Bagged but not counted: the under-reporting of COVID-19 deaths in TN

On Wednesday, the Government Dharmapuri Medical College Hospital administration was on a fire-fighting mode, combating off queries on “rumours of 47 COVID deaths on a single day on Tuesday at the hospital.”

It began off with an unverifiable WhatsApp message that was subsequently denied by the hospital administration. “Take it as false information. Only 7 deaths are due to [COVID-19] positivity. The remaining include those admitted with symptoms, and swab negative patients suffering from complications as “sequel to COVID-19”,” mentioned Dean of the hospital K. Amudavalli. “Those numbers are for 36 hours and not 12 hours, and include symptomatic patients, who need oxygen, with co-morbidities, they are all sequel to COVID-19,” mentioned the Dean.

Similarly, at the Krishnagiri authorities medical school hospital, 23 deaths had been recorded on Friday, but solely 3 had been recorded as COVID-19 deaths. Nine different our bodies, nonetheless, had been bagged for potential positivity as a precaution. “The virus remains for a maximum of 10 days, but the patient may develop other complications, persistent and COVID-19 related, and may not get discharged. That death after an RT-PCR negative test is not documented as COVID-19 as per the Indian Council of Medical Research (ICMR) protocol,” echoes N. Muthuselvan, dean of the Krishnagiri hospital.

This has signalled gross under-counting and under-reporting by authorities hospitals right here as half of following ICMR protocol. To be clear, swab negativity at the time of fatality, days or perhaps weeks after testing constructive will not discover its approach into the State bulletin, say the deans of the two authorities medical school hospitals right here.

“The person might test negative after 5 days at the hospital, but the virus would have damaged the lungs causing infection for two weeks or two months — this “sequel to COVID-19” will not be counted as a COVID-19 dying, as a result of the ICMR guideline says so,” says Dr. Amuthavalli.

Government hospitals have selectively taken cowl below the WHO dying coding classification, reiterated by the ICMR Cause of Death (COD) guide for COVID 19. Under this, COVID-19 is documented as the underlying trigger of dying (UCOD) when an RT-PCR take a look at is constructive – with or with out typical COVID-19 signs, when current with co-morbid signs (bronchial asthma, coronary heart illness, sort 1 diabetes). The dying is recorded as such with a special code, when the take a look at is unfavourable – but medical COVID-19 signs are current; as Probable COVID 19, when take a look at is inconclusive, but signs current; or as Suspected COVID 19, when take a look at result’s awaited, but signs current.

But authorities hospitals listed here are recording solely instances of deaths, with COVID-19 positivity at the time of dying. “Incidental COVID-19 is not taken as COVID – someone may have hypertension, diabetes or other co-morbidities and when we test for COVID-19, they may test positive. The presentation is that of a disease, but not of COVID-19,” says N. Muthuselvan, Dean of Krishnagiri authorities medical school hospital.

But there’s the catch. The second protocol of ICMR –COD guide highlights positivity with signs introduced as co-morbid situations atypical of COVID-19 signs, to be documented as COVID as UCOD.

What authorities hospitals cite as “COVID sequel” or “incidental COVID” is the sequence of occasions from the onset of the illness (COVID 19) main upto the dying of the affected person, talked about by the ICMR in its COD guide, but selectively ignored by the authorities hospitals for documenting dying.

“We have been told orally in the meeting that only deaths within 10 days of admissions will be taken as COVID-19 deaths. But this is wrong because, once community transmission has started in a pandemic, every death should be counted as a pandemic death, as per international standards,” says a medical officer in Krishnagiri. It goes on the assumption that the virus is identifiable just for 10 days, any harm accomplished by the virus after the individual testing unfavourable is not counted as a COVID-19 dying.

But, the ICMR guide nowhere states that the UCOD needs to be documented to COVID-19 provided that it happens inside a particular time of an infection. It additionally particulars the recording of time between the onset of illness and dying – which can be “hours, days, weeks or even years.”

“Of course there is -. We don’t even count SARI deaths (Severe Acute Respiratory Syndrome) as COVID-19 deaths,” says the medical officer. “For instance, a patient with breathlessness would rush only to the government hospital not a PHC (primary health centre). At the GH, we won’t spend time in collecting swabs from the patient, but start treating for SARI. When the patient dies, it is treated as a SARI death but not a COVID-19 death. It may be COVID-19, but since the swab is not collected, it is not counted,” says the medical officer. “The patient is handled, treated as per COVID-19 protocols, the body bagged as per COVID-19 protocols – only that the death is not counted.”

“To say, a person tested negative but subsequently died of lung infection due to COVID-19 (but the death is unrecorded), is not just disingenuous but fraud,” says T. Sundararaman, former Convenor of Jan Swasthya Abhiyan.

Tamil Nadu has had report of transparency in the first section and if that is taking place now, it’s tragic, he provides. “These are innovations made locally to hide deaths. There is an international standard in COVID 19 death recording. It is not up to them to bring local innovations like new nomenclature. Nobody dies of diabetes unless there is COVID-19. At least, they should be reported as a separate category of reporting. This sort of obfuscation will not just lead to un-recording of mortality, it will lead to an actual rise in mortality,” he says.