The United States, by comparison, has reported 27 coronavirus deaths per 100,000 people. Spain has reported 58. Italy has reported 52.
Belgian officials have sought to tamp down concern by suggesting their chart-topping numbers are products of their accounting methods and commitment to capturing an accurate picture of their outbreak. Other ways of estimating virus-related deaths suggest that the Belgian method might indeed turn out to be among the most accurate in the world, and that other countries may be significantly undercounting their death tolls.
The bad news for Belgium is that even in those other calculations, the country still comes off poorly compared to its neighbors, after adjusting for their size.
According to figures released Sunday, Belgium has recorded 9,052 deaths from the coronavirus. Of those, about 40 percent are “possible cases,” not confirmed by tests. Most countries do not include suspected cases that weren’t positively confirmed.
“Our way of counting things is the most scientifically correct and honest,” Yves Van Laethem, a virologist and Belgian government spokesman, told reporters Friday.
Van Laethem showed reporters a slide of calculations from the Economist magazine indicating that Belgium’s official coronavirus toll closely tracks “excess deaths” for the pandemic period — the number of deaths that exceed what would be expected for the period, based on the country’s historical death rates. Belgium attributed 7,559 deaths between March 16 and April 26 to the coronavirus. The Economist estimated that the country had 7,397 more deaths in that time period than would have been expected.
By comparison, a team of Yale researchers who analyzed U.S. mortality data in partnership with The Washington Post this month estimated that, with excess deaths as a guide, the true toll could be one and a half times higher than the official number.
There are perils to using the method, and to drawing too much from country-to-country comparisons. Full data sets can be slow to roll in, leading to undercounts. The overall excess death estimate could also include other deaths, such as people who died of unrelated diseases because they chose not to seek medical care as a result of the pandemic. And it is subject to other effects of the lockdowns, such as fewer fatal road accidents.
But because countries are counting their coronavirus deaths differently, epidemiologists have begun to favor excess death calculations as the most accurate way to track the impact of the virus.
By the Economist’s analysis, Britain was the worst-hit of the countries it examined, as measured by excess deaths compared to overall population. Spain was second; with Belgium a close third. The newsweekly did not calculate excess death figures for the United States, but estimated that New York City’s excess death rate was far ahead that of Britain. Dense cities have often been hit especially hard.
Calculations by the Financial Times show roughly the same picture.
Belgian officials acknowledge that the country has been hit hard.
“We count very accurately, but that does not alleviate that we were also severely hit,” said Steven Van Gucht, the head of viral diseases at Belgium’s equivalent of the Centers for Disease Control and Prevention.
One explanation, he said, might be Belgium’s relative population density in comparison to its neighbors: the Brussels airport, an international transportation hub, might have helped seed the disease in the crowded capital region. And many Belgians were on skiing vacations in northern Italy during national school vacations in late February.
Belgium’s nursing homes account for more than half of its deaths, partly because older Belgians are more likely than their counterparts in other European countries to live in elder-care housing. Public health authorities acknowledge that they were slow to realize the risks the homes posed as a vector to spread the disease. The Belgian military deployed to a few nursing homes to help keep them running after many of their workers were themselves struck by the coronavirus.
The World Health Organization has said it believes up to half of deaths from the coronavirus in Europe might be in elder-care homes.
Van Gucht said Belgian officials didn’t believe their nursing home situation was any worse than elsewhere in Europe, and they believe it has been brought under control through testing and giving protective equipment to staff.
Belgium, a wealthy country, has a relatively high medical capacity. Even at the peak of the outbreak here, the occupancy of intensive care beds never rose much above 60 percent, a fact that public health officials have focused on with some pride despite the high relative death toll.
Still, they said, no matter how the numbers are counted, Belgium had been seriously affected.
“We have gotten our good share of the virus in Western Europe,” Van Gucht said.