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Because of this enhanced bias when cumulating data, the cumulated outputs should not be considered reliable at this point and must be interpreted very cautiously. An example is number of deaths in the age group 0-14 years, where the EuroMOMO countries in the years preceding the COVID-19 pandemic experienced a decrease in mortality. The model extends this declining baseline mortality in a linear fashion. Before the COVID-19 pandemic, there was a mean of 361 deaths per week in this age group. In week 40, 2022, there is approximately 8.5% bias due to this linear trend meaning that the expected number of deaths (the baseline) is predicted to be 29 deaths lower than in week 1, 2020. This means that even though the number of reported weekly deaths is equal in week 40, 2022 and week 1, 2020, the lower baseline in week 40, 2022 means that there will be 29 deaths higher excess mortality in this week. When cumulating the weekly number of excess deaths, this bias due to the extension of the linear trend in the baseline gets high and may therefore lead to incorrect estimates. During the COVID-19 pandemic the lock-down period (week 1, 2020 to week 21, 2021) had a mean of 326 deaths per week and the following period (week 22, 2021 to week 40, 2022) had a mean of 345 deaths per week which both are lower than the average of 361 deaths per week observed in the period before the COVID-19 pandemic (week 1, 2018 to week 52, 2019). In other words, the EuroMOMO mortality surveillance system does actually not detect more deaths among the 0 to 14-years old during the ongoing COVID-19 pandemic than in the period before the COVID-19 pandemic, even if the cumulated outputs reported on the EuroMOMO website suggest so.

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