SA's Covid-19 mortality rate among top five in world, say excess death boffins

Dave Chambers Cape Town bureau chief
Covid-19 deaths in 2020 were 2.7 times the official total, according to researchers at the SA Medical Research Council and the University of Cape Town.
Covid-19 deaths in 2020 were 2.7 times the official total, according to researchers at the SA Medical Research Council and the University of Cape Town.
Image: 123rf/recstockfootage

The number of deaths due to Covid-19 in 2020 was nearly three times the official toll, and SA's Covid-19 mortality rate for the year was probably among the top five in the world.

These are some of the key findings from the team at the SA Medical Research Council and University of Cape Town which has provided weekly updates on the number of deaths nationwide since the start of the local Covid-19 outbreak in March 2020.

Reporting their findings in the SA Medical Journal, the team said while the official Covid-19 death toll for 2020 was 28,469, there were between 70,998 and 76,127 excess deaths from natural causes, depending on the calculation method.

This is up to 2.67 times the official Covid-19 death toll, and the researchers said: “The temporal trend and age pattern of the excess deaths suggest that most of these deaths are directly due to or related to Covid-19.”

However, the level 5 lockdown between March 27 and May 1 saved the lives of nearly 5,000 people who would otherwise have died from unnatural causes, such as road accidents.

And the lockdown meant there was no influenza outbreak in 2020, saving more lives.

The predicted number of weekly deaths for people older than 1 shows a clear increase during winter and a drop in the weekly number of deaths in April-June 2020, coinciding with the level 5 and level 4 lockdowns. The weekly number then increased steadily for around six weeks, reaching a peak of 16,488 deaths in week of July 15-21. This was 65% above the predicted non-Covid number of 9,967. After the first surge, numbers returned close to the predicted level within the next six weeks. After tracking close to the predicted value during September, the weekly numbers of deaths exceeded the upper prediction bound in October and rose rapidly from the end of November to exceed the predicted number by 81% in the last week of 2020.
The predicted number of weekly deaths for people older than 1 shows a clear increase during winter and a drop in the weekly number of deaths in April-June 2020, coinciding with the level 5 and level 4 lockdowns. The weekly number then increased steadily for around six weeks, reaching a peak of 16,488 deaths in week of July 15-21. This was 65% above the predicted non-Covid number of 9,967. After the first surge, numbers returned close to the predicted level within the next six weeks. After tracking close to the predicted value during September, the weekly numbers of deaths exceeded the upper prediction bound in October and rose rapidly from the end of November to exceed the predicted number by 81% in the last week of 2020.
Image: SA Medical Journal

The research team, from the burden of disease research unit at the SAMRC and the Centre for Actuarial Research at UCT, has issued monthly reports from its rapid mortality surveillance system since 2011.

When Covid-19 arrived, the home affairs department gave permission for weekly downloads from the national population register, and the researchers worked with this data to track excess deaths.

These are deaths which are above the estimated number based on trends over the previous two years.

Until now, they have been cautious about attributing excess deaths to Covid-19, but in their new report they say: “We consider that at least 85% of the excess natural deaths were due to Covid-19. This is much higher than the 28,469 officially confirmed Covid-19 deaths.

“Allowing for this and the relatively young population, Covid-19 deaths per capita in SA probably ranked in the top five countries in the world.”

The trend in the numbers of deaths from natural causes by age group. The 60-69 group exceeded the upper prediction bounds earliest and experienced the biggest increase during the peak of the first wave for both men and women.
The trend in the numbers of deaths from natural causes by age group. The 60-69 group exceeded the upper prediction bounds earliest and experienced the biggest increase during the peak of the first wave for both men and women.
Image: SA Medical Journal

The researchers — Debbie Bradshaw, Rob Dorrington, Ria Laubscher, Tom Moultrie and Pam Groenewald — said people aged 60-69 were worst affected at the peak of the first wave of Covid-19, which arrived in July 2020. At that point, they accounted for 28% of excess natural deaths.

Deaths among over-80s were much higher than reported confirmed Covid-19 deaths, and the researchers said: “It is possible that deaths among elderly people, particularly women, disproportionately occurred in care institutions or communities without accessing health services.”

The Eastern Cape's 23,424 excess deaths from natural causes in 2020 exceed the next worst-affected province, Gauteng, by nearly 60%.
The Eastern Cape's 23,424 excess deaths from natural causes in 2020 exceed the next worst-affected province, Gauteng, by nearly 60%.
Image: SA Medical Journal
This table shows the profound effect of old age on Covid-19 mortality.
This table shows the profound effect of old age on Covid-19 mortality.
Image: SA Medical Journal

The number of excess deaths from Covid-19 in 2020 was similar to the 73,500 deaths from HIV/Aids, “which would have been the leading single cause of death in the absence of the epidemic”, they said.

“In common with HIV/Aids ... there is a greater number of deaths [and higher per capita mortality rate] in women than in men.”

Overall, the number of deaths in 2020 was 13% higher than expected, but on Twitter Moultrie pointed out that the study excluded the peak of the second wave early in 2021.

 TimesLIVE

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