Coronavirus in Chile

Behind Chile’s Low Death Rate: The Battle of Alejandra Matus

Despite Chile’s Covid-19 case count growing each day, the country’s mortality rate remains at a low percentage. However, some Chilean health experts have criticized the accuracy of government-provided statistics, the lack of transparency and the fact that reporting methods change “from one day to the other.” One journalist, Alejandra Matus, has been particularly vocal in her criticism of government data, conducting her own investigation into why Chile’s reported death count is so low. Chile Today spoke with her.

It is not the first time Matus has scrutinized Chilean governmental processes; her 1999 novel El libro negro de la justicia chilena (The Black Book of Chilean Justice) investigated the Chilean judiciary’s lack of independence, and the ramifications thereof. After the book’s publication, Matus was accused of violating article 6-B of the State Security Law (inciting contempt against the state), prompting her to apply for, and receive, political asylum in the United States.

In March 2020, Matus turned her attention to her native country’s Covid-19 strategy, which she summarized as “inconsistent.” After she penned a viral twitter thread exposing ambiguous government-sanctioned protocols for listing Covid-19 as a cause of death on death certificates, Chile Today interviewed Matus to discuss her findings. 

Matus believes that such ambiguous protocols, instructed by the health minister himself, have led to a considerable undercounting of Chile’s coronavirus death toll. “It’s been really difficult to assess if the government information is accurate, complete or precise,” says Matus, adding “It’s a problem that public policy is based on those inconsistencies.” 

Private Clinics Point to Nationwide Lack of Testing Material

Throughout the interview, Matus refers to many aspects of public policy which she believes are informed by flawed data, such as methods of case counting, strategies for mapping quarantines, and policy for enforcing lockdown, but the journalist describes methods of assessing Covid-19 mortality rates as a “particularly troublesome area,” confirming that she has seen different sources of information which have not yet been made public that suggest “a much larger figure.” 

Reluctant to believe there is “anything special about Chile to cause such a low mortality rate,” she analyzed data from funeral homes, which operate separately from state authority and can therefore supply independent statistics.

Comparing Deaths Registered in March 2020 and March 2019

Her investigation began with comparing deaths registered in March 2020 to March 2019. From a source, she received data showing that March 2020 saw more than a 12 percent rise in registered deaths in Chile compared to the previous year. Data provided by Cementerio General de Santiago also revealed an 80 percent increase in deaths caused by “respiratory issues,” but only 12 percent of those were listed as Covid-19 deaths.

Her findings caught the attention of Chile’s health minister, Jaime Mañalich, who offered two explanations for the spike in deaths in March 2020. He mentioned that since the previous year, Chile had seen a one percent population increase due to migration, which would be accompanied by a rise in death rate, and he also pointed out that March 2020 had five Mondays, the day when registrars process death certificates, so an excess of Mondays in a month leads to an excess in deaths counted for that month.

Matus countered, stating that “the immigration [Chile receives] is mostly young people, and we’ve seen a decrease in young people dying in March, so the weight of the death rate is in the older population, which is consistent with Covid-19,” adding that “the population has been increasing for years but the death rate has remained stable, so this March’s excess deaths are very significant.”

In response to Mañalich’s rationale of excess Mondays, Matus said, “I reviewed data for a period of over 10 years, and there were other months of March that had five Mondays (2015 and 2010).” Over this 10-year period, the only spikes in death count were in March 2020, and March 2010, which might be a result of the excess Mondays, but is more likely to be the result of the 2010 earthquake which occurred on Feb. 27 that year, with deaths from the disaster registered on Monday, Mar. 1, 2010.

Overall, the journalist said that because of March’s position in the calendar, so long after Chilean winter, when the country usually sees more variation in death rates, “March is one of the most stable months of the year in terms of death rate,” which makes the death rate increase in March 2020 particularly conspicuous.

Assuming these excess deaths were due to Covid-19, but without any clear explanation for why those deaths were not counted as such, Matus started to examine the death certificates of people who had tested positive for Covid-19. She found an example of a patient who tested positive on Apr. 25, and who died on May 1, but her death certificate only listed “acute respiratory syndrome” and “pneumonia” as causes of death. This person was not counted as a Covid-19 fatality, but her positive Covid-19 status was handwritten on the death certificate so that the funeral home could take necessary measures against contamination. Matus does not believe her discoveries reveal “any sort of conspiracy”, but thinks “it’s just an area that lacks properly informed and followed protocol.”

Who Is Health Minister Jaime Mañalich?

The Chilean journalist does not believe such undercounting has been state-orchestrated, but she does condemn Mañalich’s death ceritificate protocols, that result in undercounting, as “ridiculous”: 

“The health minister wrote a protocol for doctors saying that they should differentiate between people who died “from” Covid-19 or died “with” Covid-19. For example in the case of someone who had cancer and got infected, they want doctors to ask, ‘did the person die from Covid-19, or did they die of cancer and happened to have the virus?'”

“Even though it’s unclear what the intention of that was, that gives a sign to doctors to only write Covid-19 [on the death certificate] when the patient doesn’t have any underlying health conditions, so you have to be totally healthy previously, get a test, and test positive to be counted, so it’s ridiculous. All those policies give confusing information to health providers and create an incentive not to write down Covid-19 deaths. So instead they’re saying, ‘well these people are dying because they’re old, these people because they were previously sick, they’re not dying from Covid-19’.”

It’s unclear if there’s any medical rationale for differentiating between patients who died from or who died with coronavirus, or if there is in fact a way of knowing exactly what killed a patient who had comorbidities, but Matus believes this policy, resulting in the undercounting of Covid-19 deaths, could be politically motivated: “It’s about trying to make Chile look good in the international community, trying to make them look like they’re doing something good or different for our mortality rate to be lower than most other countries, but it’s not true,” she argues.

The journalist also suggests that sometimes it is in the family’s best interest for Covid-19 not to be listed as the cause of death: “Insurance providers will no longer pay out for the pandemic, so if you have life insurance, the family’s incentive will be to hide [a Covid-19 death], because they risk not getting other benefits, so it’s much easier for people to deal with a simple certificate just saying pneumonia for example, because that way they can be sure they will be covered.”

Behind the low death rate, there is more to be concerned about, according to Matus. In the long run, the government’s “opaque way of managing data” should be “a concern to the medical community and researchers of all kinds,” she says.

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