The South African Medical Research Council (SAMRC) publishes the number of excess deaths in 2020 and 2021 regularly, but many people try to explain it away by saying it is due to the lockdown, and not unreported Covid-19 cases.
Analysis of excess death figures in South Africa indicates that far more people were infected and died from Covid-19 than the official figures suggest. Covid-19 mortality to the week of 17 January 2021 is most probably in the range of 111,227 to 133,128, rather than the reported 34,828, three to four times more than the official data.
Based on these revised Covid-19 mortality figures, Professor. Alex van den Heever, chair of social security systems administration and management studies at the Wits School of Governance, estimates that the true level of Covid-19 infections may range from around 6 to 9 million, which is significantly higher than the reported 1.3 million.
He analysed the excess death information published by the SAMRC to better understand its relationship to the Covid-19 pandemic.
The SAMRC estimates excess deaths using the weekly data for natural deaths for people over the age of one from death registrations in 2020 and 2021 and use historical mortality patterns for 2018 and 2019 to establish baseline projections. Deviations from the baseline in 2020 and 2021 are treated as excess mortality that cannot be explained by historical disease patterns.
On the other hand, data on deaths directly attributable to Covid-19 are published daily by the National Institute for Communicable Diseases (NICD). This data is not sourced from death certificates, but comes from an ad hoc reporting system established by public and private healthcare facilities to offer immediate surveillance of Covid-19 mortality patterns.
Van den Heever writes that the NICD data accuracy is a concern, because not all hospitals and provinces provide the same level of accuracy, the data cannot be verified, there is no apparent tracking of out-of-hospital Covid-19 deaths and people who die of Covid-19 without a positive polymerase chain reaction (PCR) test may not be included in the count.
Change in burden of disease
He says by simple deduction, deviations from the baseline must be caused by some change in the burden of disease in 2020 and 2021 that was not present in earlier years.
Two basic theories are used to explain the deviation:
- that the deaths could be directly due to SARS-COV-2 infections and the resulting disease, Covid-19 or
- that they are collateral deaths that could be indirectly linked to Covid-19, due to reduced health service access caused by lockdowns and delayed treatment, because people are scared of infection or they are told by hospitals to stay away to make space for Covid-19 patients.
Covid deaths and collateral deaths
Van den Heever analysed the data to determine to what extent the excess deaths can be directly attributable to Covid-19 disease and what can this imply about the accuracy of South Africa’s reported Covid-19 infections.
He says his analysis, using an alternative baseline derived from the first 18 weeks of 2020, “strongly suggests that excess deaths are directly attributable to Covid-19 infections rather than collateral deaths” because the new infection trends by province and nationally corresponds with excess death trends.
The results differed mostly during the winter of 2020 and appears to be caused by an over-estimate of expected flu-related deaths by the SAMRC. Van den Heever says it also seems that the quality of reporting in the provinces differ in quality, with new infection reporting reflecting a consistent trajectory with uncertainty concerning the quantum. However, there appears to be problems with new infection reporting by the Eastern Cape.
“Therefore, the Covid-19 pandemic has evidently had a more severe impact on health outcomes than suggested by official reporting. It may therefore make sense for the NICD to routinely publish information on the probable undercounts of the new infection and mortality data they publish. This could usefully include an indication of the reliability of data provided by provinces,” he wrote.
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