COVID-19 in South Africa – The problem with lockdown death numbers

Pandemics Data and Analysis (PANDA) has refuted data which shows that the COVID-19 pandemic led to almost 11,000 excess deaths in South Africa.

Earlier this month, The South African Medical Research Council (SAMRC) published data detailing the number of weekly deaths reported in South Africa.

This data showed a significant increase in the number of deaths from natural causes over the course of the national lockdown, as of 7 July 2020.

According to this report, the coronavirus pandemic led to 10,994 excess deaths in the country – more than three times the official COVID-19 death count.

“Our view is that this claim is false and that simple and logical adjustments to the data for known reporting issues cause the excess fatality number to align much more closely with recorded COVID-19 deaths,” PANDA said in a statement.

The organisation noted that this figure is remarkable when compared with the reported COVID-19 deaths for the same period, which amounted to 3,354.

“It might be tempting to conclude that approximately 30% of the true COVID-19 deaths are actually being reported and we may be significantly understating the true COVID-19 deaths.”

PANDA said this is not the case, however, as an inspection of how the SAMRC reported this data shows.

Excess deaths and problematic reporting

“Excess deaths” are classified as the difference between expected deaths and actual reported deaths, including those attributable to COVID-19 and natural causes that could not be treated as people could not be cared for.

The data used in the SAMRC report comes from Home Affairs’ population register – which is populated as South Africans visit Home Affairs, police stations, or recognised undertakers to report deaths.

PANDA argued that South Africans need to move around to record a death, an activity which is hindered by the national lockdown.

The organisation identified two problems with how the SAMRC calculated its excess death numbers:

  • The SAMRC notes that the number of deaths “have been scaled up to estimate the actual number of deaths by accounting for the people who are not on the population register and the under-registration of deaths”.
  • Insufficient information is presented as to how the expected number of deaths is derived.

The organisation further noted that the actual deaths before the SAMRC’s abovementioned adjustment are not available, and it is unclear whether the SAMRC normally adjusts both the actual deaths and the expected deaths to account for people not on the population register.

“Because we don’t know the answers to these fundamental questions, we must make the assumption that they are acting in good faith when they increase the actual deaths number and take their figure as true,” PANDA said.

PANDA noted a problem with the SAMRC’s graph detailing the excess deaths since 6 May, stating that rather than expecting the average number of deaths over this period, SAMRC has used the lowest baseline they could find to calculate the excess deaths.

This graph is shown below.

SAMRC excess deaths

Rationale behind adjusting death numbers

PANDA acknowledged that the SAMRC offers an explanation for adjusting these figures, but it questioned the logic of this decision.

“Essentially what they say .. is that because natural deaths were down during lockdown, they ignored that data and reset the baseline for the excess deaths calculation from the point where there was a rapid increase in those deaths,” PANDA said.

Pertinent segments of the SAMRC’s explanation for these changes are cited below:

“During lockdown in South Africa, it was observed that the number of natural deaths was much lower than predicted value than in other countries and the weekly numbers were tracking the predicted trend at a level between the lower prediction bound and the predicted value.

Using the predicted value as the base would understate the impact of the COVID-19 epidemic. It was therefore decided to identify the relative level that the deaths were tracking during the lockdown, prior to the emergence of the COVID-19 deaths.

The estimated number of deaths in the week prior to a clear rapid increase in numbers (e.g. the week starting on 6 May for Cape Town, Western Cape and nationally) was taken as a proportion of the lower prediction bound and the base was calculated to track the lower bound.

The proportion was set to produce the numbers of reported COVID-19 deaths in that week.

PANDA noted that the SAMRC’s best estimate was actually performing quite well prior to the COVID-19 pandemic and that the SAMRC offered no reason for why natural deaths would fall to the lower bound the moment lockdown started.

“It does not make any sense that deaths from natural causes should have reduced during lockdown, especially since the natural deaths were tracking at or above the best estimate of natural deaths immediately prior to lockdown,” the organisation said.

PANDA said that lockdown may have made it more difficult to report and record deaths during the lockdown, leading to a sharp increase once lockdown was relaxed due to the processing of this backlog.

While the opaque nature of the data makes it difficult to determine the validity of the reporting, PANDA said that looking at excess deaths as reported for a single week is not useful, and that deviation from accepted methods for calculating overall excess deaths requires a more detailed explanation from the SAMRC.

Closer to the truth

PANDA said that if you compare the actual deaths to the original best estimate of deaths, you the number of excess deaths is 3,159 – much closer to the reported COVID-19 deaths for the period.

“This is an entirely different conclusion to the implied result that only 30% of COVID-19 deaths are being accurately recorded right now,” PANDA said.

The organisations said that just as the SAMRC rebases its calculation arbitrarily, it is possible to manipulate the to show no excess deaths if you base expectations on pre-COVID-19 best estimates.

“SAMRC should be disclosing the data they use and the methods they have adopted for making adjustments,” PANDA said.

“Pending this explanation, the finding that there has been any excess death beyond the stated COVID-19 numbers, and that such deaths should be considered to be deaths from COVID-19, must be treated with scepticism.”

“The alternative explanation that the mortality data reflects difficulties in reporting deaths during lockdown seems to us to be more plausible,” the organisation said.

Now read: These graphs show where COVID-19 is spreading in Gauteng and the Western Cape

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COVID-19 in South Africa – The problem with lockdown death numbers