The official death toll from coronavirus has risen by a further 53, taking the total to 5,643, the public health institute RIVM said on Friday. A further 35 people have been admitted to hospital and 200 more have tested positive for the virus, the RIVM said.

However, the real death toll has been estimated at up to 40% higher, and new figures giving the total number of recent deaths in the Netherlands indicate a significant excess mortality rate.

Research by national statistics agency CBS, the RIVM and Amsterdam teaching hospital suggest that in the first nine weeks of the coronavirus epidemic, almost 9,000 more people died than would have been expected in normal circumstances.

This is the equivalent of an excess mortality rate of 32%, the CBS said. The official Dutch coronavirus death toll only includes people who have been tested.

How many of the additional deaths were due to coronavirus can only be established on the basis of death certificates, the CBS said. If these deaths are indeed related to the coronavirus, the NOS points out, the Netherlands’ death rate will be similar to that in Belgium, which counts all suspected corona deaths, including in care homes.

The CBS said that so far there does not appear to be a difference in the mortality rates depending on income, but that in the first six weeks, people with an ethnic minority background did appear to be over-represented.

Nevertheless, in absolute terms the number of people with a non-western background who died from Covid-19 is ‘very small’, the CBS said,

The CBS, has also studied the death rate in nursing homes and other institutionalised care homes to try to assess the impact of coronavirus on residents.

In the first 10 weeks of the year, an average of 1,160 people in residential care died, but in the week April 6 to 12, that had soared to 2,400, more than double the expected figure. By the week April 27 to May 3, the death toll in institutionalised care had dropped again to 1,400.

Officials were late to try to combat the spread of coronavirus in nursing homes, and widespread testing has only just been introduced.