But why do so many die?

Even though the official figures for Covid-19 infections have dropped significantly the past few weeks, the death toll in the Vhembe region is worrying. The latest available figure stands at 300 Covid-19 related deaths, but when various other data gets taken into account, the picture looks much bleaker. It is believed that many more people have been infected by the virus and have died than what the official figures state.

The second wave has passed

Statistics supplied by the Limpopo Department of Health indicate that on Sunday, 7 February, the number of infected persons (active) in Limpopo had dropped to 1 701, with the cumulative infections standing at 59 090. The province has recorded 1 496 Covid-19 deaths.

In Vhembe the situation has also changed dramatically in the past month. On 13 January this year the official figure for active infections stood at 2 147. Most of these were in the Thulamela district (842), with Makhado not far behind on 770. At that stage the official Covid-19 death toll was 105.  

On Sunday (7 February) the figures supplied by the Department of Health showed that there are only 314 active Covid-19 cases in Vhembe. The cumulative infections have gone up to 11 193. Thulamela still has the most number of active cases (130), with Makhado second (108), Collins Chabane third (51) and Musina in the last place (25).

The worrying part is the steep increase in fatalities. In less than a month’s time the death toll has gone up to 300 in Vhembe. Most deaths occurred in Makhado (144), with 101 deaths in Thulamela.

Why the sudden spike?

On 19 January, the Limpopo Health Department released a statement in which it tries to explain the sudden rise in the death toll. The department ascribed it to administrative processes.

“The province has captured an additional 238 deaths following the final capturing by the National Institute of Communicable Diseases (NICD). These are the figures which could not be immediately reported on the official statistics due to delays in capturing. These figures go as far back as August 2020. Of this number, 160 are from private facilities while 78 come from public facilities,” the department said.

Even though this explained part of the discrepancies in figures pointed out by health experts, it did not address the full extent of the problem.

One cause of concern is the excess deaths reported throughout the country. These are deaths that exceed the average prediction and the Limpopo province seems to be culprit number one.

More deaths than usual

Every year more than half a million people die in South Africa. The deaths must be reported and these figures get recorded on the National Population Register. Institutions such as the SA Medical Research Council (SAMRC) use the figures to do predictions, which again assist with planning.

The predictions done work much the same as a budget of a business. The business can look back at previous years and estimate what the income and expenditure should be. The business can also adapt the figures to make provision for special circumstances (i.e. during a strict lockdown turnover may be affected and income will drop.) When it then turns out that the turnover is dramatically higher or lower than the budget (prediction), questions need to be asked as for the reasons for the deviation.

The SAMRC uses a methodology that accounts for various factors, even including making provision for people not registered on the country’s population register. Based on historical data the prediction was that in the period between 29 December 2019 and 30 January 2021, a total of 569 998 deaths (people 1 year and older) will be registered. The figure includes 550 949 “natural deaths” and 49 337 “unnatural deaths”. (An unnatural death is when there is an external cause such as an accident or homicide that caused the death.)

The surprising part is that, in South Africa, much more people died last year than what the figures predicted as being “normal”. The unexpected or additional deaths are referred to as “excess deaths” In the period between 3 May 2020 and 30 January 2021 the number of excess deaths in SA stood at 132 481. On 30 January this year the official Covid-19 death toll stood at 43 951.

And in Limpopo?

Based on an analysis of the available figures, the Covid-19 statistics for Limpopo are not very reliable. The SAMRC’s prediction for natural deaths of people 1 year and older in the province (between 29 December 2019 and 30 January 2021), is 68 500.

Taking into account the actual deaths that were recorded, 11 469 people more than the estimate died. Even if one factors in the Covid-19 death toll for the province (1 496 on 7 Feb), it still leaves almost 10 000 deaths unaccounted for.

This figure is especially worrying if one tries to create some perspective. It means that the residents of an average-sized town simply disappeared in less than twelve months.

Although the discrepancies between actual deaths and expected deaths occur in all provinces, it is especially high in Limpopo and Mpumalanga. It may indicate a significant under-reporting of Covid-19 cases in these two provinces.

Some explanations

In a recent article on excess deaths published on GroundUp, Alex van den Heever of the Wits School of Governance provided some clarity.

One of the main problems seem to stem from the manner in which Covid-19 deaths are being recorded. Covid-19 statistics are gathered by the National Institute for Communicable Diseases (NICD). The data, however, is not sourced from death certificates, but from an ad hoc reporting system established by public and private health care facilities. The intention of the ad hoc reporting is to offer immediate surveillance of Covid-19 mortality patterns.

Van den Heever points out that data accuracy for this system is not consistent and often varies from hospital to hospital. It is also difficult to verify data with an ad hoc system.

A further problem is that there is no apparent tracking of out-of-hospital Covid-19 deaths. People who die without a PCR test being done, may not be included in the count. “It is therefore probable that the official reports do not reflect actual Covid-19 mortality,” the GroundUp report reads.

The conclusion reached in the article is that excess deaths are most directly attributable to Covid-19 infections rather than collateral deaths. “As a result, South Africa’s Covid-19 mortality to the week for 17 January 2021 is most probably in the range 111 227 to 133 128 rather than 34 828. This is roughly a three- to four-fold difference from the official data,” the article reads.

The really worrying part is that mortality is the end-result of a serious problem. In South Africa the mortality rate among Covid-19 patients is around 3%. Should one attribute the excess deaths to Covid-19 infections, it means that the real figure for Covid-19 infections in Limpopo could be well over 350 000.

Date:12 February 2021

By: Anton van Zyl

Anton van Zyl has been with the Zoutpansberger and Limpopo Mirror since 1990. He graduated from the Rand Afrikaans University (now University of Johannesburg) and obtained a BA Communications degree. He is a founder member of the Association of Independent Publishers.

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