Coronavirus | Spike in excess deaths during pandemic

Interpreting deaths in Chennai

Ambulances wait at a crematorium in Chennai on May 13, 2021.   | Photo Credit: Aloysius Xavier Lopez

Chennai saw over 12,000 more deaths in 2020 than the average of the five preceding years — a 20% increase over those years and a 10.66% increase over 2019 alone, the highest single year change in a decade. Officially, the city recorded just 4,000 deaths from COVID-19 in 2020. It is unclear how many of these ‘excess’ deaths were uncounted COVID-19 deaths or were due to other causes including lack of access to health services. This pattern is likely to repeat itself in 2021. More deaths have been reported in the first four months of the year than during any similar period in the last decade. The ‘excess mortality’ in 2021, which could include other deaths, is also nearly four times the reported COVID-19 death count of 730 deaths for the same period.

Excess mortality

Chennai’s municipal corporation maintains information on every death certificate issued for over a century. The data presented here are based on deaths counted by the date on which the actual death took place, as reported in the death certificate. The city corporation says that it registers virtually every death that takes place within the city corporation limits.

Interpreting deaths in Chennai
 

With the rising population, the number of registered deaths has gradually gone up every year. While data since 2010 have been analysed, the five most recent pre-pandemic years (2015-2019) provide the best comparison as their mortality statistics are closest to what a ‘normal’ year should have looked like. Between 2015 and 2019, Chennai saw 62,457 deaths every year on average (the average was substantially driven up by high mortality in 2019, which registered an increase of 7% from 2018). In 2020, Chennai saw over 74,000 deaths — an increase of 19% over the five-year average and 10.7% over the 2019 figure. From the end of March 2020 through April and part of May, the city was under lockdown. As would be expected for a city that sees over 100 deaths in road accidents alone every month, monthly deaths in Chennai declined in March and April. However, from May to September, there was a large spike in deaths, particularly in June, when more than 50% more deaths were reported than the previous five-year average. With the decline of the first wave by September 2020, excess mortality in Chennai began to fall too, but remained more than 10% above the five-year average. From February 2021, this ‘excess mortality’ began to rise too, and in April 2021, deaths were over one-third higher than the five-year average. The data for April 2021 in particular are likely to be an underestimate as people have up to a year to register deaths.

All over the world, cities and countries have accepted that the official toll from COVID-19 does not represent the accurate or full toll. The U.K. and some jurisdictions in the U.S. like New York City report both confirmed and suspected or probable COVID-19 deaths. The latter category includes people who did not test positive prior to death. Despite this being part of India’s official protocol on the counting of COVID-19 deaths, it is not being followed in practice. Officials in States including Tamil Nadu, Kerala, Maharashtra and Delhi have told this author that they only count deaths among people with a positive test prior to death as COVID-19 deaths. Reporting from States including Gujarat, Uttar Pradesh and Bihar has indicated similar trends.

 

To get past this lack of data, some reporters have attempted to collate data from crematoria and burial grounds. However, this method too is fraught with error — crematoria do not maintain complete records; in some cities, a few crematoria are carrying out all COVID-19 cremations giving the impression of a greater increase in cremations than the data warrant; and many cremations and burials are being carried out following COVID-19 protocols even when the death in question is not necessarily from COVID-19.

Also read | Chennai’s daily coronavirus count drops below 5,000 on May 24, 2021

 

Mortality statistics

Given the inadequacy of official data and the loopholes in novel sources, many researchers are turning instead to estimates of ‘excess mortality’ — the difference between deaths from all-causes in pandemic years and those in ‘normal’ years. Countries around the world including several Latin American, European and North American countries publish updated data on their usual and current mortality. India, however, has not published mortality statistics since 2018. Some better-run States and cities have published this data themselves. Mumbai’s ‘excess mortality’ for 2020 closely mirrors these findings about Chennai; in 2020, Mumbai reported 1,12,000 deaths as against its 2015-19 average of 90,100 deaths, an increase of nearly 20%.

 

These findings on Chennai raise important questions. One, even relatively well-administered cities like Chennai and Mumbai reported a 20% increase in mortality in 2020, and Chennai is seeing a further rise in 2021. This should put an end to speculation over whether or not the pandemic drove death rates up. Two, these differences cannot be explained away by the official death toll from COVID-19. London, a city of comparable population to Chennai, has reported over 15,000 excess deaths from March 23, 2020 to now, an increase of nearly 30%. However, the city has seen over 19,000 deaths with COVID-19 mentioned on the death certificate. That is a clear indication that although mortality has risen, the city is certifying many of the deaths as COVID-19-related, unlike Indian cities. Finally, Chennai’s data suggest that other cities and States would do well to release their all-cause mortality statistics and provide estimates of excess mortality. Cities like Chennai and Mumbai with strong administrative systems are also likely to have stronger health systems — they might be missing some COVID-19 deaths, but we have greater reason to fear that States with under-developed capacity might be missing many more.

Rukmini S. is an independent journalist


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Printable version | Oct 24, 2021 1:18:05 PM | https://www.thehindu.com/opinion/op-ed/interpreting-deaths-in-chennai/article34645264.ece

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