The Czech Statistical Office has published a report on the number of deaths last year, which also takes into account the number of deaths on Covid-19. Compared to 2019, 15% more people died in our country last year, but surprisingly, Covid-19 is the second, not the first cause of death. Even though the total number of deaths usually changes by only a few percentage points year-on-year, from which we can conclude that the pandemic that began in 2019 contributed to the high mortality rate. Among other things, it also changed the way autopsy is performed in Slovakia.
Sources: CZSO, IHIS CR, Michal Palkovič - pathologist, Robert Lischke - doctor
A total of 17,235 deaths directly or indirectly related to covid-19 were reported in 2020, of which 11,968 were being continuously reported by health care providers to the central epidemic management system and 5,267 were added subsequently.
"The performed validations and evaluations of the causes of death showed that in 10,539 cases of death, i.e. in 61.1%, covid-19 was also its root cause,"
says Šárka Daňková, the guarantor of the IHIS CR Registry List of the inspection of the deceased.
Autopsy is crucial - and its methodology has changed
According to a report by the Czech Statistical Office, validations of a panel of experts and other analyzes of reports from health care providers show that about 5% of deaths last year were not related to covid-19. And even in those where the new virus is listed as the root cause of death, a number of other serious diseases have been documented, especially heart disease, diabetes or cancer. Only an autopsy can reveal the real cause of death.
We asked Michal Plakovič, the director of the Section of Forensic Medicine and Pathological Anatomy at the Office for the Supervision of Health Care in Bratislava, exactly how the pandemic affected the course of the autopsy.
"We are still performing the activity assigned to us by law. The law requires us to order an autopsy in case of suspicion of any dangerous infectious disease. That means we continue to do what we have been doing before. In all cases of suspected coronavirus infection, or any other diseases, we request an autopsy,"
Michal Palkovič explains the change in the autopsy process for LP-Life. Autopsies have changed in the wake of the pandemic worldwide, and right now, attention is being paid to the autopsies of people who have already been vaccinated.
The difference is that we are now mainly focusing on vaccinated patients, i.e. the deaths of vaccinated patients, where we either identify the mechanisms associated with vaccination or, on the contrary, exclude them. Thus, autopsies have changed significantly since the beginning of the pandemic. At the beginning of the pandemic, we used to perform an autopsy on all patients that we had available and where we could enforce it. That was in about eighty percent of cases. The remaining twenty percent were either patients who were only examined after death, or there was no reason for an autopsy because it was a clear case. This changed during the second wave, when autopsies were performed mainly on suspicious cases, obscure deaths, or deaths of young people from not entirely clear causes. Our attention currently lies on this scope, plus the deaths of vaccinated patients."
In 2020, 129,289 inhabitants of the Czech Republic died
Last year, a total of 19,171 people died of heart disease, and 10,539 people died of covid-19. These data were collected by the CZSO from mortality statistics.
Compared to the previous year, i.e. 2019, the number of deaths was higher by almost 17,000, which represents a 15% year-on-year increase. The coronavirus pandemic is statistically the second most frequent cause of death not only in our country as a whole, but also in individual regions, with the exception of the Olomouc and Moravian-Silesian regions, where it was the third most-frequent cause of death, right behind heart failure.
The curves complement each other
Interestingly, the death curve copies the curve of pandemic waves in the Czech Republic to some extent. Most people died in November - namely 15.8 thousand - followed by October and December with almost 14.2 thousand deaths. The year-on-year increase in the number of deaths was concentrated in these three months.
In terms of calendar months, in addition to covid-19, there was an increase in mortality in other diseases in the last quarter; Covid-19 hit the strongest in November 2020, when 4.5 thousand people died of the disease in a single month, which is twice the number of deaths of all malignant neoplasms together.
Covid-19 overtook stroke
The overall CZSO report shows that the average age of deaths on covid-19 was 77 for men and 81 for women, which is a relatively high age for both sexes. Interestingly, 89% of these patients died in hospital.
In general, about 30% of people die each year from various heart diseases, dominated by coronary heart disease, which was the most common cause of death (14.8%) last year.
However, there was a change in the imaginary second place, where Covid-19 replaced vascular diseases of the brain. In 2020 Covid-19 occupied this position with 10.5 thousand deaths, i.e. 8% of the total number of deaths. Strokes dropped to third place with 7.6 thousand deaths, followed by heart failure (6.7 thousand deaths) and lung cancer (5.3 thousand).
"There is a huge group of patients with lung cancer. It’s one of the most common diseases, which is very often diagnosed late and difficult to treat,”
Professor Robert Lischke, Head of III. surgical clinic of the 1st Medical Faculty of Charles University and the University Hospital Motol, said about malignant lung tumours for LP-Life.
"Coronavirus has affected our work on many levels. First of all, at the beginning, we had to cut down the number of planned surgeries, which got us into a situation where we had to make a selection of sorts, which is in itself ethically and organizationally very problematic, but there was simply no other way. In addition, everyone who was to undergo surgery had to be tested for Covid, which is still true today. Another level is the use of protective equipment, contact with a huge number of patients and colleagues, which means fear that we will get infected, that we will infect our colleagues, because a lot of doctors and nurses caught Covid. In the context of transplant programs, we are facing a shortage of donors, some of our patients have contracted Covid after transplantation, and there is a huge mortality rate there, approaching 30%. Which is logical, because the target organ for Covid-19 is the lungs,"
Professor Lischke comments on the problems he had to face last year.
Covid deaths by age and region
Covid-19 even made the top ten most common causes of death in the young adult age group, i.e. 25-44, where it ranked 8th with 72 deaths, although its share of all deaths in this age group was only 2.5%. In the middle age category (45-64), however, it took 5th place (789 deaths; 5% of all deaths) and in the case of persons older by ten years, i.e .65-75, it landed the third place (2.4 thousand deaths; 8% of all deaths).
If we look at individual regions in more detail, the Vysočina region was the most affected by Covid-19 (10.2%), while the Pilsen region was the least affected (7.2%).
The Institute of Health Information and Statistics (IHIS CR) summarized the basic results of analyzes of mortality data for the year 2020, the more detailed publication of which will follow. Data processing was performed in accordance with international methodologies, where, according to the World Health Organization (WHO), death due to Covid-19 is defined as death due to a clinically relevant disease in a person with a confirmed or probable Covid-19 infection, unless another cause of death can be identified.
Let’s pray that statistically, the situation keeps improving. The 2021 results will certainly be affected by the second, and possibly the third, autumn wave of the pandemic. We can only hope that vaccination and continued research will help stop the increased mortality.