Nearly 11 thousand more deaths than expected during second wave

Four phases can be distinguished in the mortality figures when looking at the second wave of the coronavirus epidemic. During the first and second phase, there were several weeks of excess mortality, whereby mortality rose outside the range of usual fluctuations. In the third phase, mortality was below the expected level for several weeks (but within the interval, meaning there was no undermortality). During the last phase (up to week 24 inclusive), mortality was higher than expected (but within the interval), with excess mortality in one single week. In week 25, mortality was lower than expected, and in the following week as expected again.

At the beginning of January, the Netherlands started its vaccination programme. Elderly people and people in long-term care institutions were the first to be vaccinated.

Higher mortality caused by COVID-19

The higher mortality figures during the second wave are entirely due to COVID-19. Between mid-September and the end of March (the period for which the figures on causes of death are known), 18.0 thousand people died of COVID-19. The total number of deaths in that period was 9.2 thousand higher than expected. The fact that the number of COVID-19 deaths was higher than excess mortality up to the end of March is related to the absence of a flu epidemic in the winter of 2020/'21. In an average year, relatively many people die during a flu epidemic in the winter. During the first wave of the coronavirus epidemic, mortality from COVID-19 was more or less the same as excess mortality.

Elevated mortality among long-term care users, but to a lesser extent than during the first wave

During the second epidemic wave, there were 3.7 thousand more deaths (8 percent) among people receiving care under the Long-term Care Act (Wlz) than expected. At 9 percent, this was slightly higher among the rest of the population (7.0 thousand more deaths). During the first wave, there were 5.2 thousand more deaths among long-term care recipients than expected, and 3.8 thousand more deaths among the rest of the population.

Among long-term care users, more people than expected died during the first and second phase of the second wave. At 22 percent, excess mortality was slightly higher in the second phase than in the first phase (20 percent more deaths). There were also more deaths among the rest of population during these two phases, but excess mortality was lower than among long-term care users (13 percent during the first phase, 12 percent during the second).

Mortality declined in the third phase, with 11 percent fewer deaths among long-term care users than expected. Among the rest of the population, the death rate was approximately at the expected level. The fourth phase saw an increase in mortality among the rest of the population; there were 10 percent more deaths than expected. The mortality rate among long-term care recipients was 5 percent lower than expected.

Higher mortality among men

Although there are more elderly women than men, more men died during the second wave of the coronavirus epidemic (65.8 thousand men against 64.5 thousand women). There were 6.9 thousand more deaths among men (12 percent) and 3.9 thousand more deaths among women (6 percent) than expected. During the first wave, mortality among men was also more elevated.

Mainly more deaths among 65 to 79-year-olds

During the second wave of coronavirus, there were 4.9 thousand more deaths (7 percent) among the over-80s than expected. In the age group 65 to 79 years, there were 4.9 thousand more deaths (14 percent) than expected. Among people under 65, this number stood at 0.9 thousand (6 percent). During the first wave, excess mortality amounted to 5.7 thousand among people aged 80 and over, 2.7 thousand among 65 to 79-year-olds and 0.5 thousand among people under 65.

Higher mortality during the second wave of coronavirus was first seen among people aged 80 and over. Not much later, the number of deaths also increased among 65 to 79-year-olds. Mortality remained above the expected level for a longer time in this age group. Among people under 65, there were a few weeks with elevated mortality during this period.

During the third phase (in early 2021), mortality among the over-80s fell rapidly and has since remained below or around the expected level. There were 10 percent fewer people aged 80 and over than expected in this phase. Mortality among people under 80 was also lower in this phase than in the first two phases. In the fourth phase, however, the number of deaths in this age group rose again resulting in excess mortality.

Data sources for RIVM

To date, the National Institute for Public Health and the Environment (RIVM) has registered 17,757 COVID-19 deaths. These include 11,376 recorded since mid-September (as at 6 July 2021). RIVM receives data on confirmed COVID-19 deaths from municipal health services (GGD) around the country on a daily basis. The actual COVID-19-related death count in the Netherlands is higher because of the following reasons: it is possible that not all people with COVID-19 have themselves tested, there is no reporting obligation for COVID-19 and registration sometimes takes a little longer.