Findings from SA death reports during pandemic are surprising: expert

Two fascinating phenomena have been exposed by the weekly death report brought out by the South African Medical Research Council (SAMRC) since the start of the Covid-19 pandemic in SA.

The first is that the death rates for young children decreased during the first year and the second is that the Northern Cape has had the highest death rate of all provinces.

These are over and above the already publicised findings that deaths from injuries (particularly interpersonal violence and motor vehicle collisions) dropped dramatically during the most stringent phase of lockdown, when movement was strictly limited and alcohol banned — a phase during which young men in particular saw the benefits in terms of lives saved.

Excess deaths, as defined by the World Health Organisation (WHO), refer to “the number of deaths from all causes during a crisis above and beyond what we would have expected to see under ‘normal’ conditions”.

Speaking to Sunday Times Daily last week, Prof Debbie Bradshaw, from the SAMRC, outlined some of the interesting data that emerged beyond Covid-19-related deaths.

The SAMRC will soon be bringing out a report that explores this in more detail, but Bradshaw said ahead of the report that the team was surprised by the emergence of a positive trend.

“What has been very surprising is that the death rates for children under age five decreased during the first year of the pandemic. In other words, during 2020, rates actually went down,” she said.

Wanting to double check their information, the team also examined trends in routine health information data and found that “there had been a lot fewer cases of childhood diarrhoea and pneumonia admitted to hospitals during the winter periods when they are most expected”.

With that as the backdrop to the Northern Cape’s unusual pattern, 'I think there might be an issue of access to care in the province, possibly related to large distances to get healthcare'. 

—  Prof Debbie Bradshaw

This could be because of “cleaner hands, social distancing, crèches being closed, moms having more time to look after and breastfeed their children”, said Bradshaw.

The finding does not refer to neonates (babies in their first month of life), however. But apart from them, deaths came down “for infants and children from one month to 59 months” and that, said Bradshaw, “was a most unexpected thing”.

“We track the number of excess deaths, but we also calculate the per capita per 100,000 population and we then age-standardise because Covid has been more serious for older people. So, for example, the Western Cape has an older population than Gauteng, where there are many more people of working age. This means it is important to contrast the age-standardised cumulative death rate as if they both had the same age structure in the population. We have used the national age structure as the standard and it’s been really fascinating to me that the Northern Cape comes up as having the highest excess death rate.”

Bradshaw said it was “most unexpected”, but might have something to do with the population being so sparse.

“In the first wave, the excess death rate was not that high in the Northern Cape. It appeared to take a long time for the virus to set in and spread from person to person. But what we’ve seen in the third wave is that it’s been very protracted and the province is just not getting rid of it. It has gone on and on and on,” she said.

This stands in sharp contrast to Gauteng, for example, where the virus “spread quickly, had a sharp increase, then came down quickly afterwards as well”.

With that as the backdrop to the Northern Cape’s unusual pattern, “I think there might be an issue of access to care in the province, possibly related to large distances to get healthcare. Perhaps going onto oxygen or getting treatment quickly are challenges,” Bradshaw said, adding: “We just don’t know yet, but the high death rate is concerning and it is essential for older persons to get vaccinated to be protected from serious illness.”