Photo: Predrag Trokicic
Photo: Predrag Trokicic

On Friday, September 25th, the National bureau of statistic (NBS) published the data on the numbers of births and deaths in Serbia in August 2020. Since our official Covid-19 reporting system has been compromised for quite some time now, the total number of deaths could be one of the rare indicators of the real situation and the real consequences of the pandemic.

The answer, in a word, is: catastrophic. But we’re not talking only about numbers here, but also about politics. It is time we ask ourselves how many unnecessary deaths are to be blamed on the actions of the government and the Crisis committee, especially since the sudden relaxation of the measures in early May. So, let’s start from the beginning.  

Naturally, and unfortunately, since the bureau of statistic is part of the government, I have to start with a disclaimer. The numbers from the NBS are just that. Whether the total number of deaths per month is accurate or not is a whole separate subject. Among other things, this number is based on the date of entry into the registry of deaths, which can lead to problems in reporting. In February and March this year, before Covid-19 had any effect on mortality in Serbia, the NBS recorded a decline in the number of deaths which remained unclarified, so the validity of any analysis depends on the accuracy of these numbers. 

According to the NBS, and by extension the registry of deaths, 8,730 people died in Serbia in August. Although the Bureau in its report compares this number only with the data from August last year, what we need to discuss here, and what has been measured around the world for months now as “excess of deaths” due to the pandemic, is the comparison with the average number. For the purpose of this article, I took the mathematical averages for each month from 2010 until today to show whether and how the numbers of dead from 2020 are different, first during the strict protective measures imposed in spring and, second, since their abolition.

For example, in August, the number of deaths exceeds the ten-year average by 885 (the average is around 7,844 dead). Official data from the ministry of health states that “only” 146 people died during this period due to Covid-19.

Of course, a mere mathematical average could be deceptive here, since it tells us nothing about deviations.

However, the number of deaths for each month is pretty consistent, year after year. Seasonal infections, for example, are the reason why December, January and February are almost always the deadliest months, while August and September are traditionally the least deadly. Looking at the numbers from August year after year, things become clearer: according to NBS data, the greatest deviation in the number of deaths in August for the past ten years was recorded in 2017 and it was only 322. In other words, 563 more people died during August 2020 than during the deadliest August since 2010.

August is generally a “quiet” month when it comes to mortality, with small oscillations: school holidays, vacations, even the weather, all influence the relatively low mortality rate. When it comes to July, the situation is completely different, and in 2020 a catastrophic and unexplained number was recorded.

According to the NBS, 10,023 people died in Serbia in July 2020, which is 1,896 people more than the ten-year average for July. The previous biggest deviation was 508, in July 2015. In other words, this is the biggest recorded deviation in the number of deaths for the past decade, in a month when the ministry of health reported only 291 Covid-19 deaths.

Going further back, the deviation from the average is significantly lower in June (456) and within standard deviation for May and April (207 and 126 more than the ten-year average, respectively). What does this all mean when we’re talking about the pandemic?

The protective measures imposed in Serbia, which were then judged to be among the harshest in the world, lasted from March until early May. Recording problems aside, the time needed for the spread of disease, development of symptoms, complications and deaths to have their effect tells us that June is the earliest point in time we would expect to see an increase in the number of deaths due to the abolition of measures in May – which is exactly what NBS data suggests.

According to reports of the ministry of health, during the period from June 1st to August 31st 469 people have died from Covid-19 in Serbia. On the other hand, within the same period, the total number of deaths deviates from the ten-year average by 3,238, i.e. around 13.5 percent. This is ten times more than the so-called standard deviation. And, assuming the numbers reported by the NBS are accurate, this is actually the real death toll of Covid-19 since the relaxation of measures.

Of course, this doesn’t mean that the virus itself has killed 3,000 people more than officially reported. Excess mortality during an epidemic is tricky: the health system is stretched, patients get redirected, departments closed. How many people have actually died of Covid-19 and how many because they didn’t receive the care which would have saved them under normal circumstances?

However, we shouldn’t be (too) distracted by the distinction between death “of” and “because of” Covid-19. In many countries, both in Europe and worldwide, which were more severely affected by the pandemic than Serbia, this discussion marked the first months of the pandemic, when the need to somehow explain the catastrophic reactions of “rich” countries like Belgium and Great Britain arose.

As it turned out in those cases, the difference between the numbers “of” and “because of” is not as big as it may appear. Namely, just like an epidemic can jeopardize the normal functioning of a healthcare system, the changes in behavior resulting from the epidemic can decrease the general mortality rate: people pay more attention to their health, social distancing reduces the infection rate of seasonal diseases, fewer traffic accidents (assuming any measure of quarantine is in place) and so on. We can’t be sure how much of the “excess mortality” was caused by untested Covid-19, but it is extremely careless, even unscientific, to attribute that mortality to protective measures instead.

Besides, since we’re talking about politics, the official position of the ministry of health is that Covid-19 didn’t put a strain on the Serbian healthcare system at all. In other words, we are managing it. But, if our resources are sufficient and our capacities aren’t overwhelmed, what caused those several thousand deaths, unrecorded and unexplained, which surpass the ten-year average and coincide in time with the decision of the government to suddenly relax all protective measures? Why did all those people die, then?

That’s not the only question they owe us an answer to. The scandal with fake numbers of infections and deaths came and went, at least in the media, but these numbers show, once again, that the problem is much deeper than any specific scandal: no one even thought it necessary to officially address this huge deviation. Where are the explanations, estimates, research? Why do we still not have accurate numbers, instead of having to rely on questionable data from the registries?

In other words, the problem was never masks, vaccines, or protective measures which, it seems, temporarily saved us this spring – the problem is that the primary maxim of our response to Covid-19 was: keep the people in the dark. The biggest danger was never high mortality rate, but the government’s fear that the people would blame them for it. Whether Covid-19 is directly or indirectly responsible for the huge rise in mortality from June onwards, its main accomplice in this catastrophe is clear.

The author is an editor of the Odiseja magazine on science in society.

Translated by Marijana Simic

Pešč, 01.10.2020.