A state public health official said the 2021 numbers are provisional, and the actual all-cause death numbers can be higher. (Express/File)IN CALENDAR year 2021, when hospitals across India were battling the delta wave of Covid-19, Maharashtra recorded a significant 20.47 per cent increase in all-cause deaths to 9.74 lakh as compared to the previous year. This was over and above the 16.57 per cent rise in all-cause deaths in calendar year 2020. Maharashtra accounted for almost 10 per cent of all-cause deaths across India in 2020.
Four key insights emerge from an analysis of data obtained by The Indian Express from the state’s Civil Registration System (CRS) under the Right to Information Act.
Direct and indirect impact
The SHARP rise in deaths is attributed to not just Covid-19 deaths, but also indirectly to the pandemic. Many a time, patients could not have reached hospitals in time since the healthcare system was stretched. The pandemic also adversely affected people with chronic health issues.
A state public health official said the 2021 numbers are provisional, and the actual all-cause death numbers can be higher.
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A month-wise analysis of all-cause deaths for the state showed that before the pandemic, the average monthly death was hovering around 58,000 which climbed to 67,398 in 2020 and 81,197 in 2021.
Globally, several studies have shown that the post-Covid state has also been associated with increased risk, and individuals who may have died after having contracted Covid-19 would not have Covid explicitly mentioned as the cause of death. Dr Avinash Supe, in-charge of the Covid death committee in Maharasthra, said, “Certainly, there has been a rise in all-cause deaths in Maharashtra. This data includes both direct and indirect impact of Covid which has been observed globally.”
Dr Lancelot Pinto, epidemiologist and pulmonologist from Hinduja hospital said that the healthcare system was stretched to its limit during the peaks of the Covid-19 pandemic, and it is possible that individuals may have died due to non-Covid causes because of them reaching the healthcare system late.
“….and passed away before a test was done, or there was no access to testing. Individuals with a lower respiratory tract infection are known to be at a higher risk for heart attacks and strokes, and it is possible that individuals dying of these causes were assumed to have died because of these causes, and the link with SARS-CoV-2 was either not looked at, or not deemed important enough to report,” Pinto said.
Health experts also noted that the pandemic further affected the population, especially patients with chronic health issues. Significantly, data obtained in a separate RTI application in June this year revealed that Mumbai had witnessed a six-fold rise in deaths related to heart incidents in the first six months of 2021. “It has been blamed on the pandemic when people with heart attack symptoms reached hospital late, which pushed up the mortality rate,” said Dr Prafulla Kerkar, interventional cardiologist, Chairman of Guidelines Committee of Cardiological Society of India (CSI).
A district-wise analysis of the CRS data showed that out of 36 districts in Maharashtra, 22 recorded all-cause deaths above the state’s average surge. Jalgaon saw the maximum surge in terms of percentage increase of 45 per cent. In 2020, the district witnessed 23,458 all-cause deaths, which jumped to 38,121 in 2021. Of this, only 1,267 or 3.3 per cent deaths were related to Covid-19.
This is followed by Sindudhurg, another rural district, which in 2020 witnessed 6,539 all-cause deaths which jumped to 10,300 in 2021. However, Covid-19 deaths – 1,304 – accounted for 34.67 per cent of all deaths.
Nandurbar, the district with the highest tribal population in the state, recorded a surge of 46.70 per cent as all-cause deaths increased from 10,068 in 2020 to 14,770 in 2021. Of the additional deaths of 4,702, as many as 778 or 16.52 per cent were related to Covid-19.
Coincidentally, the Covid case fatality rate (CFR) in all these small districts was over the state’s average of 1.81 percent in the second wave. The CFR of Mumbai was 4.06 per cent in 2020 which dropped to 1.40 per cent. But the CFR in smaller districts like Sindhudurg, Osmanabad was over 3 per cent.
Doctors attribute multiple factors behind the disparity in the number of all-cause deaths in rural and urban areas including poor availability of critical care beds, super speciality services, and advanced diagnostic facilities with faster turn-around-time. “Whereas cities like Mumbai had approximately two critical care beds per 1,000 people, in several rural regions only one critical care bed was available for about 2,500-3,000 individuals. If studied thoroughly, one would find that the graph of Intensive Care Unit bed availability will run parallel to the Case Fatality Rate of the region,” said Dr Abdul Samad Ansari, Director, critical care services, Nanavati Hospital, who was a former member of the Covid-19 task force.