The South African Medical Research Council (SAMRC) recently published a report which included information on both natural (age, disease, infection) and unnatural deaths registered on the national population register.
The findings show that by the second week of July, there were 59% more deaths from natural causes than would have been expected based on historical data. In her commentary, Prof Debbie Bradshaw, Chief Specialist Scientist and a co-author of the report, said the timing and geographic pattern leaves no room to question whether this is associated with the COVID-19 epidemic.
In a short interview, Bradshaw explains the findings.
“The South African Medical Research Council has been getting data from the Department of Home Affairs of all the deaths that are registered. We’ve been using that for many years to provide a picture of what mortality rates have been and that report has been produced on an annual basis. During February/March this year, with the possibility of the COVID-19 epidemic, we realised that that would need to be speeded up and we investigated how to get data more quickly and process it,” she said.
“Since about March, we’ve been doing a weekly report on the number of deaths that are registered and over the weeks we realised that there is a pattern during the year with the number of deaths going up in the Winter months – this is often associated with the flu and is also related to other conditions which increase during Winter. We used historical data to predict what would be expected for each week and we’ve been tracking the weekly numbers of deaths against what would be expected.”
The report also highlighted the rapid decrease in unnatural deaths with the implementation of a hard lockdown, and the return to usual numbers following the lifting of a hard lockdown and the restrictions on alcohol, with a sudden increase in the first week of June.
“We realised that there was quite a big impact of lockdown on the number of deaths. That was particularly noticeable in the unnatural deaths: road accidents, murders, suicides etc. With the lockdown, less people on the roads and alcohol restrictions, there was an immediate drop – almost to half of what it was previously – in unnatural deaths,” Bradshaw said.
“In natural deaths, that is the deaths from ageing or from diseases, we also saw that there was a bit of a drop. It started tracking lower than the predicted levels. We think – and we don’t have access to the data which could tell us exactly what it is – that with lockdown there was certainly an impact on the flu epidemic that we usually have in Winter. The social distancing, handwashing and wearing of masks would have affected that as well.”
Tracking weekly excess deaths is not a new phenomenon – several countries in the developed world have been reporting these trends, particularly to assess the impact of influenza. With the outbreak of the COVID-19 pandemic, more countries have started doing this. Such analyses have generally demonstrated that during the pandemic, countries experience excess numbers of deaths over and above confirmed COVID-19 deaths.
“The report we put out now is showing that in some provinces, in particular Eastern Cape and Gauteng, that the gap between the number of COVID-19 deaths and excess deaths is big. It is important for us to do more work to get some research done to find out exactly what is causing that. It could be that there are people with COVID-19 not getting to health facilities or people dying at home. It has been seen in other countries as well,” Bradshaw said.