Unlike other cities in India which registered excess deaths during the first and second COVID-19 waves , Kerala’s capital Thiruvananthapuram recorded a decrease in number of overall deaths in 2020 and 1,196 “excess deaths” in 2021 (till May), according to the Civil Registration System data accessed by The Hindu through a Right to Information application.
Compared with the pre-pandemic years (2015 to 2019) when the city corporation registered an average 16,652 deaths, in 2020, despite the pandemic, only 14,734 deaths occurred. If instead of averages, a year-by-year growth rate of deaths is considered, the city’s 14,734 registered deaths were fewer than the estimated 18,340 deaths in 2020.
This is in line with 2020 figures for the entire State of Kerala, released early this year, which showed that the absolute number of deaths in 2020 reduced by 11.1% compared with the 2019 figure. (This gap has closed to 7.9% now, according to the latest figures).
Effective response
A natural reduction in deaths due to fewer road accidents and respiratory illnesses such as COPD, H1N1 and pneumonia besides water and food-borne illnesses as people stayed indoors due to lockdown was one reason. But the lower COVID-19 mortality in Kerala was also due to an effective public health response that stood out in comparison with that of other States. This factor is evident in Thiruvananthapuram as well.
Unlike 2020, however, the increased number of fatalities due to COVID-19 in the second wave, led to 1,196 and 707 excess deaths between January and May and April-May, respectively, in 2021. The COVID-19 death count for the city limits for January to May 2021 and April-May 2021 were 507 and 453, respectively, for undercount factors of 2.35 and 1.6, respectively. However, the Corporation also reported a COVID-19 death toll of 1,007 in June 2021 alone (till date), which includes reconciled figures from deaths in the second wave besides those of patients from nearby panchayats as well as Kollam district and Kanniyakumari who died at the Government Medical College in Thiruvananthapuram.
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In the entire period of the pandemic from April 2020 to May 2021, despite a cumulative COVID-19 death toll of 765, the estimated decrease in overall deaths was 646.
This is unlike more populous cities such as Hyderabad and Kolkata with an estimated undercount factor of 17.5-30.5 and 4.5, respectively, in 2021, and Bengaluru and Chennai with 2.3 and 5.6, respectively, for the entire pandemic period (April 2020 to May 2021). Undercount is measured as the excess deaths divided by the official COVID-19 toll. Not all excess deaths are COVID-related but a bulk of them could be, during a pandemic.
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‘Home deaths’
A public health expert, who spoke to The Hindu , explained that there could be deaths due to other causes which might have occurred outside hospitals and would be reported later in the system. Such ‘home deaths’ “get reported much later when questions of property transfer or requirements of death certificates arise,” he said, which could lower the gap between the expected death toll and the actual registered numbers.
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Mohammed Asheel, Executive Director, Kerala Social Security Mission, who has been at the forefront of the State’s COVID containment activities, said that while delay in reporting could be one factor, the one thing that could be inferred for sure from the said data was that the number of COVID-19 deaths missed, at least in the Thiruvananthapuram Corporation limits, was not high.
“The difference in the estimated excess death toll and the actual COVID deaths is not very significant and unless we can get a split-up of the cause of deaths, we cannot draw any other conclusion. It just emphasises the strength of our surveillance and reporting system,” Dr. Asheel said.
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While the reduction in death figures for Thiruvananthapuram coincide with those for the State in 2020, the low undercount in the city limits in 2021 cannot be assumed for other districts in Kerala. A perusal of month-wise CRS data for other districts would have to be done to see if the trend holds true for the entire State and to correctly estimate the undercount factor for Kerala.
(With inputs from C. Maya in Thiruvananthapuram and Vignesh Radhakrishnan)
