While it is clear that the coronavirus pandemic has increased mortality in Israel, it is important to understand by how much.
A new Taub Center study conducted by Prof. Alex Weinreb provides these estimates for 2020. It calculates “excess mortality” in Israel in general, examines mortality by age groups, and analyzes how much this excess was affected by Israel’s age structure.
The data show that after accounting for population growth, the number of deaths in Israel has increased by about 7%, but when also accounting for the reduction in mortality that was expected, the increase is about 10%.
From early September to early October, Israel’s overall mortality rate rose to a level last observed in the 1990s, when life expectancy was about four years lower than it is today. Overall, the excess mortality rate in Israel is lower than would be expected given the population’s age structure and patterns of coronavirus infection among Israelis. It will result in a decrease of about two months in life expectancy at birth and a decrease of almost three months in life expectancy at age 65. The high rates of infection and mortality among haredim and Arab-Israelis will result in a more substantial increase in excess mortality in these population groups and a sharper decline in their life expectancy.
Identifying mortality from the coronavirus is a rather challenging task, as it is difficult to ascertain whether the virus was the primary cause of death, a contributing factor, or a background characteristic, and whether the patient was already on the brink of death or whether, in the absence of the virus, s/he would have lived for many more years. Another challenge is to distinguish between the direct and indirect effects of the virus on mortality – such as diverting most of the healthcare system’s resources to address the pandemic and away from treating and preventing other medical conditions.
Between the coronavirus pandemic waves – Israel’s overall mortality rate has been the lowest in recent years
In a study by the Taub Center, Prof. Weinreb examines the difference in mortality rates from all causes between 2020 and preceding years. In addition, he examines trends in mortality rates by age group. The study shows that while mortality has been decreasing for years, there has been a slowdown in the decrease in recent years, most likely arising from the increasing prevalence of health conditions such as diabetes and obesity.
However, in early 2020, the situation looked quite different: during the first two months of the year, mortality rates in Israel were at their lowest ever – fewer than 11 deaths per 100,000 population per week – a decrease of 7% compared to the same period during the years 2017-2019.
The effect of the coronavirus on mortality rates was first felt at the end of March and became particularly notable from the beginning of July through the end of September. Yet it is important to note that between these waves of high pandemic mortality, rates returned to lower levels than those registered in 2017-2019.
The coronavirus pandemic caused excess mortality rates in general, but this was partly offset by a marked decrease in mortality rates among under-30s
Between March 18 and December 31, 2020, the number of deaths was higher than in the corresponding period in previous years by 7% when only taking population growth into account. However, when also taking into account the expected reduction in mortality rates in the absence of the coronavirus, the estimates of excess mortality increase.
In an analysis by age group, Prof. Weinreb finds that in age groups over 55, mortality rates were particularly low in the first two months of the year, especially among those ages 65 and older. Mortality rates in these groups rose from mid-March to mid-July to the levels observed in 2017-2019, and from there continued to rise to uncharacteristic heights, particularly among 65-74-year-olds.
Among young people a different picture emerged: among those aged 0-19, mortality during 2020 was 23% lower than in the 2017-2019 period, and among 20-29-year-olds, about 4% lower. These trends support the claim that the decline in mortality in the general population has continued, in contrast to patterns observed in the US where mortality from causes not related to Covid climbed in 2020, and where there was no sign of mortality reduction at any age.
“The total number of coronavirus deaths in each age group is a product of the age-specific rate of infection, the age-specific probability of death from the coronavirus, and the number of people in each age group. The risk of mortality varies across age groups and, as such, this risk is affected by society’s ability to maintain a low rate of infection,” explains Prof. Weinreb.
Since the outbreak of the pandemic, confirmed infections were disproportionately in the 20-55-year-old age group. As for older Israelis, the rate of confirmed infections among those ages 80 or older during the first wave was 40% higher than their share of the population, by September it dropped to about 60% of their share in the population, in October it rose again, and then it again declined. A similar trend was observed among those ages 60 and older. These trends indicate some success in protecting older Israelis from infection. Had the infection rate been proportionate to Israel’s age distribution, Israel would have experienced about 31% more deaths. Had the infection rate been proportionate to the average age distribution in OECD countries, there would have been twice as many deaths.
Another outcome of the excess mortality rate in Israel in 2020 is its effect on life expectancy. Life expectancy at birth is expected to decline by about two months among both men and women. This means that the excess mortality associated with the coronavirus has outweighed the sharp decline in mortality rates among the younger ages. However, given the high rates of infection among young people, the decline in life expectancy is lower than anticipated.
Mortality rates have risen, but less than expected. Those most harmed are Arab Israelis and haredim.
The coronavirus pandemic has resulted in a substantial excess mortality rate in Israel. At the end of December, the official coronavirus death toll stood at 3,338. In the absence of the coronavirus, says Prof. Weinreb, given the 7% reduction in mortality during the first 11 weeks of the year, there would have been a decrease of around 2.5% in mortality across the whole year, compared to 2017-2019.
Instead, from the end of July to the beginning of October, excess mortality in Israel reached a peak of 30%, pushing the overall mortality rate to levels not seen since the 1990s, when life expectancy in Israel was about four years lower than today. When population growth is taken into account, the wave of coronavirus deaths increased the total number of deaths by about 7%. If the expected reduction of mortality in the absence of the coronavirus is also taken into account, coronavirus increased the number of deaths by about 10%. Although this is a significant increase, it is lower than the increase in other countries (for example, 18% in the US, where mortality levels were already much higher than in Israel prior to coronavirus).
“It’s important to remember that the flu epidemic in 2015 also reduced life expectancy in most European countries by more than three months, even in countries with good healthcare systems,” explained Prof. Weinreb. “A two-month decline in life expectancy in 2020 due to the coronavirus is therefore a relatively moderate decline, though we don’t yet know what to expect from 2021, as the mortality rate in the last two months has been unusually high. However, it is important to understand that wearing masks and maintaining social distance helps reduce the transmission of other diseases, as evidenced by the very low number of influenza cases this winter.”
Existing data do not allow for an accurate estimation of the effect by population group for the whole year, but data earlier in the fall show that about half of those infected among those ages 65+ by mid-October were from the haredi population, and coronavirus-related mortality rates were four times higher among haredim than their share in the general population. Thus, the decline in life expectancy can be expected to be disproportionately concentrated in haredi areas. Similarly, among the Arab-Israeli population excess mortality is expected to be higher, not because of particularly high rates of infection, but because of underlying conditions, especially diabetes and heart disease, both of which are more common in this population group.
“The coronavirus pandemic has far-reaching effects on all areas of life in Israel, and it has substantially increased excess mortality. A two- to three-month decline in life expectancy, as Prof. Weinreb found, is significant, but smaller than the decline observed in other countries and in such Israel has achieved a certain degree of success,” said Taub Center President Prof. Avi Weiss.