Singapore's overall death rate did not increase despite Covid-19

Singapore's death rate per 100,000 population stood at around 530 in 2021.
Singapore's death rate per 100,000 population stood at around 530 in 2021.ST PHOTO: NG SOR LUAN

SINGAPORE - Singapore's overall death rate has not increased despite more deaths from Covid-19, and this is because those who died from the virus would likely have otherwise perished from other medical conditions.

In fact, a closer look at the mortality numbers here shows that the Republic's death rate in 2021 is lower than the rates in 2016, 2017 and 2018 - before the Covid-19 pandemic began - and is only slightly higher than 2019 and 2020.

Singapore's death rate per 100,000 population stood at around 530 in 2021, marginally lower than the death rates in 2016 to 2018, which ranged from 547 to 563 deaths per 100,000 population.

This is known as the concept of mortality displacement, two infectious disease experts here - Professor Teo Yik Ying, dean of the Saw Swee Hock School of Public Health; and Associate Professor Vernon Lee, who heads the Ministry of Health's contact tracing centre, wrote in a commentary published on Saturday (Nov 6).

Older people with pre-existing conditions make up the vast majority of Covid-19 deaths here, and it is likely that this same group of people would have otherwise died from other medical conditions.

Mortality displacement often happens during crises such as epidemics, famine and war. These shocks take a toll on people who are sick and already frail - especially the very old.

This hastens some deaths, and produces a temporary forward shift in mortality.

Covid-19 may be doing this to those with severe underlying illnesses, aggravating these illnesses and, in turn, triggering heart failures and deaths, the experts wrote.

A good amount of time - almost two years - has also passed since the pandemic started here, and the fact that Singapore's overall death rate did not spike due to Covid-19 could also be because its public health policies have borne fruit.

Professor Paulin Tay Straughan, a sociologist from Singapore Management University, said she attributes this to the nation's sound public health policies and holistic pro-health and active ageing approach.

For instance, the privileges given to the Pioneer and Merdeka generations have helped to encourage older folk to seek help earlier and participate in preventive health programmes, she added.

But moving forward, as Covid-19 fatigue is felt more heavily, the mental and emotional well-being of those who are isolated will be a greater concern.

"We worry about the older adults who remain socially isolated this period, those who live alone, in particular. Their well-being has been negatively impacted due to the safe management measures, so it is important for us to look for opportunities to reconnect with them," Prof Straughan said.

As Singapore transitions to accept Covid-19 as endemic, the number of deaths attributed to the virus will inadvertently rise.

Asked if Singapore's death rate would spike, Associate Professor Alex Cook, vice-dean of research at the Saw Swee Hock School of Public Health, said: "While we don't know how many Covid-19 deaths we will experience over the months ahead, the number mentioned in the commentary seems quite plausible: 2,000 a year."

He added: "At that level, it would equate to about 30 to 40 deaths per 100,000 population. If we add 30 to 40 to the annual counts, it would be noticeable but not by any means a 'spike'. Rather it would be about a 5 per cent to 10 per cent increase over the usual numbers."