8.7k ‘reconciliation deaths’ since May 1 push up fatalities in Maharashtra
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 Tuesday, for instance, Maharashtra reported a total of 661deaths. Of this, 208 occurred in the previous 48 hours and 87 in the previous week. The rest, according to the state public health department’s daily press release were deaths that occurred even earlier in various districts and corporations.
Categorisation of deaths takes timeLast year, ICMR issued guidelines based on the parameters provided by the World Health Organization (WHO) to categorise deaths into Covid and non-Covid.
Dr Avinash Supe, chairman of the state’s death audit committee, said, “Just because a patient has been diagnosed with Covid-19, it doesn’t mean that the cause of death is the infection. If a patient has severe comorbidities such as 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 as a Covid-19 death. We have to categorise such deaths by following the scientific parameters laid down by ICMR and WHO. This process often takes between six and eight days.”
All hospitals, including those in rural areas have to upload details of this on a central server.
Dr Sanjay Salunke, civil surgeon at Sangli, said most hospitals mention Covid-19 as the primary cause of death on the application -- but this is officially confirmed only after the audit team signs off.
“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 , then it is referred to the state audit committee,” he said.
The process is similar in every state, the Maharashtra doctors said.
“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.
Delay in data upgrade on centralised portalWith the outbreak of the second wave in the middle of February, hospitals were overwhelmed with a large inflow of Covid-19 patients. Many with manpower crunch were struggling to attend to patients. As a result, timely uploading of data on the centralised portal took a backseat.
“Each hospital has 1-2 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 updating,” 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 that halted the data updates. “There have been regular issues of load shedding (power cuts); many centres don’t even have fax machines,” said an officer from Wardha requesting anonymity.
The state health department has held a series of meetings with the districts to discuss delays in reporting deaths. “We have decided to form WhatsApp groups so that district-level experts can directly communicate with the higher officers if they are confused about categorisation of deaths due to underlying health complications,” said Dr Supe.