TR EMERITUS

Why is excess mortality in Singapore still so high even though the COVID-19 pandemic has long ended?

Excess mortality (or excess death) is a term used in public health that refers to the number of deaths from all causes during a crisis above and beyond what we would have expected to see under normal conditions.

In this study, data on mortality from the pre-COVID years from 2015 to 2019 is taken as the base to project the normal expected number of deaths going forward. It is then compared with the actual number of deaths from 2020 onwards to derive the excess deaths. It is a more accurate gauge of the pandemic as different countries have different methods of classifying deaths from COVID with some under reporting while others over reporting. It is also useful as a red flag that something ominous may be happening.

Thus, when the pandemic struck, the number of deaths would increase, over and above what would be normal, but would go back down to the expected level when the pandemic ends.

However, according to Our World In Data - which sources data from the Human Mortality Database, the World Mortality Dataset, The Economist and the World Health Organization - the excess mortality in Singapore, as well as many other countries, have not subsided back to normal levels, despite the pandemic having ended.

During the initial phase of the pandemic, from around March 2020 and up to end August 2021, a period slightly more than 17 months, excess mortality in Singapore was slightly below 0% - for some months it was a small positive, while for other months, a small negative, so that on average it was slightly below 0% (See 1st graph).

So, during this period, we did well. There were fewer deaths than normal. The lockdowns, social distancing and mask wearing could have reduced the number of deaths from other infectious diseases. There could also have been fewer deaths from industrial, road and other accidents since we were in lockdown or semi-lockdown modes. As such, the number of deaths from COVID were less than the number of deaths from other causes that were averted, as a result of the extraordinary precautions that were taken.

Interestingly, the vaccination rate then was still low - for half of that period, vaccination had not started, and for the other half, it was in-progress, and yet, the number of deaths from COVID was very low.

Then, excess deaths started spiking and reached a high of 32% in October 2021 and 31% the following month, despite the country having recently reached the important milestone of fully vaccinating 80% of the population.

The Ministry of Health (MOH) said that “we observed a higher number of deaths in the months of October and November because of the Delta infection wave”.

The most vulnerable people - the elderly and people with underlying comorbidity - having unfortunately died and can’t die again, the excess mortality started decreasing and reached a low of 1% in January 2022.

Then excess mortality started rising again and reached a peak of 35% in March 2022. By that time, about 85% of the population had been fully vaccinated and about 64% had been boosted (3rd shot), but MOH said that the second spike in deaths was due to the Omicron strain.

When the pool of people vulnerable to the Omicron strain became smaller since most of them have died, and the rest of the population were not susceptible to the virus, excess deaths started dropping again and reached a low of 8% in June 2022.

According to the government, the situation had stabilized, and it announced in late August 2022 that safety measurements would be further eased, non-fully vaccinated travelers to Singapore would no longer be required to serve a 7-day Stay-Home-Notice, and in October 2022, the F1 Grand Prix resumed. The pandemic was effectively over.
Excess deaths happens during periods of extraordinary events, like the pandemic. By definition, excess mortality will be 0% when the pandemic is over. Yet, it is still hovering between 11% to 25%, post-pandemic (Data up to June 2023).

Is there something unusual occurring simultaneously as the pandemic, and is still adding to excess deaths even after the pandemic has ended?

Worryingly, our excess mortality post-pandemic has been generally higher than all other countries, including developed countries which have older populations than ours. (See 2nd graph)

Did we do something all other countries did not do?

In August 2021, Reuters reported that “with 80 percent of its people fully vaccinated against COVID-19, Singapore is now the world’s most vaccinated country.” Today, 92% of the population is fully vaccinated AND boosted (3 does of the mRNA vaccine). And since immunity will wane, the Ministry of Health encourages all individuals above 6 months of age to take an additional dose of the updated vaccine 6 months to a year after their last dose.

Singapore is thus by far, the most vaccinated country on Earth.

Is that also why Singapore has the highest post-pandemic excess mortality? Bear in mind Pfizer and Moderna have never ascertained the long term effects of the vaccines.
The UK Parliament recently had a hearing on excess deaths in the country. Mr Andrew Bridgen, Member of Parliament for Leicestershire since 2010, who raised the topic, said, “The excess in London is only 3%, whereas it is higher in every more heavily vaccinated region of the UK. It should be noted that London is famously the least vaccinated region in the UK by some margin. Studies comparing regions on a larger scale show the same thing. Studies from the Netherlands, Germany and the whole world each show that the highest mortality after vaccination was seen in the most heavily vaccinated regions.”

In 2020, life expectancy of the Singapore population was 83.7 years. It dropped to 83.2 years in 2021 and then to 83 years in 2022. Is it going to drop further on account of its high vaccination rate, post-pandemic?

We turned society upside down when the pandemic started. The mainstream media couldn’t wait to report every death. And yet now, post-pandemic, there are far more excess deaths than there were then, but the MSM, the Government and Members of Parliament, are turning a blind eye.

The excess deaths should not be in vain. We need to acknowledge the phenomenon, find out why, and make sure it never happens again, otherwise, history will not judge us well.

Foong Swee Fong

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