What is happening with the coronavirus numbers?

• Direct. Last minute about the coronavirus crisis

For a few days, the daily figures of the coronavirus epidemic have been raising great confusion due to the contrast between those given by the Ministry of Health and those provided by the autonomous communities. What are these discrepancies due to? What route does that data take?

On May 11, the new diagnosis, surveillance and control strategy entered into force in the transition phase of the COVID-19 pandemic, with which the system with which Health had been collecting and transferring the data of the different communities to adapt it to epidemiological evolution.

The figures of the discussion

Until today, the number of deceased amounts to 27,128, according to the calculation of the Ministry of Health. A historical series that will be updated in a few days, when the autonomies conclude the validation of the data of the worst part of the pandemic .

The disagreements do not occur only in the number of deaths , but extend to the number of hospitalizations and admissions in ucis . But the death toll is, as the director of the Coordination Center for Health Alerts and Emergencies (CCAES), Fernando Simón, says the ones that "hurt the most . "

"The times it takes to complete the process have changed a lot"

They are the deceased by coronavirus with a confirmed positive diagnosis. Two figures have also set off alarms. The information provided by the Daily Mortality Monitoring System (MoMo) based on civil registry data, which indicates that between March 17 and May 25, there have been 43,000 more deaths than statistically expected for this time of year, representing an increase of 42%.

And the National Statistics Institute (INE), according to which the estimated deaths in Spain during the first 21 weeks of 2020 (until May 24) amount to 225,930, 24.1% (43,945) more compared to the same period of 2019.

Simón has explained over and over again that the figure is nowhere near final , that we have to wait for the validation of the communities and that there will be time - when studying death certificates with the cause of death - to clean and define the historical series.

Health is now concerned, above all, with the evolution of the pandemic and the rapid and effective control of outbreaks that occur, and it is these data - new infections and their surveillance - that focus the attention of health technicians. public.

The diagnosis, surveillance and control strategy

The new system was released two weeks later to give autonomies time to acclimatize to the new indicators required with the aim of obtaining individualized information on each case, now that they can better verify and validate the data, as the healthcare pressure has decreased.

Thus, since Monday, May 25, the Ministry informs as a novelty of the cases diagnosed the previous day and in the last 7 and 14 days, those confirmed with the onset of symptoms one week and two weeks before, as well as hospitalizations, ucis and deaths in 7 days; The communities must report this information, among others, before 12:00.

But the premiere coincided with the "disappearance" of almost 2,000 deaths from the global count , something that Fernando Simón blamed on the fact that cases that were duplicated or that did not meet the case definition had been eliminated, among other criteria. Since then, the discrepancies have only followed one another.

How is it possible, for example, that for more than a week the Ministry has not changed the overall number of deaths in the Community of Madrid when it itself reported 12 deaths overnight? Or that for two statistics in a row Health maintained the same number of total deaths when Castilla y León had transferred two new ones that were not included?

As the person in charge of the CCAES has pointed out several times, the series will remain frozen and will only be modified when a death occurs the previous day; and this is how it will be until all the communities manage to update their series, something that they hope will be "a matter of days".

How the data is recorded

The Ministry of Health clarifies to Efe that it is the communities that enter the data, individually , through the SiViEs surveillance tool managed by the National Center for Epidemiology of the Carlos III Health Institute; and it is these that the CCAES uses to show the evolution through daily updates.

So it can happen that if a community reports a new number of deaths but does not assign any to the previous day, it will not appear in the daily Health balance. The mechanism for recording deaths has been similar throughout the entire epidemic, but with the new system "the times it takes to carry out the process have changed a lot ," Simón admitted.

"The deceased will know each other, but sometimes we may have a little delay"

Yesterday I explained it this way: when a person identified as a case is hospitalized, "you have to go back to your medical history, to your notification file, and include the date. It is an act that must be done in each of the community public health. "

And if she is subsequently admitted to an ICU, "again you have to return to your file and note the date on which the admission is made." In some places this process is practically automated, but the date must be entered "anyway, either by searching for the file or by combining databases." If it is not done, it will not appear in the statistics.

If death occurs, you must go back to the patient file, either in the hospital, primary or public health database, as established in each of the communities, or simply in the medical history, and note the date of death.

It is the cases prior to May 11 that may involve more delays, since what needs to be updated is the data prior to that day , which is when the communities were most overloaded.

It may also happen that some have problems updating those previous sheets to the new surveillance system and give a death toll without the date of death. "They will, it will be known. The deceased will all know each other , but at times we may have a little delay," he justified.

Obstacles in validations

There are other obstacles that can hinder the daily collection of data; The Ministry of Health of the Canary Islands told Efe that the platform used also includes other diseases that are notifiable , which in their opinion may be a problem because these pathologies, which were previously reported, usually have a relatively low number of cases, but with the irruption of the covid tens of thousands are handled.

Some delays in dumping information could also stem from the large volume of data and the detail with which they have to provide it now, although the Canary Islands insist that it does so in real time. And to this is added that the current method is based on the number of the health card, and not all communities have developed the system in the same way.

The deceased, illustrate Efe in the Valencian Community, are identified through the information contained in the epidemiological survey. A form is filled for each person, which includes the death and its date among its variables. The variables requested by the Ministry are sent daily, along with an update of overdue data.

Their notification can take place in several ways: with information from public hospital centers , from private hospitals - which directly communicate the cases of deceased persons, but not always on the day of death; and the preparation and follow-up of epidemiological surveys, an avenue through which it sometimes happens that cases of deceased persons who died days ago are reported.

In the system used there, the AVE application (Epidemiological Surveillance Analysis), all the surveys are identified by name and surname, SIP number (the number of the health card), the medical history (if applicable), date of birth and But these data are not the ones that are communicated daily, but this system uses a unique survey code (which belongs to a single person), which is the one that is transferred.

Faced with this situation, Castilla y León, which has always shown its reluctance on how to count, believes that the Civil Registry should be the reference when calculating deaths, hence the request that this public institution streamline its work.

In accordance with the criteria of The Trust Project

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