There were 5.18 excess deaths per 1,000 people in Chennai between March 1, 2020 and June 30, 2021: The Lancet
India’s poor disease surveillance measures during the novel coronavirus disease (COVID-19) pandemic have made it hard to gauge the burden of mortality. A study, published in The Lancet in December 2021, looked at all-cause mortality in Chennai and found 5.18 excess deaths per 1,000 people between March 1, 2020 and June 30, 2021.
This suggested a 41 per cent increase over typical mortality rates.
At least 87,870 deaths were registered in the district during this period, exceeding the estimates by 25,990. A closer look at age-wise data showed 21.02 excess deaths per 1,000 people for those aged 60-69 years, 39.74 for those aged 70-79 years and 96.90 for those aged 80 years or older.
The study also documented mortality based on the socio-economic status of a region. It found that the difference in excess mortality did not differ based on this factor during the first wave but the second wave saw a disproportionate increase in mortality of lower socioeconomic neighborhoods during the second, deadlier, wave.
“Most excess deaths occurred during the second wave of the pandemic, when mortality peaked at levels 4.75-times higher than pre-pandemic observations. However, fewer deaths were registered among children than expected on the basis of pre-pandemic observations,” the study noted.
At the end of the first wave, in October-November 2020, 41 per cent of the population in Chennai had antibodies against COVID-19. The figure rose to 82 per cent after the second wave in June-July 2021.
“Mortality in Chennai increased substantially but heterogeneously during the COVID-19 pandemic, with the greatest burden concentrated in disadvantaged communities. Reported COVID-19 deaths greatly underestimated pandemic-associated mortality,” the study said.
The United States, United Kingdom, Italy and Spain — all of which have an older population than India’s — recorded 1.6-2.1 excess deaths per 1,000 people. This is significantly lower than Chennai’s 5.18.
The socio-economic factor and its role in the spread of COVID-19, highlighted in this study, indicated a need to work closely in these areas to ensure timely and proper healthcare is made available.
“The high burden of COVID-19 associated mortality in this setting, and the concentration of excess deaths in socioeconomically disadvantaged communities, casts doubt on hygiene-related hypotheses of reduced SARS-CoV-2 severity in low-income and middle-income countries due to prevalent immunity from other infections,” it said.
Mortality was reduced among men and children during the first lockdown. This trend makes sense because the leading cause of death for the former is unintended accidents and communicable diseases for the latter.
The incidence of both of these came down owing to the strict lockdown measures in early 2020. However, there is a caveat.
“Lockdown measures in India have also been associated with decreased access to health care and exacerbation of common non-communicable or chronic conditions including cancer, diabetes, tuberculosis and others. Longer-term studies remain important to determine the effect of these changes on mortality,” the study noted.
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