• Paulo Jorge Nogueira, Miguel De Araújo Nobre, Paulo Jorge Nicola, Cristina Furtado, and António Vaz Carneiro.
• Institute of Preventive Medicine and Public Health. Faculty of Medicine. University of Lisbon. Lisbon. Laboratory of Biomathematics. Faculty of Medicine. University of Lisbon. Lisbon; Institute for Evidence Based Health. Faculty of Medicine. University of Lisbon. Lisbon; Institute for Environmental Health. Faculty of Medicine. University of Lisbon. Lisbon. Portugal.
• Acta Medica Port. 2020 Jun 1; 33 (6): 376-383.

IntroductionPortugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-cause mortality during the early COVID-19 pandemic period.Material And MethodsPublic data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period.ResultsAn excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65) [corrected].DiscussionThe data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals.ConclusionDespite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths [corrected].

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