Inaccurate Covid-19 death reporting can lower international health assistance

From March 8 to May 12, 2020, 269 Covid-19 deaths were officially recorded in Bangladesh. By contrast, a report of the Centre for Genocide Studies (CGS) based on daily newspaper reports found that 929 Bangladeshis with symptoms consistent with Covid-19 died during the same period.

In recent weeks, evidence has come to light that coronavirus treatment units in multiple government hospitals, including Dhaka Medical College, have misreported coronavirus deaths. This raises questions about the reliability of the number of coronavirus deaths.

We cannot test the body of every deceased person who showed Covid-19 symptoms to confirm the cause of death; however, the CGS report and confirmed hospital data discrepancies together suggest a gap between official and unofficial numbers of coronavirus deaths in Bangladesh.

The gap between the official and unofficial death reporting is not unusual in Bangladesh. However, the Covid-19 pandemic presents a particularly complex situation; several factors influence death underreporting in the absence of a reporting standard. These factors include the improper and insufficient testing of coronavirus patients during their hospitalisations, the time lag between testing and results, and specimen collection inaccuracies.

The overall rate of deaths occurring outside of hospitals has also been unusually high, suggesting that some Covid-19 deaths have occurred in asymptomatic individuals. Finally, a considerable number of persons who died following the onset of Covid-19 symptoms have been identified as "normal" deaths; and families, in some cases, have hidden Covid-19 infections out of fear or in response to social pressures.

As a lower middle-income country, Bangladesh will likely face three inevitable public health concerns due to inaccurate Covid-19 death reporting. First, the allocation for public health is approximately two percent of the country's GDP, which is highly insufficient considering the needs of the people.

The people of Bangladesh, therefore, need to rely on the various types of health aid and assistance made available by international development partners and organisations; this aid often takes the form of short and long-term loans and project supports along with research and technical assistance. NGOs working on basic public health issues such as handwashing with soap are also highly dependent on foreign assistance.

Therefore, significant numbers of unreported Covid-19 deaths can falsely suggest to the international development partners and organizations that Bangladesh has been little affected by the coronavirus; this, in turn, can reduce much-needed aid and assistance for public health improvement programmes.

It is also important to understand that public health aid and assistance is limited at the moment, and our development partners can shift their funds to support other highly affected Asian and African countries. World Bank and Asian Development Bank recently approved $200 million, approximately Tk1682 crore, as a loan to support Covid-19 responses in Bangladesh.

This will not be enough if the government needs to mount and maintain ongoing coronavirus mitigation and adaptation responses as current wave of the pandemic surge. Additionally, many national and local NGOs would be forced to cancel health improvement projects related to Covid-19 responses due to lack of funds.

Second, we will need a low-cost or free vaccine supported by the World Health Organization or our developed partners (e.g. the United Kingdom, United States, Japan, or China). While no vaccine has been confirmed at this time, these countries are most likely to develop an effective coronavirus vaccine. Bangladesh is not the only country that is seeking vaccine-related aid and assistance from these countries: we have our competitors, too.

Low official coronavirus death rates due to underreporting will rank Bangladesh as a lower-priority country, which may cause public health problems including more Covid-19 deaths due to lack of medical assistance and eventually lack of access to a tested vaccine.

Third, inaccurate death data can be problematic when preparing strategies for the future wave of the pandemic. Without accurate data, public health researchers and policy analysts will not truly understand the dynamics of Covid-19 as it has spread; this will limit their ability to accurately predict likely trajectories and outcomes for similar situations.

In this way, inaccurate data reporting can harm ongoing public health efforts and limit access to aid and assistance now and in the future; poor people will ultimately be affected the most.

Underreporting or censoring coronavirus death statistics is not uncommon across the world, and we have seen that countries like China and Italy adjusted their death numbers after their first wave of the pandemic. Some may have incentives to conceal coronavirus deaths, but the Directorate General of Health Services (DGHS) should continue tracking and reporting both confirmed coronavirus deaths and deaths of persons with Covid-19 symptoms.

Now and in the near future, these provisional numbers will enable scientists, public policyanalysts, and development partners to accurately assess the Covid-19 mortality rate in Bangladesh and to offer data-driven pandemic preparedness strategies.

Dr Mazbahul G Ahamad, is a postdoctoral researcher at the University of Nebraska-Lincoln, USA