Everyone has heard that Spain was one of the countries hardest hit by Covid-19. Spain was also one of the first to impose the strictest of lockdowns, which transformed its busiest and most bustling city of Madrid into a deserted ghost town for two months from mid March to mid May. And in April it was reported that there were so many dead bodies that there was nowhere to put them such that temporary morgues had to be setup to accommodate them. What a nightmare.
At some point this year, official rules for assigning the cause of death were changed and autopsies became discouraged. This was done in several European countries. This probably simplified the work of many health care workers, but these changes have made the statistics relating to specific causes of death unreliable.
The one thing in life that is undeniable is death itself. We know for sure that when a person is dead, then they are no longer alive, and that this final verdict does not depend on the cause of death. It does not depend either on the real cause or on the recorded cause of death.
Total Number of Deaths
So, as obvious as this may sound—even though it has been conspicuously missing from public discourse—the only thing we can truly reliably count are the total number of deaths, because when a person is dead they have passed away, and we can entirely reliably count them as deceased.
In addition, if we are to make any comparison of the present situation with the past, if we are to look at trends over time, there is no better metric to compare a given year to other years in terms of where it stands with respect to the average and thus the expected number of deaths.
In Spain, where I have been living for 13 years, death statistics are compiled in real-time with monthly updates by the Ministry of Health (Ministerio de Sanidad). Here is the graph of the total number of deaths per year from all causes in Spain from 1987 to 2019.
(The dash-dotted line shows the linear least squares best fit. The dotted lines above and below it show the 2-sigma band computed from the variance of the de-trended data.)
We can see, for example, that in 1987 the number of deaths was around 310000, and we can clearly see that there is an overall trend of increasing numbers in time, even though there are visible fluctuations around the average trend line.
But it is surely natural to expect that in the absence of major societal disruptions, the number of deaths will be more or less proportional to the population. And also similarly natural to expect that if living conditions are poor people will leave, whereas if they are good people will be come. So, trends in the population have to be taken into account.
Here is the total number of deaths per year from all causes per million people in Spain from 1987 to 2019.
Hence, from the first plot we can see that last year, for example, in 2019, there were a total of around 420000 deaths, and from the second we can see that this corresponds to 8911 deaths per million people. And looking at overall long-term trend, we can see that these numbers are quite close to the expectation.
What about 2020
For 2020, we don’t yet have the final count. The last update was on Dec 17, and the next one will be in about 2 weeks from now. This means that we have 352 days of data and that therefore in order to compare to the numbers from previous years for which we have 365 days of data, it’s necessary to divide by the number of days. Here is the average number of deaths per day from all causes per million people in Spain from 1987 to 2020.
What does this mean
As far as the impact in Spain of the strict lockdowns, the teleworking for everyone, the social distancing and isolation, the mask-wearing, and all the other measures that have been imposed on everybody for the sake of minimising the Covid-19 death toll, I’m not sure what to say, and I won’t speculate.
As far as the data are concerned, we can say that for the current daily average in 2020 to reach the expectation based on the long-term trend, we need to reduce the number of days over which the data is stated to have been accumulated from 352 to 326. We need to assume 26 days of missing data. This could be the case.
The yearly totals in 2016, 2017, 2018, and 2019 were 409358, 422130, 427956, and 416480. For 2020 (based on a population of 46.75 million), the long-term trend yields an expectation of 410440 deaths. The value we would calculate based on the current estimates is 379686. This represents 30754 missing deaths from the total. This could well be the case.
However, if we take the data at face value, according to these official numbers from the Spanish Ministry of Health of which there are currently 10 updates, the conclusion would be that 2020 in Spain has not been a year plagued by an overwhelmingly large number of deaths. On the contrary, Spain has been blessed with the lowest death rate in almost 20 years!
Nevertheless, it could also very simply mean, that the numbers published are still missing about 31 thousand deaths to reach the expectation, and surely a lot more than that to reach what we expect from the impression we all would have gathered based on the reports from the majority of media outlets to be a massive death toll. The fact is, that we’ll just need to wait a couple of months in order to have the final numbers.
Update from Feb 6 2021
The Ministry of Health published an updated total for 2020 on January 22. Given that we now cover all of 2020, we don’t need to average over the number of days used to estimate the total, but can simply look at the total per million people. Here is what this plot looks like:
The total number of deaths for 2020 is now stated 401359. This corresponds to 8584 deaths per million people, and it is below what could be expected from the long-term least squares fit shown as the dash-dotted line. Let’s wait another month to see if the total number settles.