National Review

Death count rising

Mortality rate increasing against backdrop of strained health system

In 2021, a total of 3,606 deaths were recorded in The Bahamas, according to the Registrar General’s Department.

This is an increase of 1,054 deaths over the number of deaths recorded in 2018.

It is an increase of 978 over the number of deaths recorded in 2019.

Those are the most recent years prior to the onset of the COVID-19 pandemic in 2020.

In that first pandemic year, The Bahamas recorded 2,997 deaths.

If one were to subtract the 717 confirmed COVID deaths at the end of 2021, that would leave 2,889 non-COVID deaths — 337 deaths more than in 2018.

The number of non-COVID deaths in 2020 was 2,826; that’s 274 deaths more than the 2018 count, and 198 more than in 2019.

The increase in the number of deaths from 2018 to 2019 was 76.

It is clear, and not surprising, that COVID has had a devastating impact on our population.

And while there is no data on cause of death provided, around the world, countries have witnessed an expansion in the number of deaths during the pandemic years – a phenomenon characterized as “excess deaths”.

The Centers for Disease Control and Prevention (CDC) states that estimates of excess deaths can provide information about the burden of mortality potentially related to the COVID-19 pandemic, including deaths that are directly or indirectly attributed to COVID-19.

Excess deaths are typically defined as the difference between the observed numbers of deaths in specific time periods and expected numbers of deaths in the same time periods, the CDC notes.

Again, we don’t know in specific terms what contributed to all of the extra deaths we have experienced, but an overburdened healthcare system is no doubt a factor.

“The difference between the number of deaths in 2019 and 2021 was about 1,000. I think previously, we were seeing a difference of about 100 a year and it went up by about 10 times,” said Dr. Marcus Cooper, former president of the Medical Association of The Bahamas and current medical director of the National Health Insurance Authority.

Cooper noted that some of the deaths are not directly associated with COVID but might be attributed to the strain on the healthcare system the pandemic caused.

“What’s been happening is the healthcare system has been overwhelmed with either COVID illnesses or COVID-related illnesses and particularly in the public sector, we sort of have been ignoring those people who have non COVID illnesses – people with noncommunicable diseases.

“So, these people have been delayed and deferred in the healthcare system and many of them now are probably at a stage where they need urgent care and the healthcare system was already burdened prior to COVID and now our lack of resources is really being exposed by the numbers that we’re seeing and the inability of the hospital to accommodate these sick people.”

Last Thursday, health officials called an urgent press conference to advise that Princess Margaret Hospital (PMH) was overwhelmed with patients.

Minister of Health Dr. Michael Darville told reporters PMH was “bursting at the seams” and some patients were being transferred to the private Doctors Hospital to help alleviate the burden.

By Sunday, he said the situation was manageable and the government intended to enter an agreement with Doctors to provide continued help as needed.

We do not yet know what the cost will be.

Cooper does not see the situation improving measurably anytime soon.

“If our hospital is now in a crisis mode and our COVID deaths are probably negligible, I don’t see any reason why we should expect that it’s going to get better,” he said.

“The majority of people who are being admitted to the hospital with COVID are not being admitted with COVID symptoms. They’re coming in with other diagnoses and on testing are found to have COVID, but they’re not coming in for COVID-related pneumonia, symptoms of COVID pneumonia, shortness of breath, things like that. People are not dying from COVID.

“So, if our hospital is bursting at the seams now, I don’t see things changing very soon. I suspect, actually, that things are going to continue to get worse because we really haven’t addressed the human resource shortages, the inefficiencies of our services, particularly ambulatory services that are hospital based; we haven’t addressed those issues.”

Cooper noted that the hospital has restricted diagnostic procedures.

On June 29, PMH announced that diagnostic services of ECG, EEG and ECHO have been suspended and will only be available on emergency services.

“Persons requiring elective diagnostic service will be required to visit the hospital’s business office for further instructions and documentation to receive the service at an outsourced facility,” the hospital said.

Cooper told National Review on Monday, “These are the things that people need to get the treatment that’s going to prevent them from ending up in hospital; and if we can’t find a way to expand the services, we’re going to be in trouble for a while to come. So, no, I don’t see it getting any better.”


At the press conference at the hospital last Thursday, PMH Administrator Mary Walker was asked about the status of elective surgeries.

She noted that they remain on hold.

“With respect to the surgeries, if you think logically, if your hospital beds are occupied by persons with chronic noncommunicable diseases, you are then limited to the amount of persons you can bring in as scheduled cases to be done; and so, it’s almost like the [tail wagging the dog] kind of situation, but it doesn’t mean that persons who require emergency surgeries are not addressed; and so yes, we are still having those challenges and it’s simply because of bed occupancy and, of course, the nursing challenge,” Walker said.

Cooper said there is just no way of getting around improving human resources – a challenge he acknowledged is not easily addressed.

“I think that it’s time that we kind of focus some of our attention on improving the existing services and making services more efficient, looking at the things that are preventing people from getting into hospital, looking at the things that are causing people to have delayed discharges, so they’re taking up hospital beds which prevents people from being able to get in and seeing how we can address those issues,” he said.

“Building facilities, like I heard the minister speaking about is good, but that’s not going to improve the services we offer.

“We’re still losing nurses by the boat load because we can’t compete with the recruiters who are coming in from the US, the salaries, the bonuses, perks; and we still haven’t found a way to retain the nurses that we have. Bringing in nurses from Cuba, I think, was a good idea, but we still have some issues with filling specialized nursing care.”

Cooper also spoke to the need for an expansion of preventative care to save lives, and alleviate the strain on the healthcare system long-term.

“I think what we’re doing with NHI (National Health Insurance) is trying to improve efficiency of primary care and improve accessibility to quality primary care, and I do think that NHI is the pathway to do that, and one of the plans of NHI is to expand the services that are offered to its beneficiaries to include diagnostic tests, like x-rays and ultrasounds and scans, etc., and also to offer some cancer screening, which is something that we currently don’t offer, and we know with some of our cancers — breast cancer, we’re 5th in the world, prostate cancer we’re number 15 in the world — we have high, high rates of cancer in the country,” he said.

“So, these are things that are hopefully going to prevent people from ending up in the hospital. We need to devote some attention, some resources to addressing these issues in a primary care setting.”

In its 2022/2023 budget, the Davis administration allocated $46.2 million to the National Health Insurance Authority, up from $45 million allocated in 2021/2022.

It also allocated $10 million for catastrophic healthcare.

And $2.5 million for “health and wellness”.

Speaking during the budget debate in the House of Assembly last month, Darville said, “We believe these two line items will go a long way in addressing the country’s disease burden and will bring immediate relief to hundreds of poor Bahamians across our archipelago who have been waiting for years for catastrophic care interventions and programs to improve health and wellness.”

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Candia Dames

Candia Dames is the executive editor of The Nassau Guardian.

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