Mortality data is very important for understanding trends relating to health problems and diseases and hence for overall health policy and planning. Unfortunately, however, in many countries there is need for improving reliability of mortality data. In addition there is another serious and wider problem. This relates to delays in availability of mortality data, even more in the context of data in public domain.
While the need for improving reliability of mortality data and ensuring its early availability has always been there, this need has increased all the more in COVID times. In order to obtain good indicators for policy decisions, more reliable data on mortality is needed and without sacrificing reliability this should be available earlier. This implies that more efforts, resources and funds are needed for this, and of course the entire effort should be entirely unbiased and honest.
To give just one example of policy implications, one policy issue which has been much debated all over the world in recent months has related to whether Covid related lockdowns have been justified are not. The mortality data regarding COVID for various countries and for different periods can be compared to help in this, but at the same time it should be pointed out that other important factors are also involved in such comparisons and one such not jump to any hasty conclusions.
What is more, for helping policy we need early and better access not just to data relating to COVID mortality but more or less to data relating to all mortality. To give an example, some studies have tried to compare the data for Sweden, which avoided the path of lockdowns, with the data for some other European countries, which had lockdowns. However other scholars pointed out that it is not enough to compare COVID related mortality but all mortality. The reason given for this is that while in some cases lockdowns may have reduced direct COVID related mortality, these are likely to have led to increased mortality due to other causes ( in the short-term as well as in the longer-term) as medical treatment for several important diseases and health problems got disrupted due to lockdowns.
Let us compare two cities with a population of one million each regarding their experiences in 2020. One of them , city A, implements a stringent lockdown and manages to keep COVID mortality to just 20. However due to disruption of medical treatment and other essential activities in lockdown conditions, 40 other people die due to non-COVID factors. Hence the total extra death toll, or excess mortality in 2020, is 60. The other city called city B takes a policy decision to avoid lockdowns and so normal economic, medical, educational etc. activities continue with all non-disruptive precautions in place . In this city the COVID toll is 40 but there is no increase in any death due to any other factor so that the excess mortality is less in B than in A ( 40 compared to 60). In addition to recording lesser excess mortality, city B also enjoys all other advantages of continuing education and livelihoods, people able to meet each other for important reasons and avoiding all the other harassment as well relating to stringent and prolonged lockdowns.
When the experience of Sweden was compared to some other European countries a similar trend was revealed—somewhat higher COVID mortality but lower excess mortality, with the other advantages of continuing essential economic, educational, medical activities and social inter-actions ( with precautions in place of course). Of course mistakes were made even then and it is now realized that with greater care of the elderly and with some other efforts more lives could have been saved from COVID.
These on-going experiences and results of studies can change depending on various factors, but this much is very clear that if accurate, unbiased data is available on mortality ( particularly overall excess mortality ) then this can be very helpful in framing better policy.
Bharat Dogra is a journalist and author. His recent books include Planet in Peril and Protecting Earth for Children.