Minsk in times of coronavirus

COVID-19 death rates data shows more Belarusians deceased in Minsk alone than officially reported for the entire country

19 April 2021, 12:01 | Hleb Liapeika, Kiryl Kheifets, mediazona.by

The official reports of the Ministry of Health on the number of people infected with coronavirus and the subsequent death rates are very different from the data that authorities collected for their internal use. In 2020, more people were infected and died in Minsk alone than the Ministry of Health reported about the entire country. This fact is demonstrated by the data of the Minsk registry offices and healthcare institutions that Mediazona received access to. These data demonstrate that over the past year, the number of deaths in Minsk exceeded the typical average by 5,000 for the same time period in the previous years. This is a 29% increase in death rate. The main victims of the pandemic have been people over 60 years old.

Viktar Dashkevich, the 75-year-old actor of the Yakub Kolas Theatre, is officially considered the first victim of the coronavirus in Belarus. He died on 31 March 2020 in Vitsebsk. In 2020, 1,433 people died from COVID-19 in the country. These are the official data of the Ministry of Health.

This statement is contradicted by the data obtained by Mediazona on the death rates in Minsk, which shows that in the city alone more people died from the coronavirus than officially reported throughout Belarus.

Data we obtained

The data used in this publication was obtained from three different sources. One source handed over a dataset on mortality in 2020 from the Minsk registry offices. Each entry in this dataset includes the name of the deceased person, date of birth and death, and the record number of the death registration certificate. The dataset contained some duplicate death entries, along with some entries from late 2019. Those entries were removed from the analysis. Some randomly selected deaths were cross-checked by studying publications in the media and social networks, and by contacting relatives and friends of the deceased. The records matched in each case.

The records on deaths in November and December 2020 match the data on mortality obtained from the registry office of the Main Department of Justice of the Minsk City Executive Committee (our editorial office obtained this information from another source). The second dataset, referred to as “Report for medical statistics”, contains more detailed information about the deaths in Minsk in the period between 5 November and 30 December 2020. In particular, among other things, the cause of death is reported (including COVID-19).

The third set of data, obtained from yet another source, contains emergency notifications on COVID-19 cases detected in all medical institutions in Minsk from the beginning of June through the end of November 2020. These data include patient details, dates of their registration at the Center for Hygiene and Epidemiology, and more. A doctor from one of the city clinical hospitals confirmed that the data from the database of his hospital matched the data we have received. We also contacted randomly selected people from the list and they confirmed the accuracy of the data, including the time and location of their coronavirus diagnosis. Nevertheless, we still have doubts about the completeness of the data obtained, since several names who had definitely received a positive COVID-19 diagnosis were not found in the dataset. It is possible that the number of detected infections was even higher.

The information contained in all datasets is without doubts available to the Belarusian authorities. These data allow us to not only drawing conclusions about how COVID-19 was spreading in Belarus last year, but also how little the official reports of the Ministry of Health reflected the reality.

More cases of COVID-19 were registered in Minsk every day than officially in the country

The doctors interviewed by Mediazona explained that every medical facility treating patients with infectious diseases, not only coronavirus, reports to the District Center for Epidemiology and Hygiene on a daily basis. From there, the information is sent to the Minsk City Centre for Epidemiology and Hygiene.

According to the doctors, the COVID-19 cases were recorded not only from positive COVID-19 tests, but also from CT scans, or the presence of antibodies. Therefore, some of the COVID-19 cases were recorded retroactively by the time patients had already recovered.

The Ministry of Health publishes data on new coronavirus cases daily on its Telegram channel. Comparing the data published by the Ministry of Health with the data from one of our sources, we found that the number of infected people in Minsk every day was higher than that reported by the authorities for the entire country.

The Ministry of Health claims that from 5 July to 29 November 2020, 88,753 patients with coronavirus were registered throughout the country, including Minsk. Whereas Minsk City Centre for Epidemiology and Hygiene reported at least 101,966 cases for the same period just in Minsk.

Our dataset has missing entries for six days in this time period. Based on the numbers for the preceding and following dates, we can assume that some 4,000 more cases of COVID-19 have been identified over that period.

The data on the graph are smoothed using a centered moving average. It means that each specific point displays the average value over seven days (the actual date, three preceding, and three subsequent days). This is done in order to smooth the graph because we observe practically zero entries on the weekends and spikes at the beginning of the following week after the weekend cases are counted in.

The numbers are presented per 100,000 population of Minsk and Belarus, respectively, in order to demonstrate the difference between the official reports and the internal data available to the authorities. The population of Minsk is 2 million. The population of Belarus is 9.35 million.

Judging by these statistics, the number of cases started to decline only by mid-June. After 16 June 2020, the number of cases dropped below 1,000 per day. The Ministry of Health has not reported more than 1,000 new cases per day throughout the country in the spring and summer 2020.

According to our data, the second wave of the pandemic started in September 2020. By mid-October, doctors registered more than 1,000 cases each day; and a month later – more than 2,000 in Minsk alone. The highest total number of new cases for Belarus ever reported by the Ministry of Health was 1,975 on 11 December 2020.

In November and December 2020, more people died in Minsk each day than officially throughout Belarus

The data collected by the Main Department of Justice of the Minsk City Executive Committee contains information on total deaths registered in Minsk in the period from 5 November to 29 December 2020. Each entry reports the cause of death in accordance with the ICD-10 codes, as well as the medical facility that established the cause.

Over those two months, COVID-19 had been listed as the cause of death in 700 cases (272 deaths from 5 to 31 November, and 428 deaths from 1 to 29 December). Coronavirus deaths accounted for 15% of total deaths during this time period.

The Ministry of Health does not publish data on coronavirus deaths for Minsk but only the total for Belarus. According to the Ministry’s Telegram channel, during that period, only 415 people died from COVID-19 in Belarus (167 people between 5 and 31 November, and 248 between 1 and 29 December). This number is lower than that officially reported for Minsk alone for the same time period.

According to the registry office data, in December 2020, on average 15 deaths were reported daily in Minsk due to COVID-19. The Ministry of Health reported an average of  8–9 deaths a day due to COVID-19 for the entire country.

The graph below is smoothed using a centered moving average. According to our data for Minsk alone, the record number of deaths due to COVID-19 was 27, reported on 17 December, 2020. On that day, the Ministry of Health reported only nine deaths for the entire country.

The number of COVID-19 deaths may be even higher – coronavirus is not always reported as the cause of death

Аn anonymous employee of one of the pathoanatomical agencies in Belarus explained to Mediazona how COVID-19 deaths are reported. “If a patient dies in a hospital, an attending doctor makes the final diagnosis and reports the primary, the secondary, and the tertiary diseases, as well as any complications.” All diseases are reported according to ICD-10 codes. Doctors inform the relatives of the patient’s death and the body of the deceased is transported to the pathoanatomical office.

An autopsy is performed if the administration of the medical facility where the deceased was treated and died warrants its necessity. Following the autopsy, a pathoanatomical diagnosis is made and recorded in the death certificate. If an autopsy is not performed, the attending physician makes the final diagnosis and issues a death certificate.

After that, the relatives of the deceased receive a medical death certificate that they take to the regional registry office where the death is officially recorded. All data from all the city districts is sent to the registry office of the Main Department of Justice of the Minsk City Executive Committee, where the mortality statistics for Minsk are calculated. It is this data that Mediazona received from its source.

If a person dies at home, the police and a family physician are called. The police check that there are no violent injuries. The family physician looks at the medical records of the deceased. If the deceased had recently visited a doctor and had an illness that could have potentially caused death, then it is reported as the cause of death. In controversial cases, the body is sent for a forensic medical examination.

On 2 April 2020, the Ministry of Health issued a mandate explaining when COVID-19 must be reported as the cause of death. The mandate states that the illness caused by COVID-19 (for example, a viral pneumonia) is recorded in the pathological diagnosis as the primary cause “in the presence of a severe interstitial viral pneumonia with characteristic morphological signs”.

If a deceased had other serious illnesses and developed complications due to coronavirus, then COVID-19 could be an integral part of the combined underlying illness. In this case, as stated in the mandate, it is COVID-19 that must be reported in the medical death certificate as the primary illness.

According to the same anonymous employee, the primary illness is recorded in the registry office data, and in both cases, following the Ministry of Health mandate, COVID-19 will be reported as the cause of death. Therefore, in our mortality dataset for November–December 2020, the 700 deaths were due to COVID-19 as the primary illness.

Our source also noted that if all doctors followed the mandate of the Ministry of Health, “we would have had the most honest statistics in the world”. Falsifications, in his opinion, occurred from the verbal orders of the management of healthcare institutions and “propagated bottom up”.

According to him, in an attempt “to not mess with the statistics,” the pathologist could simply record COVID-19 in another section of the death certificate. If a patient had another serious illness, COVID-19 could have been reported as the secondary illness (but only the primary one is included in the statistics).

Heart diseases, such as atherosclerotic or postinfarction cardiosclerosis, as well as arterial hypertension, are commonly used to conceal COVID-19 statistics.

“It is very convenient to hide anything behind atherosclerosis because most of those who die from COVID-19 are over 50 years old. By the age of 50, every third person will have some manifestation of atherosclerosis,” says the pathologist. Therefore, not only COVID-19, but many other illnesses can be hidden behind this cause of death.

According to the registry office data, 1,549 people died from variations of atherosclerotic heart disease, which makes up 32.8% of those who died in November-December 2020. It is difficult to say how many of these deaths can be attributed to COVID-19, because “a fairly large percentage of controversial cases fall into this category, which makes it difficult to establish the exact cause of death”.

According to our source, if a person was over 85, “old age” could be reported as the cause of death (if an autopsy was not performed). There were 123 such cases in November-December, according to the Minsk registry office, and 29 of the deceased were slightly younger than 85.

Without a positive test, COVID-19 will never be reported as the cause of death, “even if everything is obvious to the pathologist at the autopsy”. The posthumous examination reports are not always informative and are often obtained with a long delay, especially in rural areas.

In 2020, 29% more people died in Minsk compared to the previous five years’ average

In an environment where the COVID-19 statistics is unreliable, excess mortality data helps estimate the scale of the epidemic. This number shows how many more people died in a year relative to the previous five years’ average.

Usually, Belstat publishes death rates data for Minsk in the quarterly statistical bulletin called “The socio-economic situation in the city of Minsk”. The average number for 2014–2019 was some 17,400 deaths per year.

The registry office data obtained by Mediazona indicates that 22,454 people died in 2020 in Minsk, i.e. about 5,000 more than in the previous five years on average. That is, during the pandemic year, mortality increased by 29%.

The quarterly data shows that the COVID-19 epidemic in Belarus reached its peak during the second wave in autumn 2020. In the fourth quarter, the increase in mortality was over 59%.

The main victims of the epidemic are people over 60

People over 60 account for 81% of total deaths in Minsk in 2020. The largest increase in mortality occurred among the elderly people – instead of the usual 13,827, there were 18,191 deaths registered in Minsk for that age group. The increase in mortality for the 60–69-year-olds was 30.45%, and 27.7% for the 70-year-olds.

In November–December, at the peak of the second wave of the COVID-19 epidemic, the proportion of people over 70 who died from COVID-19 was 56.3% (if we add that number to the 60 to 69-year olds, the percentage rises to 81.6% of deaths due to COVID-19 for both age groups).

The average life expectancy in Belarus is 78 years for women and 64 years for men. In all age groups, men die 2–3 times more often, with the only exception for people over 70. There are significantly more women in this age group.

A more complete picture of excess mortality in Belarus, not just in Minsk, could be provided by Belstat, who has repeatedly postponed the publication of these statistics for 2020 without any explanation. They initially planned to release the data in early April 2021, then postponed it to 16 April, and now the date is set for 17 May.

Analysing death rate information available to us right now for Minsk alone, we can observe that Belarus faced an unprecedented increase in mortality in 2020, while the official numbers of the Ministry of Health do not reflect this fact and are easily refuted by the documents from the registry offices and healthcare institutions.

Mediazona would like to thank the iSANS Analytical Center for their help in preparing this analysis, as well as Dzmitry Kabak, who analyzed excess mortality due to COVID-19.