It is possible and probable that the excess deaths caused by the pandemic have been underestimated.
MANILA, Philippines – During a disaster, it is difficult to count deaths and to ascribe them to the disaster or to some other cause. Deaths can also be prevented or caused by the responses to the disaster .
Excess mortality is computed by subtracting the expected from the actual number of deaths. The number of expected deaths is the average deaths during the five years previous to the pandemic – that is, the average annual number of deaths from 2015 to 2019. Determining the excess mortality allows us to identify the causes of deaths that probably either resulted from the pandemic or from the response to it.
In addition, there was also an increase in the number of deaths from malnutrition, most probably from the loss of income and from food insecurity. Although we don’t have an age breakdown, we know that very young malnourished patients are at higher risk of death compared to older patients. Notably, a large part of excess deaths were due to unknown or unclassified causes, which could be due to difficulties in ascertaining the actual cause of death. Circumstances behind the pandemic could have aggravated certain comorbidities. These include diseases such as hypertension, ischemic heart disease, and cerebrovascular disease.
“As strict lockdowns took effect in 2020, supply chain disruptions led to difficulties in procuring certain laboratory reagents essential for performing tests to evaluate cancer patients. These caused significant diagnostic and treatment delays for patients,” Dr. Tud noted. Overall, patients who were previously diagnosed with cancer were unable to follow up on their condition. This had the greatest impact on patients with more aggressive malignancies, such as lung and renal cancers.
“Early in the pandemic, hospitals struggled to routinely test patients. I suspect these patients that died with cardiovascular disease could have COVID, but it was difficult to make that diagnosis without a test. Some of those who expired were untested, which could underestimate our COVID death numbers. In general, COVID puts everyone at greater risk for cardiovascular disease so it can all overlap,” Dr. Noche explained.
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