We have been hearing about deaths almost on a daily basis recently. Are these deaths really caused by COVID-19? – Joseph Borg

When reporting deaths, we follow the WHO international guidelines for certification and classification of COVID-19 as cause of death. For the first three weeks of 2022, 67 per cent of the reported deaths were as a direct result of a COVID-19 infection while, for the rest, COVID-19 was a contributory factor. For all the reported deaths since 2020, COVID-19 was the underlying cause of death (direct result) in 81.7 per cent of all reported COVID-19 related deaths.  

The most common direct cause of death from COVID-19 is pneumonia. Pneumonia is an inflammation of the tissue in one or both lungs. The symptoms of pneumonia can develop suddenly over 24 to 48 hours or may come over several days. Common symptoms include a cough, difficulty in breathing, a high temperature and chest pain.

 Why are we seeing all these deaths among the elderly? – Mary Camilleri

As we know, COVID-19 vaccination was always first prioritised to those more at risk, starting with the 80+ cohort and then working down the age groups, in order to ensure that the most vulnerable are protected against severe disease and death.  

Vaccination is known to elicit a more uniform immune response than infection as, after an infection, the immune response is known to be erratic, when it happens, and also may be more variant dependent than vaccine-induced immunity since vaccines are designed in such a way as to be active against various different parts of the virus. It is also very difficult for variants to have modified all possible sites where vaccine-induced antibodies and immune cells could attach themselves.

As one would expect with all deaths, COVID-19 mortality increases by age in all groups. In addition, it is well known that the immune response may be less strong as one ages and that immunity against coronaviruses may wane over time, be it following infection or following vaccination.    

A vaccine, while giving good protection, does not grant 100 per cent protection, which is why the public health measures we have been advocating since the very beginning – avoidance of crowds, social distancing, wearing of masks and hand hygiene – remain critical layers of protection even when protected with a vaccine. No measure is 100 per cent protective but, together, they achieve a higher level of protection.

Is the vaccine really preventing COVID-19 deaths? – John Fenech

The deaths we are observing are mostly in the 60+ population, with a predominance among the over 80s. That said, it is also quite clear that the booster has been very protective when it comes to mortality. From the beginning of the year till now we have seen that half of the deaths directly caused by COVID-19 occurred in the boosted population.  This is expected as with the high coverage of our population with the booster, especially in older age groups. 

In fact, these 50 per cent occurred among the 95 per cent of over 60s who have already received a booster vaccine dose. The remaining 50 per cent have occurred among the five per cent who remain without a booster dose or even unvaccinated.  The unvaccinated are clearly the most at risk. Indeed, one-sixth of the deaths (or a third of those deaths occurring among those who have not had three vaccine doses) have occurred in the very small proportion (less than one per cent) of this population cohort that remains unvaccinated. 

The appeal is, therefore, for those who have not had their booster to do so as quickly as possible. Needless to say, those with no vaccination at all should proceed without further hesitation to have their vaccine.

Among those having COVID-19 as a contributory cause of death since the beginning of 2022, just over 60 per cent had already received a booster vaccine dose. Once again, when one considers that these occur within the 95 per cent who have already received a booster vaccine dose and the remaining 40 per cent occur within the remaining five per cent who either have two doses only or none at all, it is very clear that, even with frail patients suffering from other serious conditions, their chances of survival are better with three doses.

It is worth noting that, according to a study carried out by WHO for the whole European region, it is estimated that, on top of the 305 deaths observed between November 2020 and November 2021, there would have been an additional 860 deaths if we did not have the vaccination programme in place and the enthusiastic uptake we have seen among the Maltese public. Indeed, it is estimated that 74 per cent of the expected deaths have been averted through the vaccination programme.

Have any questions to ask the superintendent? Send an e-mail to askcharmaine@timesofmalta.com.