Based on the epidemiological surveillance of COVID-19 mortality, the observations on the first seven waves combined of the epidemic in Belgium (01/03/2020 – 11/09/2022) are as follows:
Waves
- 66.8% of the COVID-19 deaths occurred during the first two waves of the epidemic. In absolute numbers, most deaths took place in wave 2 due to its length, but the highest peak of weekly COVID-19 deaths was observed during wave 1 (1,985 deaths during week 15 2020).
Age and sex
- 91.8% of the COVID-19 deaths were 65 years and older.
- The median age of COVID-19 deaths was 84 years old and the average age was 81.6 years old.
- In all age groups up to 80-84 years old, males represented the highest fraction of COVID-19 deaths.
Places of death
- Most of the COVID-19 deaths took place in hospitals (67.7%), followed by nursing homes (31.9%). During wave 1, there was an even distribution (50.2% and 48.7% respectively).
Case classification
- 87.7% of the COVID-19 deaths in Belgium were laboratory-confirmed cases. In 2021 and 2022 around 96% of the COVID-19 deaths were laboratory-confirmed cases. During wave 1, 4.0% of COVID-19 deaths were radiologically-confirmed cases and 26.8% were possible cases.
Nursing home residents
- 44.7% of the COVID-19 deaths were nursing home (NH) residents and 71.3% of them died in NH. While in waves 1 and 2, a quarter of all the NH deaths took place in hospital, in the following waves, it shifted to a more equal distribution of deaths between NH and hospitals.
COVID-19 mortality rate
- The overall crude mortality rate (CMR) due to COVID-19 in Belgium, reached 281 per 100,000 inhabitants. It was higher in Wallonia (331 per 100,000 inhabitants), followed by Brussels-Capital Region (297 per 100,000 inhabitants) and Flanders (252 per 100,000 inhabitants).
- At provincial level (and Brussels-Capital Region), Hainaut had the highest overall COVID-19 CMR (385 per 100,000 persons), while Walloon Brabant had the lowest (213 per 100,000 inhabitants). When taking the age structure into account, Brussels-Capital Region had the highest and Flemish Brabant the lowest COVID-19 age standardized mortality rate.
- Among NH residents (all ages) the COVID-19 CMR in Belgium reached 7,500 per 100,000 inhabitants and 923 per 100,000 inhabitants among non-NH residents (65+).
COVID-19 case fatality ratio
- The COVID-19 case-fatality ratio (CFR) in Belgium was estimated to be 0.65%, but it increased exponentially with age (4.92% for 75-84 years old and 9.87% above 85 years old for both sex). During wave 1, when testing capacity was limited and only severe and hospitalized patients were tested, it reached 11.3%.
- The risk of dying from COVID-19 was larger and consistent for men, across all age groups.
- COVID-19 CFR decreased over time.
All-cause and excess mortality
- The all-cause CMR for Belgium was the highest for wave 2 (522 per 100,000 inhabitants).
- The number of deaths in excess for wave 1 was roughly comparable to those caused by COVID-19 obtained via the epidemiological surveillance.
- Excess mortality was also the highest during wave 1, with a 26.6% excess of death (8,410 deaths in excess). Brussels-Capital Region experienced the highest excess mortality among the three regions (1,379 deaths in excess, 57.2%).
- The percentage of excess mortality was relatively high in all regions during the first two waves and then dropped drastically. There was an under mortality in Flanders in wave 3, suggesting a harvesting effect.
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