Are Covid-19 deaths being undercounted in Switzerland?

The number of people dying from Covid-19 can be difficult to establish. Undercounting can occur when another cause of death is assigned to someone who has died from the disease, a particular risk when people die outside hospital.

China recently increased the Covid-19 death toll in Wuhan by 50%, according to China’s Xinhua News Agency. 1,290 deaths were missed from the original number (2,579) because the health system was reportedly overwhelmed at the beginning of the outbreak. Some patients who died at home without treatment were not included, as were a number of people dying in medical facilities that were not not linked to the epidemic information network, said the report. On top of this, Xinhau reported that the rush to save lives left patient records incomplete and resulted in belated, missed and mistaken reporting.

Similar reports have emerged from northern Italy, where hospitals were overwhelmed and many people died at home.

One way to gain a sense of the scale of any potential undercounting is to compare total actual deaths to normal seasonal estimates based on historical data.

When researchers looked at all deaths in some northern Italian provinces they found official Covid-19 deaths explained less than half of the year-on-year increase in March deaths, leading them to suspect significant undercounting of Covid-19 deaths.

The chart above shows the pronounced spike in the death rate in northern Italy over and above what would be expected – chart source.

Is there an unexplained rise in deaths in Switzerland?

According to data from the FOPH published by RTS (see chart above), between 15 March and 5 April 2020, a total of 4,371 people over 65 died in Switzerland.

Based on historical figures, between 3,259 and 3,789 people in this age group would be expected to die over this period.

Based on the range of expected deaths over these three weeks there have been between 582 and 1,112 more deaths than forecast, or up to 34% more.

The total number of people over 65 officially dying from Covid-19 across these three weeks was 656, a number falling within the 582 to 1,112 range of deaths in excess of what would normally be expected over this period.

And while the official Covid-19 death figure of 656 is well below the excess death range median (847), it does appear to be within the bounds of probability.

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