Regional excess mortality during the 2020 COVID-19 pandemic in five European countries

The impact of the COVID-19 pandemic on excess mortality from all causes in 2020 varied across and within European countries. Using data for 2015-2019, we applied Bayesian spatio-temporal models to quantify the expected weekly deaths at the regional level had the pandemic not occurred in England, Greece, Italy, Spain, and Switzerland. With around 30%, Madrid, Castile-La Mancha, Castile-Leon (Spain) and Lombardia (Italy) were the regions with the highest excess mortality. In England, Greece and Switzerland, the regions most affected were Outer London and the West Midlands (England), Eastern, Western and Central Macedonia (Greece), and Ticino (Switzerland), with 15-20% excess mortality in 2020. Our study highlights the importance of the large transportation hubs for establishing community transmission in the first stages of the pandemic. Here, we show that acting promptly to limit transmission around these hubs is essential to prevent spread to other regions and countries.G.K. is supported by an MRC Skills Development Fellowship [MR/T025352/1]. M.B. is supported by a National Institutes of Health, grant number [R01HD092580-01A1]. The work was partly supported by the MRC Centre for Environment and Health, which is funded by the Medical Research Council (MR/S019669/1, 2019-2024). V. Gómez Rubio is supported by grant SBPLY/17/180501/000491, funded by Consejería de Edu cación, Cultura y Deportes (JCCM, Spain) and FEDER, and grant PID2019-106341GB I00, funded by Ministerio de Ciencia e Innovación (Spain). M.E. and J.R. are supported by by the Swiss National Science Foundation (grant 189498). The work of the UK SAHSU Unit is overseen by Public Health England (PHE) and funded by PHE as part of the MRC-PHE Centre for Environment and Health also supported by the UK Medical Research Council, Grant number: MR/L01341X/1), and the National Institute for Health Research (NIHR) through its Health Protection Units (HPRUs) at Imperial College London in Environmental Exposures and Health and in Chemical and Radiation Threats and Hazards, and through Health Data Research UK (HDR UK).S