Wide disparities among districts in COVID mortality

Epidemiologists ponder whether it is the difference in clinical management or institutional factors

Thiruvananthapuram Wide disparities among districts in COVID-19 mortality data have raised questions as to why some districts seem to be faring well in comparison to others. While epidemiologists ponder whether it is the difference in clinical management or institutional factors behind this disparity, some districts have fewer deaths merely because of under-reporting and data mismanagement, say experts.

An analysis of COVID deaths in Kerala between September 15 and December 14, 2020 (2,173 deaths), when the epidemic curve hit the peak, shows that the proportional mortality in the 20-40 years age group is just 1.5% in Kozhikode while it is more than its double in Kollam and further up in Thiruvananthapuram. In the 40-60 age group also this variations can be seen, with Kottayam (30%) and Thiruvananthapuram (26%) recording the maximum deaths while Kollam has 18% and Kozhikode 16%.

(Wayanad and Idukki were excluded from this analysis as the figures were insignificant at the statistical level.)

This is an age group wherein most of those who succumbed to COVID were probably the breadwinners of families. Co-morbidities would have set in in this group, but this is one group where more lives can be potentially saved.

“There could be any number of reasons, including the fact that some districts could have been doing better reporting. As COVID-19 has no definitive treatment, could this disparity be due to improved clinical management in certain districts? The question is whether there are correctable factors in districts which can help save more lives,” a public health professional points out.

A comparative study of COVID treatment and outcome data from all institutions which have treated at least 500 or more patients could perhaps throw deeper insights into this, he adds

Under-reporting of deaths

However, the disparity between districts in fatality rates had been noted earlier itself and this is nothing but gross under-reporting and data manipulation by some districts, a member of the State’s expert committee on COVID says.

“In many of these districts, the daily deaths reported by Collectors were in total variance with the data released by the State government. Pathanamthitta and Wayanad are two districts where this was very evident. In Pathanamthitta, at one point, when the official data put the number of total COVID deaths in the district at 16, the Collector’s report clearly put it as 105. This disparity has continued,” he says.

The death reports from districts are scrutinised at the State level by a death audit committee, before these are officially accepted as COVID fatalities.

“Districts like Thiruvananthapuram have a high case fatality rate, because all COVID deaths are listed. Pathanamthitta, which has the highest proportion of elderly in the State and the highest disease transmission (case/million population), has one of the lowest CFRs of 0.19, according to official data. This just does not hold water,” he points out

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