Madrid was the community in which more deaths from Covid were out of official statistics

Eleven months has taken the INE to publish a complete statistic about mortality in 2020.The data has raised great interest because they show when, how and where the infected of COVID-19 died from the information provided by the death medical certificates.The figures, as expected, confirm that more people died than those declared by the Ministry of Health.The gap between the data shows how the first wave left many cases and deceased without accounting for lack of diagnosis.Only deaths with a positive evidence were notified to the central government.

But statistics allow to extract new conclusions.There were communities that in the second wave continued to register a considerable lag between the deaths declared to the Ministry of Health and those that have then been revealed through INE Mortality Statistics.Madrid is at the head of that difference with 34% more deaths from the communications.Then Castilla y León, with 24%.

The data also draw two pandemics due to the deep differences between the first wave that overflowed the health system and what came later.People who died with Coronavirus between January, when it was not even known what COVID-19 was, and June did it mainly in urban nuclei, without diagnosis and residences.However, the deceased from July spread throughout the territory - the virus spread free and was especially harmful in small and aging villages after the end of confinement - had the infection confirmed by PCR and passed through the hospitals, according toThe analysis that Eldiario.is made of the data provided by the INE.What did not vary in 2020, regardless of the wave, was the age of the deceased: one in four deaths were recorded in people between 85 and 89 years.

In the second wave the data fit better, except exceptions

The gap between mortality figures in health statistics and which reflect the death certificates shows two pandemics in 2020.A first wave where many deaths from Covid were left without accounting for the low availability of tests to detect the coronavirus and a second wave where the arrival of the PCR and the antigen tests multiplied the diagnostic capacity.An example of the greatest lags was Madrid, epicenter of pandemic in Spain.Reached a peak of 300 deaths daily at the worst moment of sanitary collapse, according to official data.The new data published by the INE raises this peak above 500 deaths every day.

"It was impossible to capture everything there was: the diagnosis was unbeatable and it was difficult to have faithful records.What was done with the media there was and then it is seen that it has been improving, "says Epidemiologist Mario Fontán.In the first months we must remember that only hospitals performed PCR, and only patients who arrived with respiratory difficulty.The tests took time to be accessible to primary care.

Between February and May the INE records 46.000 Deaths because of COVID-19 while government figures barely include 29.000 of those deaths.From July on, with the increase in diagnostic capacity, the difference is less than 4.000 deaths: 28.000 according to the INE and 24.500 in government figures.

The curves, therefore, are matched in most communities after July, when the death data sent by autonomies to health fit with death certificates.The following graph shows that comparison in each community: in blue, the official deaths daily according to the data of the Ministry of Health, in red, the deaths with confirmed covid, and in orange, all the deaths where the main cause of death is the coronavirus(possible or confirmed).

The differences, however, also persevered in the second wave in a small group of territories where there are many more deaths, according to the INE, that the deaths of deaths communicated to the Ministry of Health.These are the cases of Madrid, Castilla y León, Asturias, Catalunya and Andalusia.

How can this be explained?Three of these communities were very beaten from the beginning, and it can be inferred that their communication systems continued collapsed or did not count in the same way, according to sources consulted."It could occur, for example, that there were prolonged income that ended in death by Covid as the main cause, according to the doctor, but does not enter the other system because it occurs beyond the 28 days established by Castilla y León," says Fontán.The daily notification, in any case, forced a speed for which most systems were not dimensioned by the shortage of public health personnel.

The cities suffered first ... then the peoples

The first wave of pandemic was mainly urban.Coronavirus mortality between March and May concentrated on large cities, metropolitan areas and their areas of influence.In that period, 85% of the deaths were in municipalities of more than 20.000 inhabitants.The worst situation was lived in the provincial capitals, where more than 150 people died per 100.000 inhabitants en tres meses."It is logical, because the virus needed airplanes or ships (to a lesser extent) to enter and in the cities the population that travels for work or that has time and resources to travel is concentrated.It was basically a problem that came from outside.In the second wave that happened and it was internal mobility that determined the expansion, "says Fontán.

That explains that from summer, overcome the strictest confinement and with the holidays, the virus expanded through the territory.Then it wreaked worse in the areas with a more aging population: more than half of the deaths of the rest of 2020 occurred in rural areas.51% of deaths between June and December were in small towns and cities (up to 20.000 inhabitants).In the second half of the year, in the municipalities of up to 10.000 inhabitants fallecieron 123 personas por cada 100.000 inhabitants, una tasa similar a la que se había vivido en las urbes más grandes durante la primera ola, donde la tasa de mortalidad llegó a 133 por cada 100.000 inhabitants.

51% of the deceased without a diagnosis were in a residence

The gap between the first and second wave is very evident in another area: the place where the infected died.During the months of March and April the Coronavirus fully attacked the socio-sanitary centers, where about 13 died.000 older people only in those two months.In addition, 51% of deaths without diagnostic evidence of all 2020 were concentrated in residences.

The graph shows how this situation changed in the second wave (between October and December): deaths in residences descended significantly with respect to the first wave, and most of the deaths were given in hospitals.

The deaths in the houses were relatively few (in relation to the total number of deaths): 4.030 people died at home, of which more than half (2.329) correspond to the months of March and April, when the outbreak of pandemic and sanitary collapse occurred.

The ages do not change with the waves

Although the behavior of the pandemic in Spain showed differences between the first and second waves, it was not so in the case of the ages of the people deceased in Unoy another period.In fact, the proportions of deaths for age stripes between January and June, on the one hand, and between July and December, on the other, they are practically identical.

Although in the first half of the year almost double people died in the second (46.662 people compared to 28.177), the distribution of deaths by ages is almost traced.The most affected age group was that of people between 85 and 89 years: they represent almost 1 in 4 deaths per COVID-19 in both semesters.The next group where there were more deaths was that of people from 90 to 94 years, followed by 80 to 84.On the contrary, children under 50 did not suppose even 1% of the deaths in 2020.In short, the elderly were the most beaten by the epidemic.

Flu mortality and traffic accidents, the ones that fell the most

How did COVID-19 impact on the mortality of the rest of pathologies?The crisis and sanitary collapse following the pandemic resulted in other diseases.To see the impact of coronavirus on the other causes of mortality, we have compared the number of deaths for each cause of death throughout 2020 (only those causes of death have been taken into account with more than 500 cases in the year) withThe average of recent years (from 2016 to 2019).

The flu is the cause of death that lowers, even ahead of traffic accidents, which fell into chopped (23%) due to mobility restrictions.In 2020, 30% less than people died than the average of recent years.

But not all deaths fell.The deaths associated with diseases of the genitourinary system (32% more), senility and mental disorders (22% and 21%, respectively) or hypertensive diseases, among many others, among many others.For example, tumors: deaths from neurological tumors, skin, urinary or respiratory tract increased by 2020.

In this interactive table it is possible.