Historically High Excess Mortality During the COVID-19 Pandemic in Switzerland, Sweden, and Spain

BACKGROUND: Excess mortality quantifies the overall mortality impact of a pandemic. Mortality data have been accessible for many countries in recent decades, but few continuous data have been available for longer periods. OBJECTIVE: To assess the historical dimension of the COVID-19 pandemic in 2020 for 3 countries with reliable death count data over an uninterrupted span of more than 100 years. DESIGN: Observational study. SETTING: Switzerland, Sweden, and Spain, which were militarily neutral and not involved in combat during either world war and have not been affected by significant changes in their territory since the end of the 19th century. PARTICIPANTS: Complete populations of these 3 countries. MEASUREMENTS: Continuous series of recorded deaths (from all causes) by month from the…