TN underreported Covid deaths in 6 TN hospitals: NGO
Deaths that are due to Covid and its complications is likely to be 8.4 times to 9.8 times more than the number of Covid-19 deaths declared by the state government in six hospitals, according to a report from Chennai-based Arappor Iyakkam -- a movement started for transparent and accountable governance.
In its report, released on Tuesday, Arappor Iyakkam analysed death data from six government hospitals in Tamil Nadu and found that the number of deaths has drastically increased in April and May, compared to the same months in the past three years, suggesting a gross underreporting of Covid-19 deaths.
“Deaths due to Covid are likely to be underreported at least 8.4 to 9.8 times in these six hospitals,” says the report.
“There is no other major disease or cause that has led to this drastic increase in deaths during this time other than Covid-19,” says Jayaram Venkatesan, founder of Arappor Iyakkam.
Tamil Nadu has reported 12,943 deaths in April and May this year (as of 13 June, some deaths from previous months are reported belatedly in health bulletins, which are accommodated in the report). “Approximating the same underreporting factor of 8.4 to 9.8 times for the entire state, the likely number of deaths due to Covid in Tamil Nadu may be between 108,721 and 126,841 against the reported number of 12,943,” the report said.
The group chose six hospitals for their analysis, Government Rajaji Hospital in Madurai, Coimbatore Medical College Hospital, Mahatma Gandhi Memorial Medical College and Hospital, Trichy, Government Vellore Medical College, Government Medical College and Hospital, Karur, Government Hospital Headquarters Tiruppur. The report said that only these six hospitals had uploaded month-wise death certificates online, and they represented all regions of Tamil Nadu. The report uses daily data for the years 2019, 2020 and 2021 from January up to May.
Death data from the six hospitals revealed that the total number of death certificates issued in April and May combined are 4,437 and 3,261 for 2019 and 2020, respectively. This has increased to 11, 699 this year.
The report found that there has been an increase of at least 8,438 deaths in April and May together compared to the same months in 2020. However, the total number of deaths of patients declared as Covid-19 victims during the same period by the daily medical bulletin of Tamil Nadu’s health department is only 863 in these six hospitals.
The second wave started in April this year and began peaking in May in Tamil Nadu. After the hotspot of Chennai saw a peak up until the third week of May, the virus hit the district and hinterlands, and cases began rising in the southern and western districts of the state. That was also the time when the Dravida Munnetra Kazhagam (DMK) won the assembly elections on May 2 and formed the government on May 7. The state went into a lockdown on May 10 and has begun opening up staggeringly from Tuesday. “The increased mortality is directly proportional to the rise of the second wave of Covid. Therefore, the increased numbers in April and May compared to previous years are most likely due to Covid and its complications,” the report said.
The analysis concluded that the number of deaths is likely due to Covid-19 and its complications in these six hospitals is likely between 7,262 and 8,438 in April and May this year. “Given that the government has consistently underreported in each of these hospitals, it could be attributed that this phenomenon exists throughout the state as well,” the report said.
The hospitals have denied that it is a case of underreporting. “We are 100% following only ICMR guidelines,” said Dr A Rathinavel, dean, Government Rajaji Hospital, Madurai. The hospital has issued 3,152 death certificates in April-May this year, out of which only 172 were declared as Covid-19 deaths. “The swab test has to be positive to be certified as a Covid-19 death.” The state health minister M Subramanian had last week reiterated this as the ICMR guideline that even if a patient is positive at the time of admission and turns negative before their death, it will not be considered a Covid-19 death. Forms 4 and 4a of the ICMR guidelines are for the treating doctors to record the underlying cause, contributing factors and immediate cause. WHO provides codes such as U07.1 for Covid deaths and U07.2 for probable Covid deaths.
In Coimbatore Medical College Hospital, 3,464 death certificates were issued in April-May this year, out of which only 323 were declared as Covid-19 deaths. “We certify a cause of death after analysing every individual patient and not by just following guidelines,” says the dean of the hospital, Dr A Nirmala. “Every day, our panel of doctors meet to analyse the death. Deaths can be due to incidental Covid, which we brand as death due to other causes. For instance, some deaths are directly due to other causes such as uncontrolled hypertension, kidney disease. While treating that cause, we have to take a swab. If it turns positive, but the patient doesn’t have Covid-19 related symptoms, it will be considered a death due to other causes. Just because the person is infected, it doesn’t mean they are dying due to Covid-19 alone.”
The report has been sent to chief minister M K Stalin and health minister Subramanian. The report asks the government to come out with death numbers at hospitals and homes compared to the previous years for the entire state. The exercise was carried out to help eligible families avail compensation announced by the government in case of Covid-19 death. The report highlighted Covid-19 patients whose cause of death was declared as other reasons such as viral pneumonia, who cannot avail compensation. “Underreporting can cause a huge problem for thousands of families who require documentation to avail compensation,” the report said. Last week, a PIL was filed with the Madras high court regarding accurate reporting of Covid-19 deaths for receiving compensation. It sought a report on the issue from the state and the union government on the case.
“We don’t have any necessity to hide Covid-19 deaths,” Subramanian said. “What are we going to achieve by underreporting? My opinion is that only if we show the true number of Covid-19 deaths, will people have a combined feeling of fear as well as awareness. We have been following ICMR set guidelines for certifying Covid-19 deaths. However, we don’t want to dismiss the report, so we are directing an investigation in these hospitals. We only want to be transparent.”