The news about excess mortality in the Netherlands has not gone unnoticed. Not surprising, because we are dealing with a unique situation. Health researcher Anton Kunst, who specializes in researching trends in mortality, agrees. He works as a professor Social Epidemiology at the Amsterdam UMC. He is also part of a committee of ZonMw, an organization that finances and commissions research into excess mortality during the corona pandemic, among other things.
‘Normally you see a few clear peaks in the year in which excess mortality occurs, for example due to a flu epidemic. But I did not expect that the excess mortality would also continue in 2022,’ says Kunst.
Excess mortality in the Netherlands in 2022
So what kind of numbers are we talking about? According to Statistics Netherlands, 14,500 more people died than expected in 2022, which is an excess mortality of 9.3 percent. This excess mortality was measured in all age categories. Then of course the big question is: why? How do we find out the cause? Which reasons can we rule out and which things remain uncertain? These are questions to which various studies funded by ZonMw will provide answers.
Did the corona vaccine cause the excess mortality?
Let’s start with the most infamous potential cause: the corona vaccination. You can’t open social media, or you read comments somewhere in which ‘the jab’ is blamed for (sudden) deaths. Unjustly, thinks Kunst: ‘On the basis of the clinical studies that were carried out prior to the administration of the vaccine, we can say that the vaccine is safe. It is therefore very illogical that the vaccine is one of the explanations for the excess mortality.’
Yet some people seem to have that image. ‘That is why it will be investigated in 2023,’ says Kunst. ‘If only to clarify what is really happening in the Netherlands.’
Vaccination data has been released
But those concerns have been around for a long time. Why will the link between vaccination and excess mortality in the Netherlands only be investigated this year? That has everything to do with the locked vaccination data. RIVM cannot simply announce who has and has not been vaccinated in the Netherlands because of the GDPR legislation. This European legislation guarantees the protection of personal data. And without this data, it is difficult to compare vaccinated and non-vaccinated.
‘But at the end of 2022 the vaccination data were released anonymously,’ says Kunst. ‘Now research proposals can be submitted, and I’m sure they will come. It’s super interesting data to research. I expect the first results on the differences in excess mortality between vaccinated and non-vaccinated to be published in the course of 2023.’
However, Kunst emphasizes, given the positive results of previous clinical research, it is unlikely that we will see that the vaccine is the (main) cause of the excess mortality. Especially since most of the excess mortality can be explained much more simply.
Possible explanations for the above-average number of deaths
In fact, according to Kunst, about 90 percent of the current excess mortality in 2022 is quite clear. For that we only have to look at the data from Statistics Netherlands, which takes over and collects the causes of death from death certificates. ‘In 2020 and in 2021, the number of people who died from corona was quite similar to the estimated excess mortality. This way you can easily see that there was a strong connection between covid-19 and excess mortality in those years. Only in the fall of 2021 was there a bigger difference.’
The data of causes of death in 2022 is already largely known, until September. ‘Eighty percent of the excess mortality corresponds to the number of corona deaths,’ says Kunst. ‘In addition, there was a flu epidemic that contributed to the excess mortality, and there were also much milder cold viruses circulating. People with fragile health can also die from such mild viruses.’
Influence of the weather
And what people often don’t realize is how big the influence of the weather is on the number of deaths in the Netherlands. For example, in 2022 there was a heat wave in the summer, which was already quite warm anyway. The KNMI reported 81 warm days instead of the usual 64. ‘On every day that is warmer than 25 degrees, mortality increases,’ says Kunst.
But the biggest killer is the cold. ‘In December it was almost ten degrees colder than usual for a week, it was -5 instead of above zero. That ten-degree difference results in a 10 percent increase in mortality. You can simply calculate that.’ A cold week in particular can be fatal for the elderly and heart patients. The cold air puts stress on the body, putting extra strain on their cardiovascular system, sometimes resulting in a heart attack.
Deferred care
All the above explanations are quite easy to trace: we know what the influences of the weather and viruses are. Added together, according to Kunst, they explain about 90 percent of the excess mortality. That leaves about 10 percent ‘unexplained’ excess mortality. If you want to explain this, you end up with things that are more difficult to research, such as the consequences of delayed care and the indirect consequences of corona.
For example, several studies show that infection with the virus entails an increased risk of cardiovascular disease. ‘Suppose someone experiences a corona infection’, Kunst begins, ‘and dies of heart failure a year later. Then his death certificate does not state that he died of corona. While it did start there.’
And then the deferred care, how do you research something like that? ‘These consequences are chronic and run throughout the year. Then a precise cause is more difficult to find out. You don’t see a clear peak, like with a flu epidemic.’ For example, if you want to know whether people died more often from cancer due to delayed care, you will have to look at the data of individual patients from 2019, 2020, 2021 and 2022. ‘You want to know at what stage the cancer is when people report to the oncologist and how many people subsequently die. You can then see, for example, whether people approached the doctor at a later stage during the pandemic.’
Such studies are now underway, but it is not yet clear how great the effect of delayed care is. ‘That takes time,’ says Kunst. ‘You have to follow people for years. But it is certainly being investigated.’
The impact of the energy crisis
Another potential cause of the high excess mortality, which according to Kunst often remains underexposed, is the strained economy in the Netherlands. There is a shortage on the labor market, which means that people often have to work harder due to the lack of colleagues. Earlier research showed that mortality increases during such times. In the Netherlands, inflation is now spiraling out of control and people are literally left out in the cold due to the energy crisis. ‘ 2022 was a restless year and certainly not good for our overall well-being. That causes extra stress for many people.’
Although stress is often a slow destroyer of the body, it can have an effect quickly. ‘Someone who already had heart problems could suffer a heart attack because of all the stress, for example. Even more so if there is a virus involved. All these causes cumulate.’ It’s a snowball effect: everything reinforces each other.
Optimistic but vigilant
The fact that public health has taken a hit is also reflected in life expectancy. It logically plummeted at the beginning of the corona pandemic. ‘But normally life expectancy rises back to the old level and even above it quite quickly after such a drop. That was not the case in 2022. The rise is very slow.’
Still, Kunst has hope that things will turn out well. “The virus is no longer as dangerous as it was at the moment. That helps. We can be optimistic, but let’s also remain vigilant.’