About the COVID-19 Fatality Gap
A Further Analysis of RIP.ie Death Notices by County in Ireland during the COVID-19 Pandemic
It is increasingly clear that the COVID-19 death toll is being under-reported around the world. This doesn’t mean that there is a wide-spread conspiracy to deceive the public, but rather reflects the challenging reality of documenting a pandemic as it unfolds.
One of the “small island” advantages we have in Ireland is that the vast majority of death notices are registered with a web site called Rip.ie, which provides a unique opportunity to quantify the wider COVID-19 death toll. In a recent analysis I compared the RIP numbers in 2020 (March 16 — April 13) with the same period in previous years, under the assumption that any sizeable difference could be linked to COVID-19. The results showed a significant excess in 2020, with more that 650 additional deaths compared with the same period in 2019; that’s approximately 50% more deaths than the official COVID-19 figures.
Are some of these additional deaths also due to COVID-19? For example, might some elderly patients have been asymptomatic with COVID-19 when they died? At the time of writing, recent reports from New York suggest a very similar excess death estimate of 50% more than the officially reported COVID-19 deaths, due to people dying in the cummity or because some COVID-19 deaths have been attributed to heart attacks or other causes. Perhaps other additional deaths are the spill-over effects from a crisis such as this, while not being directly attributable to the virus. Or perhaps there is an entirely different explanation? In due course we should come to better understand this, but for now it is worth continuing to dig into the data to see what else we can learn.
Since I posted my previous article a number of people have asked whether it might be possible to do a similar analysis, but on a county by county basis. I will report on this below, but first a few caveats.
- To paraphrase the great Dr. Leonard H. McCoy (USS Enterprise), I’m a Data Scientist not a Physician/Clinical Specialist/Health Scientists; I can talk about the numbers and trends but as to the reasons for any effects, these are better left to the domain experts. Hopefully the data will help to point the way. That’s as much as I will try to do.
- In this analysis the numbers for many counties are small. This will increase the likelihood that any difference between 2019 and 2020 is due to chance, rather than some deeper underlying phenomenon.
- Thirdly, sometimes RIP.ie includes multiple death notices for the same individual. My understanding is that this captures differences between where are person lived versus where they grew up. In this analysis I used only the first death notice for an individual because it seemed to be the once connected to where they most recently lived.
In the analysis that follows I used the same procedure described in my earlier article — comparing the number of death notices between March 16 and April 13 in 2019 and 2020— but this time, I grouped the data by county. The main question to answer is whether the excess of deaths in 2020 continue to be visible at the county level.
The bar chart below shows the total number of RIP death notices for each county during the same COVID-19 period in 2020 and 2019. There is an excess of deaths in some counties, for 2020, but not for all. Not surprisingly, Dublin accounts for the largest excess — just over 613 death notices during the March 16-April 13 period in 2019, versus 940 in the same period this year — but counties like Galway, Offaly, and Leitrim show little or no excess, while others, such as Clare and Westmeath show fractionally fewer death notices in 2020 than they did in 2019.
For some counties the numbers are small and so the differences cannot be relied upon, but overall 73% of counties have an excess of death notices in 2020 and, on average, the percentage increase for these counties is 34%. While the percentage increase for Dublin is 53% (613 vs. 940) the percentage increase outside of Dublin is just 18%.
For a more robust analysis let’s focus on counties with more than 30 death notices in 2019 during the March 16-April 13 period; these are shown in the graph below. The green bars indicate counties where there has been an RIP.ie increase in 2020. The pink bars are for counties where there has been a decrease in 2020. The height of the bars reflects the size of the increase/decrease as percentage of the 2019 death notices. And the line plot shows the actual number of excess death notices (instead of a percentage change).
As mentioned previously, Dublin’s 2020 figures indicate a percentage increase of over 50% with more than 320 additional death notices compared with 2019. The largest percentage difference is associated with Laois: there were 34 death notices in 2019 versus 63 this year, a percentage increase of more than 80%. Cavan, Kildare, Meath, and Sligo also show substantial increases (>50%) in 2020 death notices, while other large population centres such as Cork and Limerick show more modest increases (~20%).
Donegal’s 2020 death notices are actually down by 20% in 2020; Westmeath, Clare, Wexford, Galway, and Roscommon also show a decline. One explanation might be that fewer deaths are being registered on RIP.ie in these counties, but it is not clear why such an effect would be limited just to these counties. Another explanation might be that because the numbers are small, and the differences are modest, then they could have occurred by chance; this is almost certainly the case for Galway, where there has been just a 2% decline in 2020 numbers.
The analysis of RIP.ie death notices clearly points to an additional death toll in 2020 compared with the same period in 2019 — the COVID-19 excess — but the scale of this additional death toll varies considerably across counties. The variation is not easily explained by population size or density; Dublin has seen a major increase in deaths but other large urban areas, such as Cork and Limerick, have seen more modest increases, while Galway’s 2020 numbers remain flat.
Perhaps the more pressing question now is why there should be such a difference between counties at all. Is there a demographic explanation? Do the differences reflect varying pressures on local healthcare systems? Or can some differences be linked to nursing home clusters? If anyone has any suggestions then please let me know. Meanwhile I will be keeping an eye on how this develops.
It is also worth reporting that, in the months since this article was published, Ireland’s excess deaths numbers have have not continued to grow in the way that they did in March and April. The lockdowns and at-risk shielding that has been applied since March has largely worked, and Ireland has performed very well since April in terms of it’s excess deaths measure, notwithstanding the significant explosion in numbers that we are witnessing now in early 2021, and what this might mean for future deaths.
Regarding the reliability of RIP.ie as a source of real-time death data, a recent study by Ireland’s Central Statistics Office concludes that “continued analysis shows death notices on the website RIP.ie provide close to ‘real time’ mortality trends in Ireland” and further estimated excess mortality for the period March to September 2020to be “between 876 and 1,192 (i.e. deaths above those likely to be experienced under normal circumstances).”