A worrisome observation needing urgent investigation
The European monitoring of excess mortality for public health action (EuroMOMO) produces weekly bulletins of all-cause mortality and excess mortality (defined as a deviation in mortality from the expected level) from 28 partner countries**.
The Figure shows the cumulative excess mortality for all ages by week for the years 2020, 2021, and 2022. The grey line represents the cumulative excess mortality in 2020, the dark blue line in 2021, and the light blue line in 2022. We would expect a “normal” year to end with a cumulative sum of excess mortality around zero – this might fluctuate year on year, but we would not expect large deviations away from zero. Large deviations from zero would be cause for concern.
One graph in particular warrants closer inspection.
The Figure for children aged 0-14 shows that in 2020, there was an initial excess, but this then subsided and 2020 ended with a negative excess of -400. This could be interpreted as a notable but not substantial deviation from what we would expect and is in stark contrast to similar graphs for other age groups, which all show excess mortality for 2020.
The start of 2021 mirrored 2020, with fewer deaths than expected before a change in the direction of the effect around week 20 – thereafter, excess deaths began to accumulate, finishing the year with 800 excess deaths.
This trend has continued into 2022 and has already eclipsed 2021. As this is a cumulative sum, we could see a “correction” and return to normality if the year’s second half sees a sustained period of negative excess mortality. Currently, there is no sign of this abating.
Looking at the same data from a different angle is informative.
The above Figure shows mortality for the same cohort, but this time, the y-axis is mortality by week, and the x-axis represents a time series extending back to 2018. The increase that is responsible for the accumulating excess is clearly visible.
The shaded grey band in the figure shows that the “normal range” and the red line is what is deemed a substantial increase. We can see from this figure that the expected longer-term trend is for childhood deaths to fall over time. They have been increasing, hence the excess. In two weeks since mid-2021, the number of weekly deaths has breached their “substantial increase” red line, something that had not happened between 2018 and 2020.
The reasons for this increase are not clear to us but are concerning as we can discount COVID-19 as the direct cause.
The possible causes could be:
- A decrease in vaccine coverage due to restrictions – this is well documented, especially for crucial vaccines such as MMR – with subsequent increase in infections and death.
Obstacles to the delivery of vaccination services during the COVID-19 pandemic drove down immunisation rates: see CG report 2
- Mental health problems due to confinement, isolation and increased suicide.
The number of referrals and people in touch with mental health services are above pre-pandemic levels, and children’s mental health needs continue to grow: see Gov.UK
- Abandonment, violence or abuse
Within the context of child deaths (due to homicide, abuse or neglect) in England and Wales, the highest rate of homicide appears within children under the age of one (28 deaths per million population): see Home Office 2020-21
- Accidents in the home setting
Child deaths spike during Covid lockdown after series of home accidents (see the Guardian)
- Lack of access to preventive healthcare and missed Maternal And Child Health Care visits, including possible effects of displacement.
Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: see PLOS Medicine
- Any other causes we may not have thought of
Over the last three decades, substantial global progress has been made in reducing childhood mortality. There may be other complex causes, or any of these might overlap and have an overwhelming effect. We have no idea whether these or other causes are at play. We do know that is a serious problem that seems not to have engaged our leaders too seriously.