Delay in death reporting affects timely monitoring and modeling of the COVID-19 pandemic

Abstract

This study describes the COVID-19 death reporting delay in the city of São Luís, Maranhão State, Brazil, and shows its impact on timely monitoring and modeling of the COVID-19 pandemic, while seeking to ascertain how nowcasting can improve death reporting delay. We analyzed COVID-19 death data reported daily in the Epidemiological Bulletin of the State Health Secretariat of Maranhão and calculated the reporting delay from March 23 to August 29, 2020. A semi-mechanistic Bayesian hierarchical model was fitted to illustrate the impact of death reporting delay and test the effectiveness of a Bayesian Nowcasting in improving data quality. Only 17.8% of deaths were reported without delay or the day after, while 40.5% were reported more than 30 days late. Following an initial underestimation due to reporting delay, 644 deaths were reported from June 7 to August 29, although only 116 deaths occurred during this period. Using the Bayesian nowcasting technique partially improved the quality of mortality data during the peak of the pandemic, providing estimates that better matched the observed scenario in the city, becoming unusable nearly two months after the peak. As delay in death reporting can directly interfere with assertive and timely decision-making regarding the COVID-19 pandemic, the Brazilian epidemiological surveillance system must be urgently revised and notifying the date of death must be mandatory. Nowcasting has proven somewhat effective in improving the quality of mortality data, but only at the peak of the pandemic.

Excess suicides in Brazil: Inequalities according to age groups and regions during the COVID-19 pandemic

“…The maximum period for the state health secretariats to transfer the data to the national module of the system is up to 60 days after the end of the month of occurrence of death (Ministério da Saúde, 2022). Therefore, the deaths included in this study, in particular those with closure in December 2020, refer to a period greater than 180 days after their occurrence in relation to the date of data availability, thus reducing the possibility of delay in notifications (Carvalho et al, 2021).…”

Two years of COVID-19 Pandemic: Framework of Health Interventions in a Brazilian City

“…COVID-19 effects seriously impact health systems and the economy [48]. To balance measures that protect the health of the population, but negatively impact the economy is a challenge [7].…”

Enfrentamento da Covid-19 na Atenção Primaria à Saúde: documentos normativos e mortalidade

“…A subnotificação também foi encontrada na avaliação da notificação de óbitos por Covid-19 em São Luís (MA), onde 40,5% dos óbitos foram notificados com atraso de mais de 30 dias e apenas 17,8% foram notificados sem atraso ou no dia seguinte, subestimando o número de óbitos no início da pandemia (Carvalho, et al, 2021).…”

“…A subnotificação, tanto dos casos quanto dos óbitos, é preocupante, pois os gestores não possuem a real magnitude do impacto da doença na comunidade, realizando análises equivocadas da realidade, além de interferir na tomada de decisão de forma assertiva e oportuna sobre o desenvolvimento de ações de enfrentamento da Covid-19 (Prado, et al, 2020;Carvalho, et al, 2021). Além disso, o atraso nas notificações mostra uma fragilidade no sistema brasileiro de vigilância em saúde, evidenciando a necessidade de adequação no fluxo de notificação (Carvalho, et al, 2021).…”