2020 saw Portugal register highest death toll in 100 years

2020 saw Portugal register the highest annual death toll for the last 100 years.

1920 saw 144,000 people die in a virulent outbreak of seasonal flu after two already bleak years in which Europe had suffered the Spanish Flu.

This year has seen 123,667 deaths, of which Covid-19 was directly attributed to ‘just’ 6% – or in numbers a little under 7,000.

This may be a perfect moment to really look at the horrors of the pandemic. Not because of the death toll per se, but because of the deaths not attributed to Covid-19 but which the virus appears to have precipitated.

Says Expresso: “Scientists at FCUL (the faculty of sciences at Lisbon University) have estimated that for every 10 deaths attributed to Covid-19, there have been four others ‘indirectly associated to the pandemic” – people whose conditions may not have been properly monitored, because of the focus on the virus, or people who simply ‘gave up’ trying to get the necessary healthcare they needed.

According to mathematician and member of the FCUL team Carlos Antunes, “there will have been roughly 2,800 indirect deaths to add to the 6,950 that we estimate occurred up to the end of the year”.

He told the paper, this is actually a lower number than FCUL had anticipated.

But epidemiologist Manuel Carmo Gomes, also a member of the FCUL team, stressed that “if it wasn’t for the measures of containment, the Covid death toll would have been immensely greater”. He didn’t elaborate on this assertion.

The figures therefore prompt quite a few questions – not least why has this year’s total of deaths been ‘so high’, when Covid-19 only accounted directly for 6%? (Even if indirect deaths are added to the total, Covid-19 was still only instrumental in less than 8% of deaths…)

INSA, the public health Institute Ricardo Jorge doesn’t appear to have the answers. It has however identified “four moments with excess mortality in 2020. The first occurred between March and April during the first phase of the pandemic (with 1,057 deaths in excess of average numbers). The second was in May – coinciding with days with very high temperatures (363 excess deaths). The third lasted for almost the whole month of July, coinciding with a period of extreme heat (2,199 excess deaths), while the last began on October 26 and is still running, in parallel with the second wave (2,836 excess deaths)”.

Said INSA’s Ana Paula Rodrigues, a public health doctor in the department of epidemiology: “The majority of periods with excess mortality will have been associated with phenomena like flu epidemics (pre-pandemic) and Covid-19, beyond periods of extreme heat. But we cannot exclude that in the periods of heat the variation of mortality may have been indirectly affected by the pandemic, due to less use and access to health services”.

Says Expresso, confirmation or otherwise of this will only be available after “detailed analysis of causes of death which is being done by DGS (health authority) and should be known in 2021”.

Thus for the time being “the calculations on excess mortality do not allow for conclusions on the weight of Covid-19. It’s not even possible to say that in themselves the 7,000 Covid deaths are an excess”.

“Part of this mortality could vary within expected values”, explained Ana Paula Rodrigues. “And if so it would not represent this excess…”

Online Postal.pt has carried its take on the year’s death toll, recalling that in the Spanish Flu outbreak of 1918, 253,000 people in Portugal died. The year after 154,000 succumbed.

Moving into this century, 2018 saw 113,051 deaths in Portugal. At the time, the high toll was attributed to the fact that the country had so many elderly people and there had been a stultifying heatwave.

Says Postal.pt “Covid-19 is responsible for around half the total of excess deaths” this year (though Expresso’s article suggests this is still not yet clear).

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image: Cemetery Alto do São João in Lisbon