Coronavirus Part 33, 'Chokehold' and Augmenting Record Keeping

              There has been a drop in the covid-19 cases in the country in the last week as well. The weekly average number of cases has fallen to 1.3 lakh from 2 lakh which indicates a good progress in the fight against the pandemic. Exactly a month ago, the total number of cases registered in a day saw the highest number of 4.14 lakh on May 6^th. A month later, this has been reduced to a quarter of it – around 1 lakh. The entire national resources and those from foreign nations are also being deployed to tackle the virus. These measures taken seem to have bearing fruit since the past 3-4 weeks, as the cases have been reducing daily and we are back to the levels of pre-second wave. To consolidate the gains and to bring down the number further, it is advisable to continue the status quo as far as lockdown is concerned in the country. Since this strategy is working, a few more days of curfew in prevalence areas will do more good than not.

              One of the main reasons of the death due to corona virus in the country is because the infected people are unable to breathe oxygen. There are more than 650 such deaths reported in news outlets across the country. The number which is unaccounted should be far greater than this. These two months of April and May has seen people scrambling for oxygen as they have been put under a chokehold by this virus. People fall under this chokehold for few reasons: 1. It has been symbolically portrayed of the restraint this virus has on humanity 2. They are unable to breath because of the extraordinary circumstances prevalent in the air around us.

               If it can be remembered, exactly a year ago on 25^th May, George Floyd died due to a chokehold, during which he uttered the dreaded words – ‘I can’t breathe’. His death spread like a wildfire and erupted protests across the western world. ‘I can’t breathe’ has become a rallying cry among the protesters. It is the west which experienced the breathlessness last year and it is India which couldn’t breathe this year. All the major countries supplied India with everything connected to oxygen – liquid form of oxygen, cryogenic tankers, oxygen concentrators etc which the country needed the most to breathe normally again. More than 42 countries pitched in and India has received more than 100000 oxygen cylinders. This oxygen induced nightmare is never heard before in the country. The country has ramped up the production of oxygen by many MTs on a war-footing and equipped the hospitals with required supplies. After everything required is done, finally, the dreaded night mare of people struggling due to the virus-induced chokehold is beyond us. But this entire episode should be remembered and acted upon quickly in the future to save lives of people who can’t breathe.

                While 650 deaths reported due to shortage of oxygen is a conservative estimate, there is no real data of the correct number succumbed due to this condition. Likewise, there is no correct count of the number of people who died due to covid-19 in the second wave. The number of people who died from the beginning is pegged at 3.47 lakh as of today. But the second wave, which wreaked havoc across the country, is also becoming a reason for the underreporting of deaths. It has been alleged that there are grave discrepancies in the official death statistics reported by the government. Field visits made by journalists and interviews with crematorium staff, hospital staff and local government officials suggest that covid-19 deaths are being substantially underreported in many states.

               There are two reasons which have been ascribed to this limited reporting on this important statistic. 1. Deaths in India are not medically certified 2. Most of the people died are not tested covid-positive. With regards to the first point, The Indian Registration of Births and Deaths Act of 1969 mandates that all births and deaths be registered within 21 days of occurrence. Institutional deaths or deaths that occur inside a hospital are directly reported to government authorities by the facility, and non-institutional deaths which occur outside a health institution are required to be reported by family members of the deceased.

                At the time of registration, a Medical Certification of Cause of Death (MCCD) issued by a medical practitioner is required to be submitted to the concerned municipality. The certificate declares the immediate, antecedent, and underlying causes for death, and is, therefore, critical in the record-keeping of deaths in India.

                 However, the empirical data shows that only 21.1% of deaths registered are medically certified. Moreover, this number has been on the decline since 2016 with states such as Uttar Pradesh and Jharkhand certifying less than 5% of deaths registered. When it is not certified medically, the classification cannot happen as belong to covid-19. Therefore, data indicates that systemic failures in record-keeping could hinder the accurate reporting of covid-19 deaths unless carefully monitored by state health departments.

                 Coming to the second point, the guidelines for recording COVID-19 deaths in India have been issued by ICMR and the Centre for Disease Informatics and Research in adherence with the World Health Organization. A death is accounted for as a covid death if the deceased tested positive for the virus, irrespective of whether they were symptomatic or asymptomatic. There are, however, deaths associated with suspected, probable and not-tested cases. In the first two cases, if the deceased is tested negative with covid-symptoms, it is not counted under correct category.

                 If people die without getting tested for covid-19, their deaths are not recorded as covid deaths, causing the true number of deaths to be underreported. In order to derive the true cost of covid-19 on the lives of Indians, the government must undertake strict measures to correctly arrive at death data. This gross underreporting does no one any good except portraying a false figure as the correct data. This important statistic need to be correctly derived from all legitimate data sources and appropriate relief or aid has to be disbursed to the really needy people who lost vital resources of their family due to this pandemic. Without having the data, the government is helpless. I mentioned about it already in one of my earlier posts on migrant labour and repeating the same once again.

                 If the country doesn’t account for its citizens, who will monitor them and provide them with the relief needed. The government does not have correct data on unorganised, migrant labourers. The government does not have correct data on covid-19 deaths across the country.  When lakhs of our own men and women are suffering due to the covid-19, the government is helpless in helping them due to the bad practises of record keeping.