted by RÚV, there were also excess deaths in January: 70 deaths per 100,000 inhabitants, while deaths in January are, on average, usually around 60 per 100,000 inhabitants. Guðrún noted that around the turn of the year, there was a great number of covid infections. “But then there were also other infections, like influenza and RS.”

More infections = more deaths

82% of the population, aged five and over, are fully vaccinated against COVID-19, and more than 55% of the nation has been diagnosed with the disease. Given this, a reporter from RÚV asked why the number of COVID-19 deaths had increased last year.

Guðrún replied that a rise in the number of deaths could not be attributed to vaccinations. “On the contrary, I think the situation would have been much worse if there had been no vaccinations … the omicron wave was, of course, much bigger than others that had preceded it, and, as a result, more people got sick,” Guðrún remarked.

Lower Mortality Rate in Latest COVID-19 Wave

landspítali hospital

COVID-19 continues to spread through the community, but a closer look at the data presents a silver lining to the latest wave. While far more Icelanders diagnosed with the coronavirus have died in recent months, the mortality rate is actually lower than in prior waves.

During earlier waves of the pandemic, roughly 0.5 percent of those diagnosed with COVID-19 succumbed to the virus. However, since the Delta variant arrived in the country in the summer of 2021 the mortality rate dropped to 0.03 or 0.04 percent, a 10 or 15 percent decrease, RÚV reports.

Chief Epidemiologist Þórólfur Guðnason attributes the lower mortality rate to high uptake of vaccinations in the country.

Over the course of the pandemic, 93 deaths have been associated with COVID-19 infection, 56 of which have occurred this year.

The country appears to have reached the peak of the latest wave, driven by the highly transmissible Omicron variant, though an average of 1,500 new cases are being diagnosed daily through PCR and rapid testing.

Hospitals examining their alert levels

Landspítali’s Epidemic Committee is looking at how the hospital can scale back its alert level in a safe manner after weeks of operating at an emergency alert level, RÚV reports.

There are 72 patients currently in hospital with COVID-19, 64 of whom are in isolation and four are on respirators. Six children are currently being hospitalised for COVID-19.

A lot of illness going around

Despite COVID-19 cases trending in the right direction, there is a lot of illness circulating in the community, Óskar Reykdalsson, director of the capital area health care centres, told RÚV.

In addition to the coronavirus, influenza is spreading rapidly. Thanks to health measures in place to prevent the spread of COVID-19, less flu had been spreading in Iceland over the past two years.

Óskar said that it is typical that the flu is more widespread after years of lower instances. Health facilities ordered more influenza vaccine this year in anticipation of higher numbers, but demand hasn’t met supply.

“I was actually quite surprised that it was not just all used up and finished,” Óskar told Channel 2 radio. “95,000 doses were ordered for the country and 67,000 doses have been used.”

Asked whether people would be able to distinguish between having COVID-19 or influenza, Óskar said that there were differences between the pace of the diseases. With influenza, people suddenly get a high fever and headache and then the cold creeps in. With COVID-19, on the other hand, symptoms start rather mildly but then the disease grows.

Fewer Deaths Than Expected Despite Widespread Infections

Kamilla Jósefsdóttir

More people have died from COVID-19 during the first three months of 2022 than during the entirety of 2020 and 2021, Fréttablaðið reports. Ninety-one deaths have been reported from COVID-19 since the start of the pandemic in Iceland, 54 of which occurred during the new year. The newest wave of the pandemic has, however, seen fewer deaths than expected. 

Thirty-seven deaths in 2020 and 2021

Twenty-nine individuals died from COVID-19 in 2020, according to a report from the Directorate of Health. By the end of 2021, eight more individuals had passed away from the disease, or a total of 37. Since the start of the new year, 54 COVID-related deaths have been reported.

“We count deaths that doctors report as being connected to COVID-19,” Kamilla Sigríður Jósefsdóttir, Deputy Chief Epidemiologist, noted in an interview with Fréttablaðið yesterday. “We’re unable to make a further distinction. If the death is believed to have originated from an entirely different cause, then it should not be reported.”

Fewer deaths than expected

The most recent wave of the pandemic – primarily attributed to the spread of the Omicron variant – has proven especially infectious (two weeks ago, it was estimated that 70% of Icelanders had already been infected); given the number of cases, however, there have been fewer deaths than expected as compared to previous waves of the pandemic.

With a spike in cases, many vulnerable individuals – the elderly and those with underlying conditions, for example – have become infected with the disease. In an interview with Viljinn on Monday, Kamilla maintained that most of those who died from COVID-19 recently – but not everyone – suffered from underlying conditions, which influences the seriousness of the illness.

“One of the reasons why social restrictions were lifted was that Omicron was causing less serious illness compared to earlier variants, which meant that there was less need for restrictions than before,” Kamilla stated. Despite the relative benignity of the Omicron variant, there is still ample reason to practice personal disease-prevention measures:

“Avoiding contact with vulnerable individuals if you’re symptomatic and/or using a mask when close contact is unavoidable and when conditions allow. Washing your hands – etc.,” Kamilla observed. 

Not comparable to flu season

When asked if the current wave of COVID-19 was comparable to the flu season, Kamilla replied that the death rate for COVID-19 was much higher. If such an analogy were to be made, then it should be compared with influenza pandemics, which are much more serious.

According to Kamilla, the mortality rate from COVID-19 during this most recent Omicron wave is nine times greater per 100,000 residents than the mortality rate during the annual flu season in the United States. It’s also 2.5 times higher than the mortality rate in the US during the 2009 swine flu pandemic.