COVID-19 deaths are undercounted in official El Salvador stats

It is difficult to know how many persons have died as a result of COVID-19 in El Salvador.    But it seems clear that the 74 deaths out of 3826 confirmed cases of the disease on the government's COVID-19 website is a significant under count.

The Salvadoran Minister of Health Francisco Alibi has  acknowledged that there is an undercounting of deaths from the virus.  Some deaths are not included because the official statistics only count persons who have actually been tested for the disease.      

The size of this undercount may be quite significant.

I have been closely tracking the government's official statistics since the beginning of April. In the first week of May, those stats showed 20-25 persons hospitalized with COVID-19 in moderate, critical or grave condition, and an average of one person dying each day.   In the past seven days in June, the number of persons hospitalized has increased to more than 750.  Despite this increase of more than 2800% in hospitalized cases since early May, the number of reported daily deaths has never exceeded  four in a day.     

El Salvador's official statistics would produce a case fatality rate of 1.93% (the percentage of confirmed cases which result in death).  The worldwide average for this virus, however, is 5.4%.  If we applied that figure to El Salvador's 3826 confirmed cases, one might expect to see 207 deaths.

Something in the range of 200 deaths might, in fact, be closer to the truth.  Reporters from El Faro went to cemeteries in just three cities, Santa Tecla, San Salvador and Soyapango and were told those cities had buried 169 persons through June 12 using specific burial protocols to avoid contagion from COVID-19.   These protocols are used whenever there is a death confirmed to be as a result of COVID-19 or when a death is suspected to be COVID-19 related, but the deceased was not tested before dying.  The 169 deaths from those three cities far exceed the official tally of 74 countrywide. 

Salvadoran infectious disease specialist Dr. Iván Ernesto Solano Leiva was quoted in La Prensa Grafica estimating that there could be an undercount in the range of 200%.   In the same article, LPG reported on a lack of COVID-19 tests within the hospitals.    

An article in RevistaFactum titled I thought that the statistics were trustworthy, but the death of my father doesn't appear, describes one family's realization that their father's death from COVID-19 had not been captured in the daily death report of the Health Ministry.  Similarly, deaths of 15 elderly patients in a nursing home don't seem to have entered the official tally.

Official mortality data which undercounts the true number of COVID-19 related deaths is not unique to El Salvador.   The New York Times did a study of a number of countries (not including El Salvador) finding frequent undercounts.   The paper reported:

Mortality data in the middle of a pandemic is not perfect. In most places, the disparities between the official death counts and the total rise in deaths reflect limited testing for the virus rather than intentional undercounting. ...But the total death numbers offer a more complete portrait of the pandemic, researchers say, especially because most countries report only those Covid-19 deaths that occur in hospitals.

COVID-19 deaths are also widely believed to be underreported in the US.

 

El Salvador would have a better sense of the impact of this disease if the government improved its ability to count the dead.   Unfortunately the government may have a disincentive to do so if more accurate totals make the country look more like the rest of its neighbors in Central America.  In the meantime, focus on the number hospitalized.  This high and climbing number represents a better picture of the pandemic's toll than the number reported to have succumbed to COVID-19.