Counting of deaths due to COVID-19 in the city is age dependent – and even higher during the second wave
India is slowly recovering from SARS-CoV-2 . second wave of. it is still Unsure whether there will be a third wave And if yes, by how much? Assessing how many people actually died of COVID-19, and why they died, can help governments and the health care sector design their treatment strategies more effectively.
When it comes to death evaluation, the Indian Council of Medical Research has issued clear guidelines as to what constitutes a death related to COVID-19. Despite this, it is clear that there is a Low count of deaths in India For various reasons. Even in wealthy countries, where almost every death is recorded, low counts based on international analyzes of “excess deaths” have been observed. It reflects the “real world” problems of getting the right data during a public health crisis.
Given that this is the case, the Government of India or the states of the country has no shame in admitting that the number of deaths due to COVID-19 is much less than the actual figures. Public austerity is also a factor in reporting a death as COVID during a pandemic. Given the magnitude of the crisis and the precision of the planning required to address it, it is far more respectable to estimate the actual number. In this article, we focus on estimating COVID-19 fatalities in Chennai and whether the southern metropolis also falls prey to “underestimating” COVID-19 deaths, which currently affects India and the world. . it connects Articles published earlier in this newspaper.
Predicting “excess deaths” during the pandemic period requires accurate baseline data of deaths in previous years. For Chennai, age data for all-cause daily deaths (ACDs) from 2010 to 2019 are available. However, the Greater Chennai Corporation was redefined in 2012, adding a significant population to its purview. Therefore, we consider only the figures for 2015-19. The ACD increased by about 1,850 per year (3% per year) during this period. The estimated population of Chennai has also grown at almost the same rate. Therefore, we believe that, if the Novel Coronavirus pandemic had not occurred, this steady increase in ACD would have continued in 2020-21. Our estimated baseline is based on the assumption (figure 1) ACD from 2018 to 2019 is used as a baseline for average age-stratified deaths (Figure 2) since the age dependence of the increasing trend cannot be reliably extracted from data up to two years only. In summary, we have used two different baselines to analyze additional ACDs in the pandemic period, 2020-21. The first (Method I) for total (age-stratified) ACD using data from 2015–19, including the effects of the observed increasing trend. Second (Method II) for age-stratified ACD using the simple average of the 2018-19 data.
Total Baseline ACD (figure 1) shows a clear seasonality. There is a clear summer and a winter peak. We can’t tell the reason for this on the basis of the data right now.
age stratified data (Figure 2) clearly indicates that this seasonality is mainly due to deaths in the elderly age group (60+).
An investigation of ACD during the pandemic from January 2020 to June 2021, compared with a baseline of ACD from 2015 to 2019, reveals two clear observations (Figure 3) First, there has been a decrease in the mortality rate in the first wave before the lockdown and during the period between the two waves. There could be many reasons for this example, reduction in road accident deaths and other unnatural deaths, reduction in deaths due to other infectious diseases, etc. As of now, we have no reliable data to describe the cause and the mortality rate has declined during these times. The duration remains unexplained. Second, there has been an increase in ACD during the first and second wave of deaths due to COVID-19 in Chennai.
Broadly speaking, ACD decreased when the death rate due to COVID-19 was low, and vice versa when it was high. Based on this data it is reasonable to conclude that the epidemic had two opposing effects on ACD. On one hand, the number of deaths due to being infected with COVID-19 increased ACD. On the other hand, it has also come down due to the lockdown effect due to other causes of death (OCD). At the moment the reasons for this conflict are unclear. The only way to resolve the issue is to conduct an oral autopsy with the families of the deceased. This is not done systematically in Chennai. In the absence of this confirmed data, under-counting factors are defined as (excess deaths)/(reported COVID-19 deaths).
Shown are the results of the estimated undercounting factor for Chennai defined above during different periods of the pandemic (Figure 4 and Table) these undercounting factors are probably underestimated. This is because our estimated number of deaths during the pandemic period as estimated from pre-pandemic data on ACD does not account for the projected reduction in OCD due to lockdown effects. It is clear that the low count of deaths in the second wave was much higher than in the first.
The age dependence of more deaths and lower count ratio is shown (Figure 4)
ACD in “adolescents” (0–17 years) and “young adults” (18–44 years) tends to decrease during epidemic periods (deficit deaths) except in young adults during the second wave. The proportion of low counts in the first wave increases with age but the trend cannot be observed during the second wave.
It has also been reported that the death rate due to COVID-19 among the elderly was significantly lower than the international figures. However, this analysis of Chennai data indicates that this may simply be a consequence of the fact that the death toll among the elderly is much higher than that of the younger age group during the first wave. The reason for this low count is not yet clear. Is it lack of medical certification as to the cause of death as COVID-19? or other reason? This will be known in future only after a thorough investigation into the cause of death. However, it is important to acknowledge that there has been one low count that requires detailed quantitative analysis. It is important to understand the severity of this viral infection in order to formulate an effective policy for the immediate future.
(sources say: https://ourworldindata.org/covid-excess-mortality; https://chennaiCorporation.gov.in/gcc/online-services/death-certificate/; www.tnsta.gov.in/statis_analysis.jsp)
TS Ganesan is Professor, Medical Oncology and Clinical Research, Cancer Institute (WIA), Chennai. R. Rajaraman is a Professor at Homi Bhabha National Institute, Indira Gandhi Center for Atomic Research, Kalpakkam. R. Shankar is Honorary Professor, Institute of Mathematical Sciences, Chennai. Views expressed are personal
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