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© Nadezhda Chipeva
November 2020 is the deadliest month in Bulgaria for at least the last five years. This is demonstrated by preliminary data from the National Institute of Statistics (INE) on mortality in the country, published this week. In November, 15,953 people died in Bulgaria, compared to an average of about 8,300 in the same month over the past five years. The increase is greater than 92%. The difference of more than 7,600 people includes 2,560 deaths from coronavirus in the month (they are calculated according to official data from the Unified Information System). Among the other cases (more than 5,000), the epidemic again plays an important role: experts rally around this opinion, to whom Dnevnik asked questions about the data.
Also in response to a question from Dnevnik during a briefing by health authorities on Thursday (December 10), Minister Kostadin Angelov explained that he was familiar with the NSI data and had given instructions to the National Center for Public Health and Analysis to do an analysis of the increase in mortality in the third quarter of 2020 compared to last year. However, the sharp increase in mortality coincided with the beginning of the fourth quarter of the year (see graphs).
When does growth start?
Total mortality has started to increase compared to 2019 since the end of June. As varies variably, but after a few weeks (after week 40, the first of October) there is a sharp increase. “To arrive in week 46 (Editorial note – the second in November) 3,800 cases of deaths in the country, an unprecedented figure in the last five years,” Magdalena Kostova, head of management, commented to BNR at the end of November. “Demographic and social statistics” at the INE.
At the time, the data had not yet been released, but Kostova explained that the best way to monitor the odds was relative to absolute numbers: “In the 46th week in question, this rate was 30 per thousand, or 30 deaths per thousand. people. the global mortality rate for 2019 was 15.5 per thousand “(see graphs at the end of the text).
Dnevnik sent questions to the NSI for additional information on the reported data; they are preliminary, that is. there may be some additional cases in the final report. The institute explained that at the moment they do not have the rest of the key indicators for analysis, the causes of death, since they are summarized annually and it is not possible to develop them for weeks.
The reporting of deaths and the link to the coronavirus has been debated since the start of the pandemic, due to different approaches in countries: whether a positive test of death from COVID-19 is reported or other causes and comorbidities are analyzed, which may be the real reason. There is also little information in Bulgaria on this issue, but official statistics reported by the authorities are known to include people who have died after they have been shown to be infected with the coronavirus.
In mid-December, deaths and hospitalizations, especially in intensive care units in Bulgaria, can be considered more relevant data for analysis, because the official notification of infected persons is carried out only by PCR tests (tests are not counted rapid antigens). , and those cured are counted from the day the 14-day quarantine imposed on them automatically ends.
The effect of the “coronavirus” on all deaths
Tihomir Bezlov, a senior analyst at the Center for the Study of Democracy, told Dnevnik that an upward trend in overall mortality has been observed with sharp increases in the number of people infected with the coronavirus in many European countries, as well as in the U.S. Especially at the local level. He commented that the initial assumption was that they were not deaths from coronavirus, but from other diseases. Subsequently, the jump in mortality is so strong that the hypothesis prevails: not all deaths from coronavirus are registered as such.
“No one has been able to explain exactly what the cause is: unrecorded cases of coronavirus or blocked care lines for patients with other diseases. It is clear that when there are full wards, effective treatment cannot be provided for all. Probably the cause. In Bulgaria is the same. We have a big problem with normal mortality records. There are no autopsies, hospitals try to use different nomenclatures so that they do not have problems, “said Bezlov. According to him, it is especially important to note that at the same rate as the increase in deaths from coronavirus, the number of deaths registered by the INE weekly is growing.
The same opinion is shared by mathematician Petar Velkov, who since the beginning of the epidemic in Bulgaria has often analyzed data and made forecasts. He told Dnevnik that there were about 50% unrecorded coronavirus deaths. This is your hypothesis based on the analysis of systems in other countries. Velkov noted that the death rate in the country increased by 123% in the last week of November 2020 compared to the same period last year.
“With a population decline of 200,000 in recent years, the normal deviation is 5-10%. But a weekly jump of 120% …”
mathematical
According to him, the lack of laboratories for PCR tests in smaller settlements, which is another factor in the difficult registration of deaths with COVID. According to Velkov, in addition to the unrecorded cases, the cases in which the health system has not responded adequately due to congestion, which are again an indirect effect of the coronavirus crisis, must be taken into account. Thus, mathematically, almost all the increase in mortality in the country turned out to be a direct or indirect consequence of the epidemic.
The problem of self-medication and the late search for medical help
Professor Boris Bogov, director of one of the largest hospitals in the country, “Alexandrovska”, explained to “Dnevnik” that, in any case, there is an increase in mortality in Bulgaria, although it is already from first to second place in mortality by COVID. -19 in the EU (this is one of the indicators highlighted by health authorities this week). “This increase in deaths is due in all cases to the COVID infection and the pathological complications that accompany it. And last but not least, to self-medication and delayed medical treatment,” explained Bogov.
The director of “Pirogov”, Professor Asen Baltov, told “Dnevnik” that there is a slight increase in mortality in the hospital, but it is not comparable with what is indicated in the data of the INE of the country. The process of increasing the number of patients admitted to the hospital began in mid-November. Baltov also admits to the high overall mortality and the fact that many people may not have sought medical help at all.
The Union of Funeral Companies of Bulgaria confirmed for Dnevnik that there is an increase in funerals. They focused on the many cases of coronavirus deaths they found. Currently, they reported the situation as a “war.”
Given the trend that overall mortality follows that of the coronavirus, it is expected to reach new highs. So far, the first week of December has been the deadliest since the epidemic began. The death toll for the day fell 4% weekly from December 10, and new cases increased 4% in the same period despite the introduction of new anti-epidemic measures on November 27.
The forecast for the year
In an interview at the end of November, Mariana Kostova from the INE explained that “by 2020, our estimates are that there will be between 120,000 and 125,000 deaths in the country. Last year there were 108,000.” He said the reporting process is complex and goes through hard-coded RHI death notices, which are now uploaded and data on officially reported causes won’t be clear until next year. Kostova recalls that Bulgaria is among the countries with high mortality.
According to preliminary data, he announced that the birth rate in 2019 will be lower than the previous year, but it is even more difficult to summarize how much influence the pandemic or other factors have on this.
