After registering a lower number of deaths overall in 2020 compared to 2019, Kerala witnessed a significant increase in the overall death count due to the second wave of the COVID-19 pandemic in 2021, resulting in an estimated 15,222 “excess deaths” till May 31, month-wise data from the Civil Registration System show.
The overall “excess deaths” for the period April 2020-May 2021 were 13,868, which is 1.6 times more than the official COVID-19 death toll of 8,816 during this period. Not all excess deaths will be related to COVID-19, but a bulk of them will be during the pandemic.
Kerala’s estimated undercount factor of 1.6 is lower than what The Hindu estimated for Karnataka (5.8) and Tamil Nadu (6.2) for the same period.
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The undercount factor for 2021 alone (2.7) is also much lower than that of Karnataka (4.7), Tamil Nadu (6.5), Andhra Pradesh (33.8) and Madhya Pradesh (42.3).
It is also the same as the World Health Organization estimate for the Americas and Europe in 2020 — 1.6 times the recorded COVID-19 death toll. The “excess deaths” were estimated by calculating the difference between the overall death counts registered each month during the pandemic years and the average death tally in the pre-pandemic years (2015-2019).
If instead of averages, a year-by-year growth rate of deaths is considered from 2015 to 2021, the 3,03,313 registered deaths in the State were still lower than the estimated 3,12,664 deaths between April 2020 and May 2021. Yet, as registrations for recent months are not fully complete, we utilised the averages method for better approximation.
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Among districts, while Thiruvananthapuram registered the most COVID-19 deaths (1,745), the estimated excess deaths for the pandemic period was lower (941). Kannur (2,149), Palakkad (1,762) and Malappuram (1,634) recorded the highest number of excess deaths, with undercount factors 3.5, 2.9 and 2.4 respectively. Idukki (5.1) and Kasaragod (4.8) also recorded high undercounts but had fewer excess deaths (316 and 724 respectively). Kozhikode and Pathanamthitta also register fewer excess deaths than the actual COVID-19 tally.
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Rajan Khobragade, Principal Secretary (Health), Kerala, told The Hindu , “Since March-April 2020, we have followed a system where deaths occurring will be reported in the medical bulletin. Those who died after testing positive had been counted and reported. A State-level death audit committee looked at all deaths due to communicable diseases and accordingly the reports were updated. We may be the only State doing this properly by a multi disciplinary team of doctors.”
The State government had taken into account concerns about possible omission of deaths due to COVID-19, especially in some cases where patients recovered from COVID-19, tested negative and then died due to health complications.
Since June 15, following criticism about the manner in which Kerala was reporting COVID-19 deaths, the State government has introduced an online, real time COVID-19 death reporting system, wherein all deaths would be entered directly by doctors onto the WHO’s reporting format. The medical bulletins would be checked, the deaths compiled and the count released by districts.
A reconciliation of the death figures in June with 3,766 COVID-19 deaths having been registered till date, could also reduce the undercount factor for the year as more data come in.
Arun N.M., a consultant in Internal Medicine in Palakkad and one who has been closely studying the State’s COVID deaths, however, said, “It is too early to calculate excess deaths because even the deaths which occurred in 2020 are still being registered.”
He added, “Kerala definitely fares well in comparison to other States because most COVID deaths happen in hospitals and our testing and case detection has been very good.”
A Technical Paper released by the Department of Health & Family Welfare in March 2021 pointed to the fact that in 2020, despite the first wave, there was “a 5.5 % reduction in absolute number of deaths in 2020 when compared to 2019. When converted to crude death rates it was 7. 5/1,000 population in 2019 and ..only 7.2 per 1,000 population in 2020”. It attributed this reduction to “preventive and curative health services” by the department.
The lockdowns also contributed to a reduction in deaths due to fewer road traffic accidents, respiratory illnesses and food/water borne illnesses as people stayed indoors. But 2021 has resulted in a higher number of deaths, as in the rest of the country.
Dr. Khobragade added, “A longitudinal study at the national level by a group of experts based on deaths between 2015 to 2019, and those from 2020 onwards, should correctly establish the health system’s resilience.”
(With inputs from C Maya, Thiruvananthapuram and data support from Sumant Sen)
