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England and Wales had the most deaths in the first wave of European Covid-19

By Adam Vaughan

People in protective face coverings are walking through Cardiff in September 2020 before new lockdown measures are put in place

GEOFF CADDICK / AFP via Getty Images

England, Wales and Spain suffered the biggest spikes in deaths from any cause during the first wave of the Covid-19 pandemic, while countries like New Zealand, Norway and Poland appear to have gotten off relatively unscathed.

The three worst-hit countries had around 100 "excessive deaths" per 100,000 people each between February and May, which researchers say was likely due to governments slow to implement lockdowns and expand testing and tracing.

To arrive at the results, Majid Ezzati of Imperial College London and his colleagues took weekly death data from 2010 to early 2020 for 22 countries and used 16 models to account for influences such as temperature and estimate how many deaths there would be in a pandemic would have given -free world for February to May. The researchers then compared these numbers with official data for all cause deaths to find excessive deaths.


There were 206,000 deaths in all countries – 20 in Europe plus Australia and New Zealand. But how the countries fared varied greatly.

Hungary, Denmark and Australia were among the group with no increase in deaths. In the middle were countries like Sweden, which fared poorly compared to its Nordic neighbors. Most of the deaths were Belgium, Italy, Scotland, Spain, England, and Wales, with the last three in a class of their own.

"What does England, Wales and Spain worst than other countries is that combination of long and intense, long periods of action and pretty big climbs," says Ezzati.

The UK government removed the international Covid-19 death toll from its daily briefings in May, citing the fact that comparisons were "difficult" due to the different ways countries report data. However, much of the UK is showing up badly by the excessive death yardstick, believed to be the fairest way to compare countries. In England and Wales, surplus deaths rose 37 percent after adjusting for population, compared with 38 percent in Spain. "All-cause mortality goes beyond the differences in the way countries report data," says Hannah Ritchie of Our World in Data.

Demographic differences like the UK's high obesity rate, a risk factor for severe Covid-19, cannot alone explain the country's poor performance, say Ezzati and colleagues, noting that both Australia and New Zealand have worse obesity rates. The team found two consistent traits for the countries with the worst death rates: late lockdowns and slow ramp-up of testing and tracking.

According to Ezzati, the results do not say which countries will have large numbers of deaths during the second wave, which currently covers much of Europe. “We see noticeable differences. Italy has so far been later on the upswing (in excessive deaths) than other countries, while being the first (in excessive deaths), ”he says. "We cannot use this to predict the second wave as hopefully countries will act differently."

The research also found that surprisingly excessive deaths affected men and women largely equally. This is different from deaths in which more men have died. We don't know why, Ezzati says, but he speculates that it could be because women, on average, are older and are therefore worst hit by secondary effects like delayed treatment for dementia.

"The timing of the guidelines, whether locking or the ability to quickly scale tests, was the real driver of excessive mortality," says Oliver Watson, also from Imperial College London but not involved in the study. "It's pretty clear that acting early has a huge impact."

Journal reference: Nature Medicine, DOI: 10.1038 / s41591-020-1112-0

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