SINGAPORE - More than 1,000 people infected with Covid-19 in Singapore died of other illnesses within 90 days of getting infected.
This figure contributed to the number of deaths caused directly or indirectly by the virus, according to a recent analysis of excess deaths during the pandemic.
In these individuals, Covid-19 aggravated existing illnesses that caused their deaths.
The 1,087 deaths accounted for about 40 per cent, or two-fifths, of the 2,490 excess deaths in Singapore's population between January 2020 and June this year.
The official death toll from Covid-19 is 1,403 as at the end of June.
Excess deaths refer to the difference between actual deaths from all causes since the pandemic began and expected deaths if there had not been Covid-19.
In a report released on Sunday, the Ministry of Health (MOH) also said that vaccinations played a part in the numbers.
Among the excess deaths in the first half of this year, 28 per cent were people who had not been not fully vaccinated, even though only about 5 per cent of the eligible population were not fully vaccinated by mid-March this year.
Other possible explanations for the excess deaths might have been Covid-19 infections that were undiagnosed, or the virus changing the healthcare behaviour of the population, for example, making them put off health screening or delay getting medication for chronic illnesses.
However, the most likely explanation is that underlying medical conditions were made worse by Covid-19 infections, said MOH.
This could be contributed by a phenomenon in an epidemic called mortality displacement, it added.
Said the ministry: "Although (Covid-19) directly resulted in a substantial proportion of total excess deaths, it would have also indirectly resulted in some other non-Covid-19 deaths by worsening underlying medical conditions after infection."
In particular, Covid-19 increases the risk of developing medical conditions such as heart attacks and stroke, and may have contributed to deaths from these conditions in people who were infected.
MOH said there was an increase in death rates from ischaemic heart disease - heart problems caused by narrowed heart arteries - during the study period, though there was no clear evidence of increased deaths due to stroke.
On whether strained healthcare capacity may have led to excess deaths, MOH said that while many other countries experienced large Covid-19 waves that overwhelmed healthcare systems, Singapore was able to ensure that hospitals and intensive care units had enough capacity and maintained their quality of care.
Key indicators such as the rates of death within 30 days of developing a heart attack and stroke were similar from 2020 to 2021 to the rates in previous years.
The risk of readmissions to hospital within 30 days of discharge was also comparable to those of pre-pandemic years.
MOH said that the World Health Organisation (WHO) estimated the excess mortality for Singapore to be 26 per 100,000 for 2021, among the lowest of the countries that chose to live with Covid-19 in 2021.
Other countries that have low excess mortality include China, which WHO estimates has excess mortality of 2 per 100,000, and Japan with 8 per 100,000.
Neighbouring countries such as Malaysia had an excess mortality estimate of 69 per 100,000, while Indonesia had 243 per 100,000.
Compared with many other countries, both regionally and internationally, Singapore has been able to avoid a large number of deaths, noted MOH.
It attributed this to Singapore's overall pandemic response, and also the high Covid-19 vaccine and booster coverage.
"This has been possible only with the collective effort and hard work from all Singaporeans," said MOH.
"As we continue our journey towards achieving Covid-19 resiliency, we must remain vigilant, and continue to urge everyone to exercise personal protection and social responsibility."