SA's excess death mystery
By Shaun Smillie and Karishma Dipa
They are the dead, unassigned and unexplained that tell the story of either a health system under performing or a disease more deadly than we know.
Every night now, many South Africans follow a ritual. They scroll down Twitter feeds to learn of the latest Covid 19 death toll, released by Health Minister Zweli Mkhize
But as those numbers have climbed as the second Covid 19 wave swept through the country, so has a corresponding death toll.
The number of excess deaths – those natural deaths that are above what is usually expected when comparing to past patterns – have also been on the rise.
The South African Medical Research Council (SAMRC)’s latest report on weekly deaths in South Africa was scheduled to be released yesterday but it was still not made public by the late evening.
Their previous release covering the period from December 30 to January 5 revealed the number of excess deaths to have been a record 10 907 individuals. The total number of deaths for that week stood at 20 063 people.
Meanwhile, the department of health declined to comment on the matter and referred it to the SAMRC.
“The excess death numbers have shown a similar shape to the earlier peak in the year, so it is reinforcing the evidence of the current surge,” explained Professor Alex van der Heever who holds the chair in the field of Social Security Systems Administration and Management Studies at the Wits School of Governance.
“The data on the reported deaths this time is a little bit better so the undercount is less. So the question is what are these excess deaths, are they Covid deaths or collateral deaths. But my view is they are definitely Covid deaths.”
Other academics also suspect that a chunk of these deaths have been caused by the virus.
“We are not able to put a figure to it. However, given the close correlation with the spread of the pandemic in each province, we consider that a large proportion are COVID-19 related,” said Professor Debbie Bradshaw, the chief specialist scientist at the South African Medical Research Council.
Van den Heever believes that it is not just that more people have died from the virus, but that there were more infections. The official number of Covid infections is at 1.3 million, Van den Heever believes it is probably at three million.
But it is the excess death data that Van den Heever believes raises questions about how the government is gathering important information in its fight against the disease.
Collected data, except for the Western Cape suggests that private hospitals had more admissions than the public hospitals.
“It looks like the private sector has dealt with the lion's share of the Covid patients,” he said.
“When you look at the excess death information it is telling you a story that the hospital utilisation doesn’t tell us. And it suggests that either people didn’t access hospital services and died at home or they did go to hospital but that they didn't collect the data.”
There are however efforts to try and address the excess death problem.
Bradshaw said that the South African Medical Research Council is collaborating with the National Institute for Communicable Disease and the Department of Health to link different data sets and to try and identify cases where someone died within four weeks of a positive Covid-19 test.
“We think that this will contribute towards informing us about the gap between the reported deaths and the excess deaths – but it will not be able to tell us about any other causes of death that may have increased during the surges of the first and second waves,” said Bradshaw.
A new method of collecting information about causes of death is also being trialled.
A pilot test involving using verbal autopsies is planned.
Verbal autopsies involves the use of interviews to gather information about the symptoms and the cause of someone’s death.
“We are concerned that there are people who die at home without being under the care of a doctor nor having a coronavirus test. In such cases, we think that a verbal autopsy interview with the person who cared for the deceased through their last illness could help us identify whether they had common COVID-19 symptoms prior to death or whether they died from other causes of death,” said Bradshaw.
The problem is that it is likely going to take years before scientists work out what exactly was behind the massive spike in excess deaths over the last eight months.
It is a slow process where death notification forms are completed by doctors before they are sent to the Department of Home Affairs. The data is then forwarded to Stats SA where it is coded and captured for analysis.
“The 2017 data was released in March 2020 and we understand that the 2018 data are still being processed,” she explained. “This data will be informative once it becomes available, provided our doctors give full information about the cause of death based on their clinical assessment.”
However in the meantime to improve the quality of data, Bradshaw and her colleagues are urging doctors to provide quality information that they hope will help provide an answer to the mystery as to what has been causing all these unaccounted deaths in a time of pandemic.