The number of excess deaths recorded by the Civil Registration System shows that Kerala has recorded excess deaths in 2021, when compared to pre-pandemic years between 2015-2019. As per data accessed by TNM, Kerala has registered around 14,000 excess deaths due to all causes (within a population) than expected under normal circumstances. However, the figure is not as high as other states, which have reported excess deaths in lakhs.
Excess death or excess mortality is the number of all-cause deaths reported during a health crisis, which is more than what could be expected in normal circumstances. Epidemiologically, it helps understand how the health crisis has impacted deaths (directly or indirectly), if a death has been correctly diagnosed and/or what other causes can be attributed to the pandemic. In this case, the data of 2021 is compared with the pre-COVID-19 year between 2015 and 2019.
According to data from the Civil Registration System (CRS) in Kerala, between January 1 and May 31 this year, Kerala has officially registered 1,13,372 or 1.13 lakh all-cause deaths (live deaths, infant deaths and still births).
TNM calculated excess deaths based on the 2015-2019 data from the state records. The state registered an average of 98,387 deaths from January 1 to May 31 every year from 2015 and 2019. Comparing this with the 1.13 lakh deaths registered for January-May 2021, Kerala has an excess all-cause deaths of about 14,535 in 2021. However, on comparing the number of deaths between 2019 and 2021 only for the same period, Kerala has 8,867 excess deaths in 2021.
According to Keralaâ€™s daily COVID-19 bulletin, the state reported 6,700 COVID-19 deaths from January 1 to May 31, 2021.
A look at the monthly breakup shows that most of the excess deaths occured in May 2021. Kerala registered almost 28,000 deaths in May 2021, while between 2015-2019 the average number of deaths reported in the month of May is 19,600.
Note: This data, however, excludes death registration from Kochi Corporation. The data from the Corporation, which TNM accessed, showed 5,038 deaths in 2021. When tallied with pre-pandemic years, there is a possible all-cause excess death of 200-300.
Additional Chief Secretary Sarada Muraleedharan did not want to disclose/confirm the numbers, but she told TNM that the registration system was up-to-date till May 25. â€śThere were some discrepancies, and information lag. But that has been taken care of,â€ť she said.
Another IAS officer added that these numbers may rise marginally as there are people who tend to register deaths after the stipulated period of 21 days.
The picture in Kerala stands in sharp contrast to the neighbouring southern states. Karnataka recorded 1.02 lakh excess deaths between January 1 and June 15, 2021, which is five times the official COVID-19 deaths for that period. According to a report by Rukmini S for the Scroll, Andhra Pradesh saw an excess death of 1.30 lakh between January 1 and May 31, 2021 (34 times the official COVID-19 deaths for the same timeframe), while Tamil Nadu recorded 1.29 lakh excess deaths (7.5 times the official COVID-19 deaths). Hyderabad in Telangana reported 14,332 excess deaths between January 1 and May 30 this year, reported The Hindu.
What is peculiar about the data, however, is that in the first wave of COVID-19 pandemic in 2020, Kerala registered fewer deaths compared to the pre-pandemic year of 2019.
A senior IAS officer who didn't want to be quoted told TNM that many reasons could have contributed to this. â€śPeople may not have registered deaths of their kin due to the lockdown. Many in Kerala cremate their loved ones in their house compounds and donâ€™t seek a death certificate, that number may have increased in 2020,â€ť the officer said.
Under section 13 (delayed registration of birth and deaths) of the Registration of Births and Deaths Act, 1969, deaths can be freely registered within the stipulated time of 21 days of the passing of the person concerned. It can also be registered within 30 days (with payment of fees), or within one year (with fee and authorised letter from the state government) or beyond one year (with an order from Magistrate of First Class or Presidency Magistrate).
According to the annual report on the Vital Statistics of India (based on Civil Registration System) for 2018, Kerala achieved about 62% of registration of deaths within the stipulated time period of 21 days. â€śDuring the 2020 lockdown period, deaths registrations fell. It was not that people were not dying but it was harder to register deaths. Besides, if a person misses the 21-day time frame, registration becomes a complicated process. However, the process varies between and within states, although the form and certificate are the same. Kerala has an easier registration process compared to other states,â€ť the source said.
What Keralaâ€™s data suggests
Kerala has earlier registered a decrease in deaths. In 2013, the registered death toll was 2.53 lakh. In 2014, it fell by 12,621deaths and by 3,920 in 2015. It started increasing till 2019. â€śKeralaâ€™s mortality, on the whole, is declining. However, there are still more deaths as seen between 2015 and 2019. This is because Kerala is growing older,â€ť a source associated with the Kerala government said.
â€śThe average age profile of the population is increasing and changing every year. Besides, there are events like the 2018 floods, although the mortality impact has been less than 1,000. So, during the non-pandemic years, there wonâ€™t be excess mortality, and the data, if reliable, will show a smooth pattern,â€ť said the source. Incidentally, Kerala is one of the states whose civil registration is considered complete, recording high levels of registration, with many choosing to register past the 21-day period.
With lockdown in force for many months, deaths due to accidents have reduced in Kerala. Deaths due to road accidents, in normal circumstances, contribute only 1% (approximately) of the all-cause mortality in the state. With the lockdown in force for a major portion of 2020 and 2021 (till June), road accidents significantly reduced. According to the Kerala Police website, there were 4,440 road accident deaths in 2019, while there have been 1,423 deaths till June 21, 2021.
COVID-19 deaths not classified as the same?
The data above indicates that undercounting in Kerala is less, however a few hundred COVID-19 deaths may be getting classified as death by other causes. The state government follows the Indian Council of Medical Research (ICMR) guidelines (issued in early 2020) and states COVID-19 as the cause of death if the person had tested positive for coronavirus. However, over the months, this has caused confusion, as many COVID-19 patients died at home, due to post-COVID-19 complications or died after they tested negative for the virus. Recently, the Supreme Court asked the Union government to simplify the process of issuing COVID-19 death certificates.
(The number of deaths according to the Union government's CRS portal is a bit higher for Kerala from 2015-2019. It shows an average of 1,08,425 deaths in five months. This means Kerala has recorded excess death of 4,950).