Maharashtra: 9,000 more Covid deaths added after reconciliation
Since May 1, Maharashtra has added almost 9,000 deaths from Covid-19 under the category of “reconciliation deaths”, which has pushed the total fatality to 100,000 in the state, government data shows
Since May 1, Maharashtra has added almost 9,000 deaths from Covid-19 under the category of “reconciliation deaths”, which has pushed the total fatality to 100,000 in the state, government data shows. The discrepancy that’s being corrected, though, has simply to do with delayed reporting rather than underreporting or misreporting of deaths.
Public health experts say two things can explain this. First, the time-consuming process of fact-based categorisation of deaths as Covid and non-Covid as per rules laid down by the Indian Council of Medical Research. Second, the shortage of manpower and other resources during the more infectious and deadly second wave of the pandemic that led to delays in updating data on the centralised portal.
Going by data provided by the state health department, between May 1 and June 7, as many as 22,099 deaths were recorded in the state of which 8,756 were added after reconciliation. Majority of the reconciliations have been from rural parts of the state such as Satara, Sangli, Aurangabad, Solapur, Ahmednagar, Bhandara, and Wardha.
Here’s how the numbers add up: On Wednesday, the state recorded 261 Covid deaths, and an additional 400 deaths were reconciled, pushing up the state’s case fatality rate to 1.74%. The reconciled deaths, according to the state public health department’s daily press release, were deaths that occurred even earlier in various districts and corporations.
Categorisation takes time
Last year, the Indian Council of Medical Research (ICMR) issued guidelines based on the parameters provided by World Health Organisation (WHO) to categorise deaths into Covid and non-Covid. The aim was fact-based bifurcation of fatality cases related to Covid-19 infection.
Dr Avinash Supe, chairman of the state’s death audit committee said, “Just because a patient has been diagnosed with Covid-19, doesn’t mean the cause of death is the infection. If a patient has severe comorbidities like chronic kidney disease or has recently undergone organ transplantation which has compromised the immunity, we have to check all medical reports of the patient before declaring it a Covid-19 death. We have to categorise such deaths by following the scientific parameters laid down by the ICMR and WHO. This process often takes between six-eight days.”
In rural-peripheral parts of Maharashtra, all hospitals have to send updates of Covid-19 patients on the centralised ‘Facility app’ including time of admission, reference to other hospitals and death.
Dr Sanjay Salunke, civil surgeon at Sangli, said most hospitals mention Covid-19 as the primary cause of death on the application. But it is officially confirmed only after the auditing team puts a confirmation stamp on it.
“All districts have Covid death audit committees that examine health complications or casualties that are part of the deceased patient’s medical reports before confirming the death as Covid or non-Covid. If a deceased patient had too many health complications which the district-level experts fail to categorise, then it is referred to the state audit committee,” he said.
Citing an example, Salunke said when a person meets with an accident and comes to the casualty ward, he undergoes RT-PCR test for Covid-19 as per rules. If he is found Covid-19 positive, but dies because of a head trauma, it can’t be categorised as a Covid-19 death.
“There are a few parameters that need to be checked like positive RT-PCR report, CT scan findings, inflammatory markers and upper respiratory infections. If the deceased person had severe comorbidities, we also clinically examine them,” said Dr Vishal Rakh, professor, community medicine, BYL Nair hospital.
“A death certificate has two sections, underlying and immediate. If a Covid-19 infected patient had upper respiratory syndrome, it is counted under immediate. Other comorbidities like hypertension, diabetes and kidney ailment comes under underlying,” Rakh added.
Since last year, public health experts have been regularly updating backlog death data into total fatality, and said similar exercise of death reconciliation is observed across all Indian states. “We aren’t trying to hide any deaths. We are just filtering the deaths as per the category laid down by ICMR and providing fact-based information which is more transparent,” said Dr Suryakant Gitte, civil surgeon, Beed.
Since the outbreak of the pandemic, 2,862 deaths in the state have been categorised as non-Covid deaths after reconciliation by the audit committees. Of these, 2,181 are from Mumbai followed by Wardha with 151 non-Covid deaths.
Delay in update on centralised portal
With the outbreak of the second wave, in the middle of February, hospitals got overwhelmed with a large inflow of Covid-19 patients. Many with manpower crunch were struggling to attend to patients. As a result, timely upgradation of data on the centralised portal took a backseat.
“Each hospital has one-two staff members in the monitoring cell who are responsible for updating the data. But during the peak of the pandemic, all hands were on deck. So, there have been delays in data update,” said Dr Pradeep Awate, state surveillance officer.
“This also delayed the physical documentation of the deceased patients,” he added.
Along with this, many hospitals in rural parts of Sangli, Nanded and Wardha also faced infrastructural issues. “There have been regular issues of load shedding, many centres don’t even have fax machines,” said an officer from Wardha.
The state health department have held a series of meetings with the districts to discuss the delay in reporting deaths.
“We have decided to form WhatsApp groups so that district-level experts can directly communicate with higher officers if they are confused about categorisation of deaths due to underlying health complications,” said Dr Supe.
On Sunday, Maharashtra went past the grim mark of 100,000 Covid-19 fatalities, 15 months after it recorded its first death due to the virus on March 17, 2020.
However, the overall mortality rate has gone down compared to last year. This year, the case fatality rate (CFR) is 1.2%, which was 2.3% in 2020.
Talking to HT, Dr Supe said, “In 2020, we had 19 lakh cases, now (this year) we have nearly 40 lakh cases. Nearly 50,000 deaths happened in the first year. Among the 40 lakh cases, we had an equal number of deaths. So, it is important to see that even after cases doubled, the fatalities remained the same. However, the deaths this year have come in a shorter time.”