New technical guidance for national governments was released to support the enhanced measurement of two key indicators for the COVID-19 response; the number of cases and the number of deaths, as reported on national and global dashboards. The package was launched by global health NGO Vital Strategies.

Limited COVID-19 testing capacity in low- and middle-income countries makes it especially challenging to use confirmed cases as a measure of epidemic impact and burden.

“In the absence of adequate global testing capacity, measuring cases and deaths specifically due to COVID-19 is not straightforward,” said Dr. Philip Setel, vice president of the Civil Registration and Vital Statistics Program at Vital Strategies in a press release. “Rapid surveillance of total mortality can provide critical data to national leaders and health authorities as they work to temper and control the pandemic within their borders.”

 The new guidance, Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillance, offers a step-by-step manual on ‘rapid mortality surveillance,’ which relies on the key concept of estimating excess deaths due to COVID-19. The technique allows countries to rapidly determine the extent of the epidemic and accordingly plan outbreak responses.

By comparing year-on-year all-cause mortality data from national civil registration and vital statistics (CRVS) systems, countries can see how many more deaths occurred in 2020 compared to previous years, and get a snapshot of how many excess deaths may have been caused by COVID-19, according to the new guidance. The data can then be visualized separately by age group, sex, and location to further identify trends in deaths.

Brazil, Colombia and Peru already began using existing civil registration and vital statistics systems for rapid mortality surveillance through the Bloomberg Philanthropies Data for Health Initiative. Analysis of vital registration data helped identify a sharp increase in total mortality in April 2020 compared to the same time in 2019 in Manaus, Brazil, illustrating the enormous impact the pandemic has had on the city’s death rate.

“All countries need timely and reliable data to inform health planning. This need becomes particularly acute at times like now when they face a swiftly evolving pandemic,” said Dr. Samira Asma, Assistant Director General for Data, Analytics, and Delivery for Impact at the World Health Organization

Rapid mortality surveillance generates daily or weekly counts of total mortality by age, sex, date of death, place of death and place of usual residence, helping to provide a fuller picture of the scale and direction of the pandemic, including estimates of deaths due to COVID-19 that may have been missed by the traditional testing and surveillance system. Data is collected through facility- and community-based surveillance, which helps capture deaths that are also occurring in homes.

The technique also estimates indirect mortality caused by disruptions to health services, and the interaction of the virus with pre-existing conditions such as noncommunicable diseases.

“Governments need timely, reliable data to inform decisions that will ultimately save lives, now more than ever,” said Dr. Kelly Henning, head of Bloomberg Philanthropies’ public health programs. “This new technical package will empower leaders around the world with a faster, more accurate understanding of potential COVID-19 deaths, and allow them to take action to slow the spread of this pandemic.”

The technical package was developed with experts from Vital Strategies and partner organizations that helped shape the package, ensuring clarity, rigor and ease of use: Africa Centers for Disease Control and Prevention, Bloomberg Philanthropies Data for Health Initiative, CDC Foundation, Pan American Health Organization, UN Economic Commission for Africa, UN Economic and Social Commission for Asia and the Pacific, US Centers for Disease Control and Prevention, and the World Health Organization.

Image Credits: Twitter: @WHOKenya.