India has seen a surge in the number of COVID-19 deaths reported by the Union Health Ministry in recent days after Kerala started including previously undeclared deaths in its tally.
For instance, of the 585 COVID-19 deaths recorded in the past 24 hours across the country, 482 were from Kerala, the Union Health Ministry release said.
Of the 482 deaths, 90 were reported in the last few days, 341 had not been confirmed until June 18 last year due to lack of documentation, and 51 were designated as COVID-19 deaths after appeals based on the Centre’s new guidelines and the Supreme Court’s directions, a Kerala government release said.
7,000 ‘missing’ deaths
On October 8, Kerala Health Minister Veena George had announced in the state assembly that the State government would be adding about 7,000 more deaths, which occurred in the state from the beginning of the pandemic last year to mid-June 2021 and which had been ‘missing,’ to the current list of deaths due to the absence of various certificates and other technical issues.
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The government said that the unaccounted deaths occurred before hospitals started uploading data on deaths online in June this year. Thus, the State government said, it is now releasing disaggregated data on the new deaths being reported daily along with the backlog of deaths added to the total between March 2020 and June 2021.
Since June 15, the Kerala government has had an online, real-time death reporting system in place in which all deaths are entered directly. Earlier, COVID-19 deaths in Kerala were certified by the State-level audit committee, which took a decision based on a report from districts.
Excluding co-morbidities, questionable testing strategy
The Pinarayi Vijayan-led State government had been under fire from Opposition parties and some public health experts for allegedly eliminating many COVID-19 deaths from its official numbers. But the government insisted that Indian Council of Medical Research (ICMR) guidelines were being followed and refuted the charges.
The government is accused of excluding the deaths of people who had co-morbidities and the deaths of people who had tested negative for COVID-19 at the time of death.
Many experts, say reports, felt that the testing strategy in Kerala had been designed to reduce the number of deaths. Patients who tested positive and had moderate symptoms or were asymptomatic were not tested again before they were discharged. But for critical patients, there was a repeat of the antigen test to ascertain whether they had turned negative.
Thus, when patients in a critical condition died, their deaths would not be reported as COVID-19 deaths if the tests had returned a negative result, the experts said.
Kerala-based public health expert Dr NM Arun had said that the State had dropped at least 1,600 deaths in the first wave of COVID-19.
“The repeated test of critical patients is also meant to drop COVID-19 as the cause of death from the list,” Dr Arun was quoted as saying in an Indian Express report.
Modified guidelines
The demand to review the COVID-19 death tally, however, gained momentum after the Supreme Court directed the National Disaster Management Authority to recommend guidelines for ex-gratia payment to family members of those who had lost their lives during the pandemic.
“The deaths are being incorporated as per the Honourable Supreme Court’s instructions and new guidelines issued by the Union Health Ministry. All States have to do this. We have a transparent online system in place for appeals and requests,” Dr Rajan Khobragade, Principal Secretary (Health), Kerala, told Moneycontrol.
After the SC verdict, the Centre changed the guidelines to include all those who died at home or hospital within 30 days of testing positive for the coronavirus infection in the list of COVID-19 deaths. Similarly, those who remained hospitalised beyond 30 days for COVID-19 treatment, and died subsequently, too are to be included in the list.
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A few other States, including Maharashtra, Bihar and Uttarakhand, have also been making statistical corrections to incorporate previously uncounted deaths.
The Kerala government had on September 30 issued revised guidelines to determine if COVID-19 had caused a death, based on ICMR and Union Health Ministry directives, as originally advised by the Supreme Court.
“The guidelines are meant to benefit all those who are eligible. COVID-19 death certificates will be issued to the family members without any hassles,” minister George had written in a Facebook post.
The revised death figures will reverse the low mortality rate of Kerala, something that the State government has highlighted as a major feat in its battle against COVID-19.
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