Belgium’s Covid-19 Death Toll Is So High Because They’re Counting Properly

A number of news reports have speculated about Belgium’s high coronavirus death rate, some even calling the country a coronavirus hot-spot

Latest data show Belgium has suffered 82 coronavirus deaths per 100,000 people since the start of the outbreak. The figure is substantially higher than even Spain, which has suffered 57.7 deaths per 100,000 people, and Italy, which has suffered 52.5.

US President Trump even drew attention to Belgium in order to minimise the crisis in his own country, citing its mortality rate as evidence for his typically statesmanlike position that America is “doing great.”

Why Are So Many People Dying Of Coronavirus In Belgium?

A Wall Street Journal report published last night suggests Belgium’s mortality rate is high because it is the country with the most accurate count of its coronavirus deaths. While almost every country has a sizeable gap between official coronavirus deaths and the increase in mortality rate vis-a-vis previous years, Belgium does not.

This is because most countries only attribute a death to coronavirus based on a positive test, taken either during the patient’s sickness or shortly after death. Belgium, however, allows doctors to use their professional judgement to list a cause of death, as they do with other illnesses or injuries.

In the case of nursing homes, this often means counting deaths as caused by coronavirus based on reported symptoms in combination with the fact that other residents in the same home have previously tested positive. According to this methodology, more than half of Belgium’s Covid-19 deaths have occurred in nursing homes.

Belgian government minister excoriates Trump’s misuse of Belgium’s data

The high mortality in Belgium supports the point made a month ago by Melbourne University epidemiologist Professor Alan Lopez, who argued official coronavirus counts were “vastly underestimating” the true death toll.

Moving forward, the Royal Australian College of GPs recommended using “all-cause mortality to better gauge the impact of the coronavirus.”

Adopting this approach, a new Financial Times report suggests Peru may have the world’s highest Covid-19 per capita mortality rate, followed by the UK, with Belgium in third. On these numbers, coronavirus fatalities in some areas may be up to 60% higher than currently recorded.

It’s certainly food for thought when it comes to weighing the risks and benefits of re-opening businesses versus the threat of a second wave of infections.

In the chart below, from the US Centre for Disease Control, you can see that all-cause excess mortality (the black line) is considerably higher than the confirmed coronavirus deaths used to calculate the case fatality rate (CFR). This black line shows the extra deaths during the coronavirus outbreak in New York City, compared to a normal year. It is an imperfect but better proxy for the fatalities caused by the virus.