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Real-time monitoring shows substantial excess all-cause mortality during second wave of COVID-19 in Europe, October to December 2020

Our take —

All-cause excess mortality during the second wave of the pandemic (after week 40 in 2020) was described for 27 countries and sub-national areas in Europe. There was a substantial increase in excess all-cause mortality in the pooled analyses across all countries, however the excess mortality observed was lower than what was seen during the first wave of the pandemic. Those 65 years and older saw the greatest increase in excess mortality. Delays in reporting deaths at the end of the study period (week 50 and beyond) may have resulted in falsely lower mortality estimates for this period.

Study design


Study population and setting

Weekly all-cause deaths from registers or other official sources were reported for 27 countries and subnational areas participating in the European Monitoring of Excess Mortality for Public Health Action Network. Excess deaths were estimated by subtracting the expected number of deaths from those that are observed, overall and by age group (<=14, 15-44, 45-64, 65-74, 75-84, 85+ years old). Additionally, weekly observed deaths for 2020 were compared to weekly deaths observed in 2017, 2018, and 2019. Estimates were standardized using z-scores to compare across countries. Particular focus was given to examining trends during the “second wave,” or weeks 40-52 of 2020 (September-December). Countries reporting no or limited excess mortality included Cyprus, Estonia, Finland, Berlin (German federal state), Ireland, Malta, Northern Ireland, and Norway.

Summary of Main Findings

An increase in excess all-cause mortality was first seen in Israel in Week 37, then in Spain in Week 41 and in Italy and the Netherlands in Week 42. Excess mortality was also observed in Austria, Belgium, England, France, Greece, Hungary, Portugal, Slovenia, and Switzerland. The pooled analysis across countries showed an increase starting in Week 40. The pooled excess mortality across countries was 15,392 excess deaths (z-score=24.8) for all ages in week 46; this number is lower than the estimated excess deaths reported for the first wave (35,408 deaths, z-score=55). By age group, those age 65+ saw the greatest increase in excess mortality, with low levels seen in those 15-44 years old and none among those 0-14 years old.

Study Strengths

Routine collection of mortality data allows for weekly, essentially real-time monitoring of excess mortality. Stratification by age allows for further nuance in our understanding of excess mortality, that is who in the population is most affected by excess mortality.


Delays in reporting of deaths may result in lower estimates for the end of the study period (weeks 50 and beyond); as such, this period should be interpreted with caution.

Value added

This study helps us to understand both the all-cause excess mortality across 27 countries and sub-national areas in Europe, and allows us to make comparisons between the first and second waves of the pandemic.

This review was posted on: 19 February 2021