True death toll of COVID-19 in Georgia: estimates of the number of deaths from COVID-19

Abstract Problem Georgia, in terms of Covid-19 attributed mortality, ranks 8th in the World. Description In Georgia, there are no routinely conducted autopsies of the deceased. The identification of causes of death is based on the physician’s clinical decision. Absence of autopsies, lack of experience with Covid-19, are key issues of Covid-19 death certification. Considering COVID-19 as a primary cause of death led to over-reporting of COVID mortality among patients with severe comorbidities. This affects the identification of underlying cause of death (UCOD) and leads to misclassifications. Results 2021 mortal cases with Covid-19 as the UCOD, were analyzed. Cases were grouped by the interval between testing and death: <1 day - 170 cases (1.5%), 2-44 days - 9468 cases (83.5%), 45+ days - 1694 cases (15%). The group of cases with time intervals of 2-44 days, was sub-grouped according to causes mentioned in death certificates: A - only U07 is indicated, B - U07&any chain-of-event condition (pneumonia, respiratory distress, respiratory failure, etc.), C - U07& 1 or more significant contributing conditions (diabetes, stroke, etc.). According to the analysis in the group, 2-44 days distribution was: A - 6%; B - 81%; C - 13%. U07 cases in groups A and C without any respiratory conditions mentioned were defined as ‘unlikely’ COVID-19 death (19% of total). From groups with time intervals of < 1 and 45+ days (1864) 72 cases were randomly selected for in-depth analysis by a panel of experts, using additional medical records. Out of these cases, the panel of experts considered 80%, as ‘non-COVID-19’ deaths. Lessons If ‘unlikely’ and ‘non-COVID-19’ deaths aren't counted, the number of deaths is reduced by 29.5%. Lack of duration of a disease represents a limitation. A similar revision of all/2-44 day’s interval COVID-19-related deaths is required to get a real number. Conduction of a verbal autopsy is necessary. Training on coding causes of death and existing regulations is important. Key messages • There is an over-registration of COVID-19 as a UCOD. • The lack of knowledge of death certification of cases with severe comorbidities and accidents leads to over estimates.


Background:
The demographic picture in Bulgaria became worse and worse since the democratic changes at the end of the 20th century. Our country was at one of the first positions according to the level of death rate and the rate of population decline. The study aims to analyse the effect of the COVID-19 pandemic on the main demographic indicators in Bulgaria.

Methods:
Data from Bulgarian National Statistical Institute were used to analyse population growth and life expectancy and to calculate the death rate, birth rate, infant mortality rate, and the share of people over 65 years of age for 2019 in comparison with 2021.

Results:
In 2019 before the onset of COVID-19, the Bulgarian population consists of 6 951 481 people. In 2021 it declines to 6 838 937 people. The decrease in birth rate is not very significant -from 8.9ø /2019/ to 8.5ø /2021/. The analysis provides estimates of excess deaths observed during the peak of the COVID-19 outbreak in Bulgaria. The death rate is very much increased -from 15.5ø to 21.7ø. The increase affects the female and male populations equally -from 19.6ø for men in 2019 to 23.2ø in 2021 and from 16.4ø for women to 20.2ø. The life expectancy shows a certain decrease -from 74.8 years /2019/ to 74.64 /2021/. Correspondingly, life expectancy was reduced for females-by 78.34 -78.22 and for males by 71.37 -71.11 years. The level of infant mortality is not changed -5.6ø. People over 65 years are 21.6% of the total population during the compared period.

Conclusions:
The Bulgarian population is very strongly affected by COVID -19 pandemic. The COVID-19 pandemic has caused a significant number of deaths worldwide but Bulgaria ranks first in the world in terms of mortality rates. Life expectancy decline reflects the impact of temporary epidemic mortality. The impact on children from the pandemic is not very significant for the country. Society should be making major and cost-effective efforts to reduce mortality.

Key messages:
The sharp change in demographic realities has significant effects on the country's economy. The deterioration of natural growth exacerbates the need to increase labour productivity in areas with the fastest declining populations.
Abstract citation ID: ckac131.064 Impact of COVID-19 on the essential healthcare services at primary healthcare level

Background:
The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low-and middleincome countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia.

Methods:
We applied a conventional qualitative study design using semistructured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases.
iii438 European Journal of Public Health, Volume 32 Supplement 3, 2022