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The mystery of excess deaths

feature theo a patient in the icu at the height of the pandemic
A patient in the ICU at the height of the pandemic.

Covid does not explain more people dying each year

The week-by-week mortality figures – all-cause deaths – supplied to Eurostat for 2022 are now complete, though it’s important to note that the number is provisional. There does seem to be a marked trend pointing to increased mortality, however.

These are the total numbers of deaths per year in Cyprus, for the past seven years:

2016 – 5,448
2017 – 6,009
2018 – 5,798
2019 – 6,218
2020 – 6,579
2021 – 7,078
2022 – 7,354

The totals for 2021 and 2022 are provisional. (Final numbers take two years to be published; 2021 will be coming out soon, last year’s total in 2024.) One might assume that to be irrelevant, since the total can only go up as more death certificates are added – but in fact it could go down as well. One example is the issue of citizens living in the north (mainly Turkish Cypriots) whose families report their deaths in the Republic. Such cases will be forwarded to Eurostat but won’t count in the final results, which include only permanent residents.

It’s not usually a big problem – but it could be. The Eurostat total for 2020, for instance (6,649), was only 70 more than the official total (6,579); still, the final tally was lower. That’s why one should take recent figures with a pinch of salt.

Even with that caveat in mind, however, the overall trend is unmistakable. 2019 was already a bad year, yet its 6,218 deaths pale beside the (approximately) 7,354 deaths of 2022; that’s an 18 per cent increase. If you took the average deaths in 2016-19 (5,868), it’d be a 25 per cent increase!

Put another way, 1,486 more people died last year than the pre-pandemic average. That’s an additional 28 people dying every single week.

So what’s causing the increase?

“It’s almost exclusively due to Covid,” Maria Athanasiadou from the Health Monitoring Unit of the Ministry of Health told the Cyprus Mail, ascribing most of the increase in 2020-21 to the Covid deaths (around 100 and 600, respectively) in each of those years. But it’s not like Covid is surplus to the mortality we’d experience in a normal year; it doesn’t strike randomly, like a war or an earthquake. Many of those unfortunate people (especially the large proportion who died ‘with’ Covid) would’ve died anyway, of other things – especially with a virus that disproportionately targets the frail and elderly.

Another popular explanation is the natural one of an ageing population. But not only do these figures seem too high to be caused by natural ageing, it’s also that the years 2016-19 didn’t show this kind of consistent, year-on-year increase. Wasn’t the population ageing then, too?

Besides, it seems perverse to talk of demographics when so much has happened in the past three years: the once-in-a-generation event of a global pandemic of a novel virus, followed by the unprecedented events of total lockdown and mass vaccination with a new kind of vaccine. It’d actually be strange if there weren’t some impact on mortality.

Also, of course, it’s not just in Cyprus. Excess deaths have been reported all over the world. Some countries peaked earlier (Bulgaria saw a huge 40 per cent excess in 2021, but is now back to normal), others are still ongoing (deaths in Australia were 13 per cent higher than expected in the first eight months of 2022, according to that country’s Actuaries Institute). Much excess death has been correlated to Covid waves – yet the UK, for instance, continues to see a big surge, even with Covid deaths falling. ‘Why are excess deaths still so high?’ asked an article at Unherd a few weeks ago.

“Despite relatively low Covid death rates, overall excess deaths in all age groups in Europe in 2022 were as high as in 2020 and higher than 2021 – even in the oldest cohorts,” wrote Thomas Fazi and Toby Green in that article. “In Portugal, December saw excess deaths which beat all records of the previous 13 years, including during Covid-19.” Beyond Europe, non-Covid excess in the US was higher in the first half of 2022 than in 2020 or 2021 – while, just two weeks ago, New Zealand reported its biggest increase in registered deaths in 100 years, “attributed to Covid-19 and an ageing population” according to the New Zealand Herald.

Other causes have also been cited for all this. Summer heatwaves have been blamed – though not in Cyprus, where deaths were only slightly elevated this past summer. The resurgence of flu, RSV and other respiratory viruses that lay dormant during Covid has been used to explain the recent excess – in which case things should get back to normal in 2023.

Again, though, it’s impossible to ignore the obvious culprits. Thus, one explanation for our high deaths might indeed be Covid – not just the illness itself (which directly caused only two per cent of deaths in 2020, and nine per cent in 2021), but also Long Covid and the long-term damage potentially done by the virus.

A second explanation (more than one may apply, of course) might focus on the impact of lockdowns and Covid restrictions. Not only did hospitals become no-go zones during Covid waves, causing people with other conditions to die at home, but many also missed doctors’ appointments and cancer screenings, missing danger signs and allowing illness to become untreatable.

Then there was the mental trauma caused by isolation and loss of income, the increases in obesity and substance abuse due to anxiety and lack of exercise, and so on.

A third, more speculative explanation might focus on the role of mass vaccination, whether due to adverse reactions (like causing heart damage in young men) or long-term effects to the immune system.

We’re still finding out about the jabs. A recent study showed, for instance – to quote an article by William A Haseltine in Forbes, hardly a hotbed of anti-vaxers – that “repeated exposure to [mRNA] vaccines produces a rare form of antibody, IgG4”, which “does not activate the effector functions” like other IgG antibodies.

To be clear, no-one knows for sure what the change to IgG4 might imply. The link between vaccines and deaths is still unquantified – and quite controversial.

In Cyprus specifically, Theodore Lytras from the School of Medicine, European University Cyprus – in collaboration with government officials from the Health Monitoring Unit – produced a paper last August with the unambiguous title ‘Excess mortality in Cyprus during the Covid-19 pandemic and its lack of association with vaccination rates’.

“We calculated weekly excess mortality for Cyprus between January 2020 and June 2022,” explains the abstract to this paper. “Excess mortality was moderately increased in Cyprus during the Covid-19 pandemic, primarily as a result of laboratory-confirmed Covid-19 deaths. No relationship was found between vaccination rates and all-cause mortality, demonstrating the excellent safety profile of Covid-19 vaccines.”

Is Covid to blame, as the paper strongly implies? One oddity is that not all Covid waves were alike. The second wave at the end of 2020 and beginning of 2021 (before vaccines) did produce some elevated mortality for a few weeks in December – but it’s dwarfed by the Omicron wave a year later, even though everyone was boosted and Omicron was ostensibly milder. Consider the numbers for the first 10 weeks of each year, from Eurostat figures:

2019 – 1,467
2020 – 1,462
2021 – 1,388
2022 – 1,799

What caused that massive spike in 2022? (Again, the figure is provisional.) If Covid is the culprit behind increased mortality, why did a milder strain wreak such havoc in a vaccinated and largely immune population? And why did the last three months of 2022 post figures similar to a year earlier – 1666 deaths in 2021, 1621 in 2022, per Eurostat – now that the pandemic is essentially over?

Then again, looking at mortality among the under-45s – a demographic less at risk from Covid, or even Long Covid – does show a smaller effect than in the older population. These are the totals for people under the age of 45, per year (the last two from Eurostat figures):

2019 – 220
2020 – 213
2021 – 241
2022 – 232

A worrying trend, for sure. Still, we’d expect a more pronounced increase if excess deaths were being caused predominantly by vaccines, or the effects of restrictions and lockdowns – both of which would impact the young just as much as the old, probably even more in the case of lockdowns. There’s admittedly a spike among youngsters for about 10 weeks in mid-2021, which may be related to vaccine injury (that was when vaccines were being offered to this age group), but it doesn’t last long.

If deaths are being driven mostly by older cohorts, then Covid does seem plausible as a cause. Then again, it’s also possible that younger people have indeed been hit hard, they just haven’t succumbed (yet). It’d be interesting to measure people’s health in general, and compare those indicators to before the pandemic.

In the end, the inescapable bottom line is that more people are dying – all over Europe and the West, but also here in Cyprus. It’s important to track down the cause, even (or especially) if it means asking hard questions about the official response to Covid.

More information about health in general would be useful too. Have rates of depression gone up? Have cancers increased? How about autoimmune disorders? All these deaths aren’t just coming out of nowhere. Vaccine injury shouldn’t be such a taboo topic, either.

There could also be a fourth explanation for the excess deaths, namely the increasing dysfunction of our health system. The shift to Gesy, in the midst of pandemic frenzy, has been difficult. Hospitals were often unable to cope; even now, we hear stories of ambulances taking ages to arrive, sick people forced to wait hours at A&E, beds being unavailable and elderly patients left untreated in care homes. People dying in concerning numbers is a global phenomenon, but there may be specific factors in Cyprus making it worse. This, too, ought to be investigated.

After the shocks of the past three years, a general decline in health is perhaps inevitable. Unfortunately, it’s not getting any better.

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