{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T10:55:32Z","timestamp":1775127332327,"version":"3.50.1"},"posted":{"date-parts":[[2020,5,2]]},"group-title":"Epidemiology","reference-count":29,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2020,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>INTRODUCTION<\/jats:title>\n                  <jats:p>The COVID-19 pandemic is an ongoing event disrupting lives, health systems, and economies worldwide. Clear data about the pandemic\u2019s impact is lacking, namely regarding mortality. This work aims to study the impact of COVID-19 through the analysis of all-cause mortality data made available by different European countries, and to critique their mortality surveillance data.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>European countries that had publicly available data about the number of deaths per day\/week were selected (England and Wales, France, Italy, Netherlands and Portugal). Two different methods were selected to estimate the excess mortality due to COVID19: (DEV) deviation from the expected value from homologue periods, and (RSTS) remainder after seasonal time series decomposition. We estimate total, age- and gender-specific excess mortality. Furthermore, we compare different policy responses to COVID-19.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Excess mortality was found in all 5 countries, ranging from 10.6% in Portugal (DEV) to 98.5% in Italy (DEV). Furthermore, excess mortality is higher than COVID-attributed deaths in all 5 countries.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>DISCUSSION<\/jats:title>\n                  <jats:p>The impact of COVID-19 on mortality appears to be larger than officially attributed deaths, in varying degrees in different countries. Comparisons between countries would be useful, but large disparities in mortality surveillance data could not be overcome. Unreliable data, and even a lack of cause-specific mortality data undermine the understanding of the impact of policy choices on both direct and indirect deaths during COVID-19. European countries should invest more on mortality surveillance systems to improve the publicly available data.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2020.04.28.20083147","type":"posted-content","created":{"date-parts":[[2020,5,3]],"date-time":"2020-05-03T04:35:10Z","timestamp":1588480510000},"source":"Crossref","is-referenced-by-count":21,"title":["Excess mortality during COVID-19 in five European countries and a critique of mortality data analysis"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3854-8349","authenticated-orcid":false,"given":"J.","family":"F\u00e9lix-Cardoso","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5828-7628","authenticated-orcid":false,"given":"H.","family":"Vasconcelos","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-6682","authenticated-orcid":false,"given":"P.","family":"Pereira Rodrigues","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3764-5158","authenticated-orcid":false,"given":"R.","family":"Cruz-Correia","sequence":"additional","affiliation":[]}],"member":"54368","reference":[{"key":"2020120903450938000_2020.04.28.20083147v1.1","unstructured":"ECDC, Download today\u2019s data on the geographic distribution of COVID-19 cases worldwide, eng, Apr. 2020. [Online]. Available: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/download-todays-data-geographic-distribution-covid-19-cases-worldwide (visited on 04\/19\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2004973"},{"key":"2020120903450938000_2020.04.28.20083147v1.3","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9040967"},{"key":"2020120903450938000_2020.04.28.20083147v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30230-9"},{"key":"2020120903450938000_2020.04.28.20083147v1.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"2020120903450938000_2020.04.28.20083147v1.6","unstructured":"B. Aylward and W. Liang , \u201cReport of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)\u201d, English, WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), Tech. Rep., Feb. 2020. [Online]. Available: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/who-china-joint-mission-on-covid-19-final-report.pdf."},{"key":"2020120903450938000_2020.04.28.20083147v1.7","unstructured":"J. Oke and C. Heneghan , Global Covid-19 Case Fatality Rates, Apr. 2020. [Online]. Available: https:\/\/www.cebm.net\/covid-19\/global-covid-19-case-fatality-rates\/(visited on 04\/21\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.8","unstructured":"OFS, Mortalit\u00e9, causes de d\u00e9c\u00e8s, Apr. 2020. [Online]. Available: https:\/\/www.bfs.admin.ch\/bfs\/fr\/home\/statistiques\/sante\/etat-sante\/mortalite-causes-deces.html."},{"key":"2020120903450938000_2020.04.28.20083147v1.9","unstructured":"C. N. de Epidemiolog\u00eda (ISCIII), \u201cVigilancia de los excesos de mortalidad por todas las causas. MoMo\u201d, Spanish, ISCIII, Tech. Rep., Jul. 2020, p. 21. [Online]. Available: https:\/\/www.isciii.es\/QueHacemos\/Servicios\/VigilanciaSaludPublicaRENAVE\/EnfermedadesTransmisibles\/MoMo\/Documents\/informesMoMo2020\/MoMo_Situacion%20a%207%20de%20abril_CNE.pdf (visited on 04\/21\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.10","unstructured":"O. Guell , \u201cEl coronavirus causa mas muertes de las detectadas\u201d, Spanish, El Pa\u00eds, Mar. 2020. [Online]. Available: https:\/\/elpais.com\/sociedad\/2020-03-27\/el-coronavirus-causa-mas-muertes-de-las-detectadas.html (visited on 04\/21\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.11","unstructured":"C. Cancelli and L. Foresti , \u201cThe real death toll for Covid-19 is at least 4 times the official numbers\u201d, English, Corriere della Sera, Mar. 2020. [Online]. Available: https:\/\/www.corriere.it\/politica\/20_marzo_26\/the-real-death-toll-for-covid-19-is-at-least-4-times-the-official-numbers-b5af0edc-6eeb-11ea-925b-a0c3cdbe1130.shtml?refresh_ce-cp (visited on 03\/27\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.12","unstructured":"A. Galeotti , P. Surico , and S. Hohmann , \u201cDeaths from Covid-19 - lessons from Italy and other nations\u201d, London Business School, Apr. 2020, [Online]. Available: https:\/\/www.london.edu\/news\/the-true-death-toll-of-covid-19-1771."},{"key":"2020120903450938000_2020.04.28.20083147v1.13","unstructured":"INSEE, Nombre de d\u00e9c\u00e8s quotidiens par d\u00e9partement, Apr. 2020. [Online]. Available: https:\/\/www.insee.fr\/fr\/information\/4470857 (visited on 04\/17\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.14","unstructured":"ISTAT, \u201cI decessi del 2020. Dati anticipatori sulla base di un sottoinsieme di comuni del sistema ANPR\u201d, Tech. Rep., Apr. 2020. [Online]. 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Available: https:\/\/www.theguardian.com\/world\/2020\/apr\/12\/coronavirus-statistics-what-can-we-trust-and-what-should-we-ignore (visited on 04\/21\/2020)."},{"key":"2020120903450938000_2020.04.28.20083147v1.27","unstructured":"J. Tennison , \u201cWhy isn\u2019t the government publishing more data about coronavirus deaths?\u201d, English, The Guardian, Feb. 2020. [Online]. Available: https:\/\/www.theguardian.com\/commentisfree\/2020\/apr\/02\/government-publish-data-coronavirus-deaths."},{"key":"2020120903450938000_2020.04.28.20083147v1.28","unstructured":"I. Schreck , \u201cCientistas pedem desbloqueio de dados sobre Covid-19 para investiga\u00e7\u00e3o\u201d, Portuguese, Jornal de Not\u00edcias, Mar. 2020. [Online]. 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