Excess Covid-19 deaths estimated at 5 percent of Gujarat’s population across 54 municipalities, far exceeds the official Covid-19 deaths for the whole of Gujarat, as per a study published by the Harvard School of Public Health, Harvard Medical School, and UC, Berkeley on August 25, 2021. In the All-cause excess mortality in Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021) study, researchers used data from civil death registers of 54 out of 162 municipalities to estimate the impact of the Covid-19.
“We estimated 16,000 excess deaths across these municipalities since March 2020. Most of these deaths occurred during the second wave, between January and April 2021, with 9,500 estimated excess deaths,” said the report.
From March 2020 onwards 44,568 total deaths were recorded across the concerned municipalities. While deaths were higher in both 2020 (31,477 deaths) and 2021 (17,882 deaths up to April) compared to 2019 (25,590 deaths), the sharpest increase was observed during the second wave of the pandemic in 2021.
Between January and April of 2021, 17,882 deaths were observed, reflecting a 102 percent increase over the average of the previous two years for the same months. The largest percentage change was in the 50 to 60 years age group that recorded a 164 percent increase compared to mortality in the same months of the previous two years. This was followed by the 40 to 50 years age group that recorded a 152 percent increase.
Females experienced a slightly larger increase of 107 percent in mortality in 2021 compared to males, who experienced a 103 percent increase in mortality. However, males had higher mortality counts throughout the study period.
The gender discrepancy was particularly acute in the 40 to 50 and 50 to 60 years age group, where the former group recorded a difference of 91 percentage points in increased mortality whereas the latter recorded a difference of 79 percentage points.
The official death count for the entire state of Gujarat from March 2020 to August 16, 2021, is 10,075 deaths. Yet, as per the report, the sharpest increase in deaths was observed in April 2021, with an estimated 480 percent increase in mortality from expected counts for the same period. This is the highest percentage increase in deaths recorded in a single month anywhere in the world.
For instance, in April 2021, Peru recorded a 345 percent increase. Before that, in April 2020, Ecuador recorded a 411 percent increase. Such huge discrepancies emphasise the need to reassess how official death counts are collated.
Methodology used
“Official Covid-19 mortality statistics are strongly influenced by the local diagnostic capacity, strength of the healthcare system, and recording and reporting capacities on causes of death. This can result in significant undercounting of Covid-19 attributable deaths, making it challenging to understand the total mortality burden of the pandemic,” said the study.
Similarly, researchers advised against the reliance on death certificates as the sole source of information. Instead, they used information provided by an investigative journalists group The Reporters’ Collective. The data encompassed all recorded deaths from January 2019 to April 2021, and included date of death, date of registration, gender, age, and place of death information.
“We only have baseline (pre-pandemic) data from January 2019 to February 2020. Since the baseline period for fitting the model is relatively short, we may not be sufficiently capturing year-to-year variations in mortality. However, the sharp increase in mortality observed in 2021 is unlikely to fall within the bounds of normal yearly variability in mortality,” it said.
While a vast majority of these excess deaths likely represent direct Covid-19 deaths, a small percentage of these would include deaths from the indirect impact of the pandemic, and from causes unrelated to the pandemic.
“There may be lags in recording of deaths in the death registry, and not all deaths may yet be registered. According to media reports, mortality continued to be high, or rose, in May 2021, and is not yet included in the published data or in our estimates,” said the study.
Regardless, the high mortality counts across age groups argued for a careful look into the impact of underlying social determinants and the efficacy of clinical protocols and public health policies on mortality, said the study. State supported data transparency and availability can help local researchers and provide citizens and the state the tools needed to strengthen health systems.
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