November 2020 is the deadliest month in Bulgaria for at least the last five years. This is according to preliminary data of the National Statistical Institute (NSI) on mortality in the country, published this week. In November, 15,953 people died in Bulgaria, with an average of about 8,300 in the same month over the past 5 years. The increase is over 92%.

The difference of more than 7,600 people includes 2,756 who died of coronavirus in that month (they are calculated according to official data of the Unified Information System). Among other cases (a little under 5,000) again a major role playes the epidemic - specialists, whom "Dnevnik" asked questions about the data share this opinion.

Also in response to a question by "Dnevnik" during the briefing of the health authorities on Thursday (December 10), Health Minister Kostadin Angelov explained that he was familiar with the NSI data and commissioned the National Center for Public Health and Analysis to analyze the increased mortality rate in the third quarter of 2020 compared to last year. However, the sharp increase in mortality coincides with the beginning of the fourth quarter of the year.

The overall mortality rate has started to rise as of the end of June as of the end of 2019. As it rises variably, but for several weeks (after the 40th week - the first of October) there is a sharp increase. "We reach 3 800 cases of the deceased in the country, during the 46th week (the second in November) which is an unprecedented number for the last five years", commented on BNR at the end of November Magdalena Kostova, who heads the "Demographic and Social Statistics" Directorate in NSI.

At the time, the data have not yet been published, but Kostova explained that the better way is to monitor the coefficients relative to the absolute numbers: "In the 46th week in question, this coefficient was 30 per thousand, or 30 died for every thousand people. By comparison, the overall death rate for 2019 was 15.5 per mille".

As for the registration of deaths and their relation to coronavirus, there have been disputes since the beginning of the pandemic because of different approaches in different countries - whether if you test positive and die it is reported as a result of COVID-19 or other causes and concomitant diseases that may be the real cause are analyzed. There is little information in Bulgaria on this topic, but about official statistics reported by the authorities it is known that it includes people who have died after being proven infected with coronavirus.

As of mid-December, deaths and the number of people in hospitals, especially in intensive care units in Bulgaria - may be considered as the more relevant data for analysis, because the official reports of the infected are based only on PCR tests (rapid antigen tests are not counted), and the recovered patients are counted from the day on which the 14-day quarantine was imposed on them is automatically omitted.

The "coronavirus" effect on overall mortality rate

Tihomir Bezlov, a senior analyst at the Center for the Study of Democracy, explained to Dnevnik that a trend towards increasing overall mortality at abrupt increases in the number of people infected with coronavirus is noticeable in many European countries and in the US. Especially locally.

He commented that the initial assumption was that these were not deaths from coronavirus, but from other diseases. Subsequently, the jump in mortality is so high that the hypothesis prevails - not all deaths from coronavirus are recorded as such.

'No one was able to explain exactly what the cause was - under-recorded cases of coronavirus or clogged channels for aid which is provided for those with other ailments. It is clear that when there are full hospital wards, effective treatment for all cannot be ensured. Probably the reason in Bulgaria is the same. We have a big problem with normal deaths registrations.

There are no autopsies, hospitals are trying to use different nomenclatures to avoid problems," Bezlov said. According to him, it is especially important to note that the deaths recorded by the NSI on a weekly basis are also increasing at the same rate as those who died of coronavirus,

 The same opinion shares mathematician Petar Velkov, who since the beginning of the epidemic in Bulgaria often analyzes data and makes predictions. He told Dnevnik that there is about 50% unregistered death cases from coronavirus. This is his hypothesis based on the analysis of systems in other countries. Velkov drew attention to the fact that the number of deaths in the country increased by 123% in the last week of November 2020 compared to the same period of the previous year.

 According to him, the lack of laboratories for PCR testing in smaller towns, which is another factor for the difficult registration of those who died of COVID. Velkov believes that in addition to unregistered cases, account should also be taken of cases when due to overload the health system failed to respond adequately, which is again an indirect effect of the coronavirus crisis.

Thus, mathematically speaking, almost the entire increase in mortality in the country turns out to be a direct or indirect consequence of the epidemic.

 The problem of self-medication and belated medical help

 Prof. Boris Bogov, director of one of the largest hospitals in the country - "Alexandrovska", explained to Dnevnik that there is an increase in mortality in Bulgaria in any event, although the country is already the second by the highest death rate of COVID-19 in the EU (this is one of the indicators that the health authorities emphasize this week).

 "This increase in death cases is obviously due to COVID infection and to the accompanying pathological complications. And last but not least, the self-treatment and medical attention sought too late", explained Bogov.

 The Director of "Pirogov" emergency hospital Prof. Asen Baltov told Dnevnik that there is a slight increase in mortality in his hospital, but it is not comparable with the NSI data for the country. The number of patients admitted to the hospital has begun to grow since mid-November. Baltov also admits the high overall mortality rate and thinks it is possible that many people have not sought medical attention at all.

 The Union of Funeral Companies in Bulgaria confirmed to Dnevnik that there has been an increase in funerals. They focused on the many cases of coronavirus deaths they faced. The situation at the moment has been described by them as a "war."

Given the trend that overall mortality follows that of coronavirus, it is expected to reach new highs. So far, the first week of December has been the deadliest since the outbreak began. Deaths for the day fell by 4% on a one-week basis as of December 10, and new cases of illness increased by 4% on a year-to-day basis despite the introduction of new anti-epidemic measures from November 27.

 The forecast for the year

 In her interview at the end of November, Magdalena Kostova of the NSI explained that "for 2020 our predictions are that there will be between 120,000 and 125,000 deceased persons in the country. Last year there were 108,000." She said the reporting process was complex and went through paper coding of the death notices from the Regional Health Inspectorates, which are now overloaded and the data on the officially reported causes will not be clear until next year. Kostova reminds that Bulgaria is among the countries with high mortality.

 Referring to preliminary data, she said that the birth rate in 2020 will be lower than in the previous year, but how much influence the pandemic or other factors have on this is even more difficult to say.

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