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Karnataka: Lag in death registrations impacts Covid-19 mortality assessment

According to the data available by the Karnataka registrar of births and deaths, a total of 2,69,029 deaths were registered between January and July 31, 2020 in the state compared to 2,79,835 in 2019 and 2,83,484 in 2018.

Written by Johnson T A | Bengaluru |
August 15, 2020 5:55:20 pm
Karnataka covid cases, Karnataka covid spread, Covid spread at Karnataka pharma firm, Genomics study, NIMHANS, karnataka news, Indian expressNow, a scientific study which looked at the genomics of the Sars-CoV-2 virus as well as the spread of the Covid 19 infection in Karnataka has provided some answers to the mysterious spread of the virus. (File)

Despite 2,314 deaths being attributed to the coronavirus pandemic in Karnataka between March 8 and July 31, the overall number of deaths logged under the Civil Registration System for deaths in the state has reduced by 10,806 for the period between January and July as against last year the same period.

According to the data available by the Karnataka registrar of births and deaths, a total of 2,69,029 deaths were registered between January and July 31, 2020 in the state compared to 2,79,835 in 2019 and 2,83,484 in 2018.

From the time Covid-19 deaths were reported in March 2020, a total of 1,79,555 deaths were registered till July 31 compared to 1,98,547 in the year 2019 and 1,92,453 in 2018.

The dip in the absolute number of deaths registered by civil authorities during the Covid-19 crisis has been attributed to a general lag of several months in the registration of deaths, a drop in registration of deaths during the March to May period – when the lockdown was in place, and a dip in road accidents during the lockdown.

“The death rate is lower this year compared to last year because registrations are down. During the Covid lockdown, the registrations were closed and there were very few road traffic accidents. There is a time period of 21 days to register a death, and sometimes people take a lot of time in registering deaths,” Director of the Department of Economics and Statistics in Karnataka Madhu Kumar said.

The Civil Registration System (CRS) of deaths is being looked at by epidemiologists, public health experts and scientists as a key source of information to understand the impact of Covid-19 mortality in the country. Granular data like the causes of death and age profiles provided in Medical Certification of Cause of Death (MCCD) reports, brought out by the registrar of births and deaths, are expected to provide a clearer picture of the effect of the Covid-19 crisis in the year 2020.

With CRS and MCCD reports normally made available in the public domain with a time lag of over 12 to 18 months, authorities are now being urged by experts to quickly bring out reports for 2020.

In Karnataka for example, the report on births and deaths under the CRS and the MCCD report for the year 2018 was brought out only in December 2019. Efforts are now on at the office of the chief registrar of birth and deaths in Karnataka to bring out a CRS report in a few weeks time. Several agencies, including the Union Ministry of Home Affairs, has urged Karnataka to do the same.

A group of 231 Indian public health experts, epidemiologists, medical professionals, scientists and students from around the world have, in an open letter to authorities, called for the urgent placing of records in the public domain.

“Vital registration systems that record births and deaths are unrivaled health surveillance tools that are particularly valuable in responding to epidemics. These data enable the calculation of ‘excess mortality’ statistics, that is, mortality above what we would have expected under normal conditions. If made available publicly by government authorities, these statistics will help quantify the mortality impact of the Covid-19 pandemic in India in real time, and guide policy responses,” the open letter dated August 2 reads.

The letter, an initiative of Bhargav Krishna, a public health researcher at Harvard University, has public health experts like Dr R Giridhar Babu and Professor Jacob John among its signatories.

“To estimate excess deaths correctly, information on deaths for at least the last three years (2018, 2019, and 2020) would be crucial. If causes of death are available for these years, we request authorities to release these. At a minimum, we request that deaths from accidental mortality be identified separately,” reads the open letter to Indian government authorities.

According to the data, for the year 2020, there was an unprecedented 40 per cent dip in registration of deaths in the month of April – from 32,794 in March to 19,629 in April – when there was a lockdown and municipal staff were roped in for activities like contact tracing of Covid-19 patients.

Since the removal of the lockdown in June, the registration of deaths has picked up steam and a lot of fatalities that occurred during the lockdown in homes and hospitals are now being registered, officials at the office of the registrar of births and deaths said.

In Bengaluru for example, where 932 Covid-19 deaths were recorded in July, the total deaths registered in the same month was 1,199. This is compared to the 5,278 deaths registered in July 2019. For the January to July period of 2020, there have been 1,697 fewer deaths than the 37,004 deaths registered in the same period in 2019.

According to the chief registrar of births and deaths in Karnataka M Madeshu the excess deaths in Bengaluru during July 2020 is not due to the Covid 19 deaths but a factor of the back log in registration of deaths from previous months when registrations had stalled due to many factors.

“The number of deaths that occur in a month are not registered in the same month since there is a time period to register the deaths. As a result there is a lag in the numbers registered every month. The final data is with all the numbers registered in a month,” the chief registrar said.

While the data in the annual CRS reports of the registrars of births and deaths are generic in nature, the MCCD reports tend to provide more accurate information on the causes of deaths. However, only around 30 per cent of all deaths that occur tend to be medically certified in Karnataka.

The last available MCCD report for Karnataka is for the year 2018 and is based upon 1,50,415 medically certified deaths which is 31.16 per cent of the total registered deaths in the year and the data was supplied by 1732 hospitals that are part of the medical death reporting process in the state.

According to the 2018 MCCD report for Karnataka diseases of the respiratory system accounted for 8.52 percent (12814 deaths) of all MCCD deaths and was the fifth leading cause of deaths in the state that year after diseases of the circulatory system, injuries, cancer and infectious diseases.

“The 2018 annual report of vital statistics of India argues that the civil registration system ‘serves as the cornerstone of the public health system’. At no other point in the history of India has the data collected by this system been so important,” states the August 2 open letter of experts to Indian authorities to expedite the release of data on registered deaths in the country.

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