Even when the Kerala government has sought solace in the apparent reduction in all-cause mortality in the State in 2020 as an affirmation of the excellent COVID-19 and non-COVID-19 care provided during the pandemic, the civil registrations data does not tell the full story.
Analysis of the State’s birth and death registrations for 2020 shows that except in two districts, there is an unusual increase in the proportion of the people who died at home during 2020, both in urban and rural areas.
The data throws open the question of whether COVID-19 led to the denial of medical care to the elderly and terminally ill in the pandemic year. The attention of the public health system had veered towards COVID-19 care all through 2020 and it’s probably the other side of the story that is being revealed.
“It is true that the fear of COVID-19 kept people from visiting hospitals even when they were sick. Also, government medical colleges, general hospitals, and district hospitals in all districts were converted to exclusive COVID hospitals,” a public health expert says.
Many doctors have highlighted how the follow-up treatment of many with chronic kidney diseases and cancer was compromised during the pandemic. “It is possible that because of the COVID situation, a lot of chronically ill patients were not given adequate medical attention. We should introspect on whether preoccupation with COVID and our failure to create alternative systems of care have led to this increase in home deaths,” he says.
In the U.S. and Europe, nearly half of the COVID-19 casualties were in care homes. But in Kerala, there were few such deaths. Given the high health-seeking behaviour in the State, if the proportion of those who died outside hospitals is higher in 2020, it indicates that the deaths occurred at home probably due to delay in decision-making. The fear of family members contracting COVID-19 from hospitals too could have influenced their decision to not move the elderly to hospitals.
“We need more transparency in data management. Everything surrounding COVID has assumed political overtones, and this has prevented an honest appraisal,” says V. Ramankutty, a public health specialist.
Former Director General of Police Jacob Punnoose said on Facebook that it might be too early to draw conclusions on the 2020 mortality figures. “Lockdown and containment zone regulations would have affected prompt reporting of deaths,” he said.
Also, unlike in previous years, the data of civil registrations in 153 panchayats since September 2020 is missing in the current data (This data is being consolidated using a separate software). The data of Kochi Corporation since 2015 does not figure in the official civil registrations website. Thus, when the final data consolidation is done, the 2020 mortality figures might change and the proportion of deaths at home might rise further.
