Objectives: The first wave of the SARS-CoV-2 pandemic in Germany lasted from week 10 to 23 in 2020. The aim is to provide estimates of excess mortality in Germany during this time. Methods: We analyzed age-specific numbers of deaths per week from 2016 to week 26 in 2020. We used weekly mean numbers of deaths of 2016-2019 to estimate expected weekly numbers for 2020. We estimated standardized mortality ratios (SMR) and 95% confidence intervals. Results: During the first wave observed numbers of deaths were higher than expected for age groups 60-69, 80-89, and 90 +. The age group 70-79 years did not show excess mortality. The net excess number of deaths for weeks 10-23 was + 8,071. The overall SMR was 1 •03 (95%CI 1 •03-1 •04). The largest increase occurred among people aged 80-89 and 90 + (SMR = 1 •08 and SMR = 1 •09). A sensitivity analysis that accounts for demographic changes revealed an overall SMR of 0 •98 (95%CI 0 •98-0 •99) and a deficit of 4,926 deaths for week 10-23, 2020. Conclusions: The excess mortality existed for two months. The favorable course of the first wave may be explained by a younger age at infection at the beginning of the pandemic, lower contact rates, and a more efficient pandemic management.

Introduction Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. Methods Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. Results In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974–0.978), and 1.030 (1.023–1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144–1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007–1.011) and 1.083 (1.076–1.090), respectively, whereas results for Spain were virtually unchanged. Conclusion In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy.

It is unlikely that data from the Spanish flu in Switzerland will allow any predictions about the current SARS-CoV-2 pandemic. In Switzerland, SARS-CoV-2 resulted in 33 000 confirmed cases within 6 months. However, the Spanish flu resulted in 40 times more cases than SARS-CoV-2 during the same time interval, when adjusted for population sizes.We declare no competing interests.

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