BRUSSELS (BLOOMBERG) – In an art deco building in the heart of Brussels, Belgium’s leading scientists gather daily to announce the country’s coronavirus toll. It’s been grim reading.

Despite having only 11 million people, the country has reported more deaths from the disease than China. With some 57 fatalities per 100,000 inhabitants, it has the highest per capita death rate in the world – almost four times that of the United States.

According to Belgian officials, the reason for the grisly figures isn’t overwhelmed hospitals – 43 per cent of intensive care beds were vacant even at the peak of the crisis – but the country’s bureaucratic rigour.

Unlike many other countries, the home of the European Union’s top institutions counts deaths at nursing homes even if there wasn’t a confirmed infection.

“We often get criticism – oh, you’re making Belgium look bad – we think it’s the opposite,” Steven Van Gucht, head of the viral disease division at the Sciensano public health institute, said while maintaining the requisite distance of 1.5m. “If you want to compare our numbers with a lot of other countries, you basically have to cut them in half.”

Clearer Picture

About 95 per cent of Covid-19 deaths in elderly care homes haven’t been diagnosed, yet Belgium makes the decision to register them based on the symptoms shown and who the people have been in contact with. The goal is to get a clearer picture of the outbreak and better target hot spots.

At the start of each briefing at the Residence Palais, a stone’s throw from the European Commission, Belgian officials detail the day’s statistics in French and Dutch. They draw particular attention to those who die outside of hospitals – typically around half the total.

The impact of the disease on vulnerable care home residents is a growing issue. While Europe knew it would need more ventilators and intensive care capacity once the virus spread beyond China, the impact on nursing homes was unexpected, according to Agoritsa Baka, a senior expert at the European Centre for Disease Prevention and Control.

“It’s a disaster,” she said. “We did not realise how devastating Covid would be if it entered these populations.”

Excess Mortality

Yet not all European countries are measuring the impact in the same way, meaning that the numbers of coronavirus deaths are likely thousands higher than the official count of more than 110,000.

The consequence of uneven practices was evident in France. When the country reported data from some nursing homes for the first time in early April, those fatalities were almost double the number of people that died in hospitals.

Last week, Spain had to adjust its historical data after Catalonia started including people who had symptoms but didn’t test positive. This week a local radio broadcaster reported that more than 6,800 elderly died in Spanish nursing homes with symptoms but weren’t recorded in official data.

Germany’s unusually low mortality rate may be helped by the fact that the country only counts deaths that have a positive virus test.

Such discrepancies show up in a concept called “excess mortality,” the number of extra fatalities above typical trends. In Belgium, just over 300 people normally die every day, but this year, it’s jumped to nearly 600.

A project called euroMOMO, originally developed for gauging the scale of flu epidemics, is now being used to track the impact of the coronavirus in Europe.

Good Surveillance

Belgium’s practice means that nearly all deaths are accounted for in a given week, while neighbouring Netherlands has around 1,000 undefined fatalities. Some countries’ virus deaths are around a sixth of their excess mortality rates.

Better tracking could help improve Europe’s response to outbreaks, especially as the region gradually eases lockdown restrictions, raising the prospect of second-wave outbreaks. Coordinated procedures could also defuse tensions as Europe grapples with recovery efforts.

“We are still in a situation where within the EU we do not count the same way, which could lead to political misunderstandings,” said Pascal Canfin, chair of EU Parliament’s environment and health committee. “It leads to different perception awareness of the crisis.”

In the meantime, the world’s eyes shouldn’t be focused on Belgium because at least the extent of the problem is known, according to Van Gucht.

“When you have a good surveillance system, you report a lot of cases,” he said. “It’s the countries that are not reporting or that are reporting very low numbers, you should be more worried about.”

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