On Friday, the National Administration of Statistics (Dane) presented the report on covid deaths that occurred between March 2 and July 19. The document revealed that the deaths from this cause during that period were 9,124, a figure higher than the 7,956 registered by the National Institutes of Health that day.
The Minister of Health Fernando Ruiz explains how vital statistics work and how delays in information give the differences that are in any case common in all countries and in every public health event.
(In context: For every three confirmed deaths, there is a suspected covid-1
Why do Danish figures not match the ministry’s? Some people say they forged them.
Because they are two different, but complementary forms of registration. The ministry delivers a real-time number of confirmed deaths from covid-19 every day, based on the cases diagnosed as positive according to PCR laboratory technology, which is the best. This record captures information quickly and is accurate because the diagnosis is linked to a positive test; however, your coverage is the same as the test coverage.
And how is the Danish report?
Vital statistics are collected and classified by the Dane from the death certificate, which is based on the information about the cause of death through clinical diagnosis, which may or may not contain a positive PCR result. In the mortality register, the variation is greater because the criteria for each doctor to classify the cause of death can vary and it has a greater delay because the analysis is longer.
Do suspicions hide the lack of knowledge about the subject?
Absolutely. The data have delays, not distortions. Those who confuse each other or are unaware of the epidemiological registration systems or make assessments without technical basis. The two registration systems must converge towards the end of the epidemic to generate the official death toll.
The Dane reported that there were more than 3,000 deaths with suspected covid-19. How is the information clarified?
The whole part of the definition of covid-19 deaths proclaimed by the World Health Organization, where it contained a broad categorization of suspects of deaths from this disease. This is why similar situations have arisen in all countries. In its report, the Dane puts deaths of people who have a clinical picture similar to that of covid or who had contact with infected people. But a suspicious case, as the name suggests, does not have definitive results, and that is why the process continues until it is clarified.
How do you plan to arrive at the definitive answer?
We set up a case reclassification procedure that includes oral autopsies and cross-checking of databases. This process is called mortality adjustment and it has been done for several years. Mortality adjustments are made worldwide for events of public health problems.
(Read also: How does Colombia perform in diagnostic capacity with respect to US countries)
Wouldn’t it be better to wait to get specific information before publishing it?
It’s not comfortable. The quick disclosure, even if it is not crucial, is not only an exercise in transparency, but also helps to make short-term decisions. Consolidated information, which is undoubtedly of better quality, contributes to public policy and long-term decisions. Both are important.
Does transparency in information sometimes evoke a feeling that the situation is more serious?
Colombia is recognized for its transparency in its epidemiological information. It has been a deliberate decision by the ministry since the Chikungunya epidemic. This rigor led us to be the country with the largest proportional number of reported cases of Zika and Chikungunya in Latin America during these epidemics. This has also enabled our information to have been used in most epidemiological studies of these diseases. The right to health is based on the population’s right to know the health effects due to diseases. Our system may have limitations, but it is one of the most reliable on the continent.
(You may be interested in: uneven transit of pandemics in the regions)
The Dane also showed excess mortality. How many of these deaths are attributable to covid?
In the last five years, the average number of deaths in a week in Colombia was 4,500, but throughout July last year they increased and by the end of the month they were already around 6,000. This difference can be attributed to the covid, but also to other causes. The reclassification of suspected cases and the investigation of events in public health will provide the answer.
When will we know the real dimensions of the pandemic?
The mortality impact of an epidemic often occurs and remains even years after it occurred. We see it right now, with Zika: the children of infected mothers are suffering long-term consequences, as a study from the National Institutes of Health that has just been published in the world’s most prestigious medical scientific journal has shown again. The analysis of the effects of a disease is not only delayed due to delays in the information systems but also for biological and epidemiological reasons. This does not mean that we will have to wait this year to know the effects of the covid, but that we will gradually have more complete reports.
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