Chaos in Covid reporting prevents us from knowing exactly daily deaths after 2 years
This Monday, 601 deaths from Covid-19 were recorded, a figure that had not been seen since the third wave of the pandemic, corresponding to those reported over the weekend. The Ministry of Health has warned that was due to a delay in the notifications from Catalonia. On Tuesday, another 310 deaths were added. However, communities like the Basque Country are reporting zero deaths in the last 7 days for two days, while in their own weekly epidemiological report (published this Monday 14) 200 deaths were reported.
After the chaos of the first months of the pandemic, the data notification and information system was standardized in May 2020. However, there seems to be an endemic delay in deaths which makes specialists wary of the figures given daily .
Some have already given up. The delays “can influence when estimating the numbers over short periods of time, but if we look at longer periods, in the trends, we can better understand the magnitude”, he comments. mario fontanof the Spanish Society of Epidemiology.
This also happens with the supposedly benign omicron wave. “The more information systems are saturated, the greater the gap can be“. Especially in the case of death certificates, which must be recorded by hand.
Added to this is an element which is becoming more and more important and introduces a distortion in the interpretation of this sixth wave. Are we facing the worst wave since the generalization of vaccines or are the systems not able to clarify what is happening?
The European mirror to which many turn is Denmark. On February 1, he lifted all restrictions, and since then the cases and deaths have continued to rise. The Statens Serum Institute later clarified that deaths with Covid must be differentiated from those with Covid.
This may sound familiar: There was quite a debate throughout the omicron wave about whether the hospitalizations were due to the coronavirus or if it was incidental, a positive PCR in someone admitted for another reason. With the drop in income, the controversy seems to have been left aside. After the record number of deaths in the sixth wave, it was transferred to deaths.
This debate, however, is not new. An article in the Spanish Journal of Forensic Medicine She already warned, in her July to September 2020 issue, that “sometimes the dilemma of dying from Covid-19 or dying with Covid-19 is expected, and it can be complex to determine whether Covid-19 is the cause of the dying process or is it a previous disease”. And he concluded: “Here Only the reflection of the doctor who signs the certificate is possible in view of the data of the clinical evolution of the deceased patientwhich may require a thorough study of your medical history.
“It is quite clear if the person was admitted due to polytrauma caused by an accident, but in other cases it is not so clear”, explains the epidemiologist. Joan Cayla, who regrets that “at this stage” there is still no way to better monitor the parameters of the pandemic. “We should have good epidemiological surveillance systems and it should be easily controllable. There are data that sometimes do not add up: recently Health has collected many more hospitalized patients in Catalonia [que los propios datos autonómicos]it appears that due to differences in understanding of whether social health beds are hospital beds”.
The experts consulted by EL ESPAÑOL point out that it is possible that deaths “with Covid” are included among the reported deaths, but this is something that does not introduce a fundamental distortion in the data. In the end, the person who completes the death certificate is a doctor, who must take into account, beyond the positive test, whether the patient presented symptoms of Covid or whether this disease could have played an essential role in the death. death.
The slowness of epidemiological surveillance
“Public health surveillance systems are very limited, designed for notifiable diseases, which [antes de la pandemia] would not exceed approximately 100,000 cases per yearputting a very high figure”, explains Caylá, who recalls that in Spain there are cases of very well controlled computerized registers, “like those of the Treasury”, but this does not happen in the death register.
“In other countries, this certificate has already been computerized,” he points out. Jonay Ojeda, of the Spanish Society of Public Health and Sanitary Administration, Sespas. “Of course there may be Covid deaths not attributable to the disease, but with the exception of certain initiatives in an autonomous community, it is difficult to know the true figure, and that is because it is not not an information system well connected to health but depends on others. (the National Institute of Statistics) and it is not digitized”.
A) Yes, the collection of data on deaths depends on the INE, “it is not information updated or prepared to be offered in real time”. A recently published article in Health bulletinthe academic journal of Sespas, pointed out that “it would have been possible to artificially increase the number of victims of Covid-19, and also to lose deaths at the beginning of the epidemic due to unsuspected complications of Covid-19” .
Official death statistics in Spain apply WHO rules, which recommend certifying a relationship with Covid-19 in death if there is a positive laboratory test or a compatible clinical test. But a distortion occurs: “A person who died of a heart attack, and was infected and positive PCR, would be a case of Covid-19 for epidemiological surveillance, whereas for mortality statistics it should be a death from myocardial infarction.”
Ojeda adds: “At the start of the pandemic, when we did not know the pathophysiology of the disease, there were deaths that were not reported because we did not have the possibility to do diagnostic tests and because the relationship between the disease and the different causes of death was not known“. Data on excess mortality in those months reflected tens of thousands more cases than official statistics.
Report deaths on Sunday
Added to this is the fact that our country is a rare bird in Western Europe because it suspends the communication of cases during the weekend, although there are communities that offer them daily. This causes distortions in the first days of the week, which we are all used to, but it is still something exceptional in our environment.
“I was at WHO 20 years ago and the only European country that could not say exactly how many HIV cases it had was Spain“, it is said Jeffrey Lazareresearcher at the Barcelona Institute for Global Health (ISGlobal), a center promoted by the La Caixa Foundation.
“In other countries there may be a hospital that does not send its numbers on Sundays, but this is something exceptional: it has already happened in Denmark and people, who do not weren’t used to it, thought something had happened.” And he specifies: “It is no coincidence that Catalonia and the Basque Country are two regions that do not report well to the central authorities.
Regarding the Danish case, Lazarus (based in Barcelona but who has lived in Denmark for 20 years) points out that this country has a very good health and data management system, “they argue that very few people will die from Covid”, something with which he is critical: it is not only about dying but also about the consequences and the impact on other pathologies. “What they mismanaged was to explain to the population that, although there is no legal obligation, they must take precautions.”
The other underlying problem is that there are no unified criteria in Europe when it comes to reporting Covid cases, hospitalizations and deaths. “The data that must be declared to the ECDC [Centro Europeo de Control de Enfermedades, por sus siglas en inglés] they should have homogeneous criteria”, criticizes Mario Fontán, who regrets that the debate “for the Covid” https://www.elespanol.com/ “with the Covid” is treated in terms of black or white when it requires more finesse.
Yet he and Lazare believe that we have grown accustomed to noticing distortions in Spain’s Covid death notification system and that these had no impact on the management of the pandemic. “The degree of coordination and integration of data has been adequate to understand how the pandemic works,” he said. “It is always possible to improve and surely possible breakdowns have been detected, but overall we have understood each other”.