Severe features during outbreak but low mortality observed immediately before and after a March–May 2020 COVID-19 outbreak in Stockholm, Sweden

OBJECTIVES: The aim of this study was to estimate how well the excess mortality reflected the burden of coronavirus disease 2019 (COVID-19)-related deaths during the March–May 2020 COVID-19 outbreak in Stockholm, Sweden, and whether the excess mortality during the outbreak might have resulted in a compensatory reduced mortality after the outbreak. METHODS: Using previous 10-year or 5-year average mortality rates as a baseline, the excess mortality estimates before, during, and after the COVID-19 outbreak in March–May 2020 in Stockholm were compared. RESULTS: Weekly death estimates revealed that the immediate pre-outbreak and post-outbreak all-cause mortality did not exceed to excess mortality regardless of whether previous 10-year or 5-year average mortality was used. Forty-three days after the start of the outbreak, 74.4% of the total excess mortality was reportedly explained by known COVID-19-related deaths, and the present study reports an update, showing that 15 weeks after the start of the outbreak, the reported COVID-19-related deaths explained >99% of the total excess mortality. CONCLUSIONS: An exceptional outbreak feature of rapid excess mortality was observed. However, no excess but similarly low mortality was observed immediately prior to the outbreak and post-outbreak, thus emphasizing the severity of the first wave of the COVID-19 outbreak in Stockholm.