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Deaths from covid-19 in Colombia last year, from the first week of March to January 3, totaled 51,397, according to the document ‘Demographic surveillance of mortality due to covid-19 in Colombia 2020: excess mortality from all causes and covid-19 – reclassification of mortality due to covid-19’, from the Department of Epidemiology and Demography of the Ministry of Health , January 29.
This report presents the results of the pandemic mortality surveillance process, which included the analysis and reclassification of all deaths and, above all, those who were considered suspects of the virus.
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Specifically, the adjustment made to the figures represents an increase of 16 percent compared to what had been initially reported on victims of covid-19 by the authorities, and the main reason for the increase is 9,714 deaths that went from suspicious to confirmed, according to the statement. It should be clarified that this is a normal setting in the midst of epidemiological surveillance processes.
As the document notes, this task of demographic surveillance of excess mortality through the active search for registered deaths with confirmed, presumptive and discarded diagnoses of covid-19 is a permanent job of the Ministry of Health to establish how many people die from it. direct coronavirus infection or concomitant infection or other causes.
How does reclassification work?
To begin with, the document explains that deaths from covid-19 and all other causes that occur and are reported daily in the country are recorded in three sources of information: the Death Registry attached to the Single Registry of Affiliates of the health system (Ruaf-ND), which is administered by the Ministry of Health; the records of the Public Health Surveillance System (Sivigila), the National Institute of Health (INS), and the civil registry of vital events and the registry of corpses studied by the National Institute of Legal Medicine and Forensic Sciences.
Those data sources are those used for the compilation of ‘Vital Statistics’, which are periodically compiled and published by the National Administrative Department of Statistics (Dane). “All this set of institutions, registries and statistical operations make up the Civil Registry and Vital Statistics System (SRCEV) of Colombia, “the document adds.
And although the registration of deaths in Colombia is dynamic and is done online and in real time through the Ruaf-ND web application, sometimes there are delays in notification, either due to connectivity reasons in some regions or when death is not known by health workers and the bodies must be recovered from dispersed and highly rural areas.
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Already specifically on deaths from covid-19 in Colombia, It is known that every day in the afternoon the National Institute of Health delivers a report based on the information in the Sivigila, the same one made public by the Ministry of Health.
However, this count “is conditioned by the processes of recognition, diagnosis, medical certification and effective reporting to the surveillance system and the Ruaf-ND death registry,” the official document indicates.
In this sense, the surveillance carried out by the health authorities includes the assessment of confirmed deaths and the monitoring of suspicious deaths of covid-19 and even those that were discarded due to the virus and that were registered in the Ruaf-ND system.
Each of these records, which is ultimately a deceased citizen, is analyzed by surveillance teams, which carry out verbal autopsies and family interrogations, review medical records and death certificates, cross data with other sources of information and, if necessary, they are reclassified as confirmed or discarded deaths of COVID-19, “obtaining an updated and more realistic record of the mortality produced by the pandemic,” says the document.
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The deaths considered as confirmed that were analyzed were those that “in the causal chain certified in the Ruaf-ND include diagnostic terms directly related to covid-19 and a positive laboratory test”; while the suspects were those that “in the causal chain of the death certificate refer to diagnostic terms with words such as suspicious, probable, under study or awaiting results for coronavirus.”
It is worth saying that In the exercise, there were suspicious cases that were not tested for covid-19 and that had to be studied from all the other elements. And others that were initially discarded with a negative test, but that in any case were analyzed in depth by health officials.
Finally, to the compiled data set “algorithms based on clinical, paraclinical and epidemiological criteria were applied to calculate various indices that classify the evidence as strong or weak, the opportunity to take a sample within or outside the window of greater positivity of the result and the probability that the death can be attributed to covid-19 “, it is explained.
The results
As mentioned in the document of the Ministry of Health, the report gives an account of the preliminary results of the exercise to reclassify deaths related to covid-19 (between confirmed, suspected and discarded) and registered in 2020, from epidemiological week 10 ( from March 2 to 8) until 53 (which was from December 28 to January 3, 2021).
When searching information systems, officials found a total of 65,042 deaths related to covid-19 (among confirmed, suspected and ruled out) in that period of time.
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And after doing the research and applying the technical criteria, 51,397 of them were declared as confirmed deaths from the new coronavirus and 13,645 were established as probable or still suspected deaths. In all, according to the report, there were 12,909 verbal autopsies.
To understand it better: of the 43,453 deaths that were considered confirmed –registered and not in the Ruaf-ND–, 40,903, that is, 94.13 percent, were ratified in that condition and 1,601 were relocated to the suspect box.
Meanwhile, of the 18,144 deaths that were characterized as suspicious and that had not been publicly reported for the same reason, 9,714, equivalent to 53.53 percent, were reclassified as confirmed by covid-19.
And of the 3,445 deaths that were said to be ruled out before the analysis, 2,665 were definitely rejected as caused by the coronavirus. and 780 entered the confirmed list.
“In summary, the confirmed deaths accumulated to week 53 of 2020 (from December 28 to January 3, 2021) and declared by the National Institute of Health on January 4, 2021, which were 43,995, are adjusted by 16.8 percent with the reclassification of suspicious deaths, for an estimated total of 51,397 deaths confirmed by covid-19 as of that cut-off date, “says the report of the Ministry of Health.
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In two graphs that the document presents, it can be seen that most of the deaths that were suspicious and that were confirmed They occurred at the first peak of the pandemic, between July and August. In this way, the maximum mortality levels at that time went from 2,000 weekly deaths to 2,500.
It should be remembered that Colombia closed 2020 with 43,213 deaths reported by the Ministry of Health on December 31 and that, according to those same daily reports, the 50,000 deaths from the pandemic were exceeded on January 21.
“The reclassification process evidenced the relevance of routine demographic surveillance, taking into account that the death count is subject to updating the death registry in accordance with the issuance of confirmatory results of covid-19, amendments by the certifiers and the lag in the reports, “concludes the ministry document, which, in any case, clarifies that it is preliminary information subject to changes due to methodological adjustments.
HEALTH UNIT
