In France, like in Europe, an excess mortality linked to COVID-19 occured in late March/early April

The gap between deaths from all causes during the first four months of 2020 and the average for the same period between 2016 and 2019 followed a similar trend in France as in 21 European countries considered as a whole (sources). Over the first few weeks of 2020, until the end of February, mortality was generally lower than the average from 2016 to 2019. This is explained, in particular, by the fact that seasonal flu resulted in almost no excess deaths in Europe at the beginning of this year. Although, the number of deaths usually began to drop from the start of March in previous years, it instead rose significantly in 2020, reaching a peak in both France and Europe during the week of 30 March 2020. During that week, excess deaths reached 50% in Europe, i.e. there were 50% more deaths than in the same average week between 2016 and 2019 (Figure 1). It exceeded 60% in France and reached 155% in Spain, 91% in Belgium (where it would go on to reach 107% in the week beginning on 6 April) and 67% in Italy (falling from 88% the week before, as Italy saw its peak one week earlier). It then fell gradually and had almost disappeared by the start of May.

The level of over-mortality varied greatly accross European countries. Between 2 March and 26 April 2020, the vast majority (84%) of excess deaths observed in the 21 European countries can be attributed to Spain, Italy and France (Figure 2), with the share attributable to these counties reaching almost twice their usual share in overall deaths (44% for the same period between 2016 and 2019). Excess mortality in Spain, Italy, Belgium and France reached respectively 71%, 49%, 44% and 28% over the eight weeks from 2 March to 26 April. Conversely, in Germany, Europe’s most populous nation, over-mortality was significantly lower (4% over the same period). This is also the case in countries of Central and Eastern Europe.

The disparities are also significant at sub-national level (Figure 3). Over-mortality was particularly high in central Spain and northern Italy. In the worst-hit provinces of Spain (Ciudad Real, Guadalajara, Madrid and Segovia) and Italy (Bergamo, Brescia, Cremona, Lodi and Piacenza), the number of deaths recorded between 2 March and 26 April 2020 was over three times higher (i.e. over 200% more deaths) than over the same period average between 2016 and 2019.

In Metropolitan France, in the five most affected departments (Haut-Rhin, Hauts-de-Seine, Seine-Saint-Denis, Val-de-Marne and Val-d'Oise), the increase was a little lower than in the provinces of the other European countries mentioned above, rising by between 100% and 150% relative to the same period average between 2016 and 2019. Conversely, Metropolitan France's Atlantic coast includes departments (Finistère and Landes) that recorded a drop in the number of deaths in 2020 compared with the 2016-2019 average. The south-west part of the Italian Peninsula also falls into this category (provinces of Roma and Latina in particular).

For the period between 2 March and 26 April 2020, in Europe and in France to a lesser extent, these excess deaths affected men slightly more than women (with a gap of + 7% and + 3% across this period, respectively). Furthermore, the timescale was slightly different in France (Figure 4a), with greater differences at European level (Figure 4b), and the acceleration in deaths up to 30 March (the peak of the epidemic) was seen primarily among men. The male/female death ratio in France reached a peak of 1.07 over the last week of March (i.e. one week before the peak in mortality) and 1.06 in Europe. In Europe, the situation reversed from the start of April, from which point more excess mortality was seen among women than men. The male/female death ratio fell to its lowest level in the week of 13 April, before returning to a threshold of around 1 in France and a little below 1 in Europe.

Between 2 March and 26 April 2020, the increase in mortality was observed to be more prevalent among people aged 50 and above, both in France and in Europe. For both men and women, this excess mortality was more particularly prevalent, in France and in Europe, among people aged 70 and over (59% of whom were women, both in France and Europe). In France, the excess mortality was over 40% higher among men and almost 35% higher among women in the 70-74 and 90+ age groups compared with the 2016-2019 average (Figure 5). In Europe, for both men and women, this excess mortality was highest among those aged 90 or above (1% of the total population, of whom 73% are women), where it reached 50% among men and 43% among women.

This descriptive study highlights a certain number of similarities among European countries, including France, in terms of the trend in deaths observed over the first few weeks of 2020, with a peak in excess deaths linked to the COVID-19 epidemic recorded almost simultaneously in late March/early April. Likewise, excess mortality varied significantly by age groups, with the elders being most hit in France and in Europe. However, beyond these similarities, there are various marked differences in excess mortality accross countries and between departments and provinces within each country. Although several factors could explain these differences, we are not yet able to explain the relative significance of each one: differences in age structures and population density; differences in health status and access to health care; existence of clusters that emerged sometimes accidentally; different dates and terms of containment and easing across countries; number of key workers and terms for conducting professional activities over the period in question, etc.