Home / Health / As the number of cases of the virus in India increases, so are the questions about the death toll

As the number of cases of the virus in India increases, so are the questions about the death toll

NEW DELHI (AP) – When Narayan Mitra died on July 16, one day after being hospitalized for fever and respiratory distress, his name never appeared on any of the official published daily lists of those killed by the coronavirus.

Test results later revealed that Mitra had indeed been infected with COVID-19, as well as his son, Abhijit, and four other family members in Silchar, in the northeastern state of Assam, on India’s border with Bangladesh.

But Narayan Mitra is not yet considered a victim of the coronavirus. The virus was considered an “incidental”

; factor and a group of doctors decided that his death was due to a previously diagnosed neurological disorder that causes muscle weakness.

“He died from the virus, and there’s no point in lying,” Abhijit Mitra said of the discovery, which came despite national guidelines calling for states not to attribute the deaths to underlying conditions in cases where COVID-19 is been confirmed by testing.

Such exclusions could explain why India, which has recorded more than 5.1 million infections – second only to the United States – has a death toll of about 83,000 in a country of 1.3 billion people.

India’s health ministry cited this as proof of its success in fighting the pandemic and a basis for easing restrictions and reopening the economy after Prime Minister Narendra Modi ordered strict isolation of the entire population at the start of this quest. ‘year.

But experts say the numbers are misleading and India doesn’t have many deaths.

“We are underestimating the deaths for an unknown factor,” said Dr. T. Jacob John, a retired virologist.

The health ministry has gotten nervous over past allegations of insufficient death tolls, but this week declined to comment on whether states were reporting all suspected and confirmed virus deaths.

Determining exact numbers during the pandemic is difficult – countries count cases and deaths differently, and tests for the virus are not uniform, making direct comparisons misleading.

In India, mortality data recording was poor even before the pandemic struck. Of the estimated 10 million deaths each year, less than a quarter are fully documented and only a fifth of those are medically certified, according to national data.

Most Indians die at home, not in hospital, and doctors are usually not present to record the cause of death. This is most prevalent in rural areas, where the virus is spreading.

Dr Prabhat Jha, an epidemiologist at the University of Toronto who has studied deaths in India, said countries should go too far in overestimating deaths if they are to make progress in fighting the virus.

“It’s best not to have an estimate of an underestimate,” Jha said.

The Ministry of Health guidelines echo this concern by asking states to record all suspected deaths from the virus, including “presumed deaths,” those that likely died from COVID-19 but have not been tested.

But these guidelines are advisory and many states do not respect them. In Mahrashtra, India’s worst-hit state with more than 1 million cases, suspected deaths are not recorded in the tally, said Dr Archana Patil, the state’s health director.

Other states, such as Assam, have created medical groups that distinguish between “real virus deaths” and those from underlying diseases. In some cities like New Delhi or Mumbai, these panels have occasionally added lost deaths to the tally.

But Dr Anup Kumar Barman, who heads the panel in Assam, said the state doesn’t include many deaths where the virus was “incidental” and not the cause of death. In Narayan Mitra’s case, he had more symptoms than his underlying neurological disorder, Barman said.

The state of Assam was following federal guidelines and only cited the virus in those deaths due to respiratory failure, pneumonia, or blood clots, Barman added. But the guidelines list these factors as examples of how the virus can kill, and they aren’t a restrictive checklist. Barman declined to answer any subsequent questions from The Associated Press.

The state of Assam has recorded over 147,000 infections but fewer than 500 deaths as of Wednesday.

In the state of West Bengal, a similar group was sidelined in May and the state said it would later follow federal guidelines. Of the 105 deaths of those who tested positive for COVID-19 in April, the Panel found that 72, or nearly 70%, were not caused by the virus.

P.V. Ramesh, who led COVID-19 management for the state of Andhra Pradesh in southern India until July 8, said coronavirus deaths “at home, in transit or on arrival at hospitals are not counted “.

The gaps in the data also mean that India’s ability to identify peaks in natural-cause deaths in previous years is uneven. Problems with death tolling have raised concerns in countries such as South Africa.

Meanwhile, courts have criticized some states, such as Telangana, for transparency in sharing data on victims.

Additionally, federal health ministry guidelines in May advised hospitals not to conduct autopsies in suspected cases of COVID-19 to prevent exposure to the virus. Although the guidelines state that certification can be done by doctors, experts said this too led to an underestimation of deaths.

The government’s emphasis on low death tolls despite increasing numbers of reported infections has led people to think the virus was not necessarily fatal, leading to a “false sense of protection,” said Dr Anant Bhan, who researches. public health and ethics in the city of Bhopal. This has led to people letting their guard down by not taking precautions like wearing masks or keeping social distance, Bhan said.

Regional officials also felt the pressure to minimize deaths to prove the health crisis was under control, said Dr. S.P. Kalantri, director of a hospital in the rural district of Wardha, Maharashtra. There were initially “subtle suggestions” by district officials to “minimize the numbers” by listing some deaths as being caused by underlying diseases, he said.

Maharashtra state health director Archana Patil said this had initially been a problem in some districts, but officials have since been advised to report all deaths.

Cremation workers, meanwhile, have reported an increase in recipient bodies, whether due to the virus or not.

In a crematorium in Lucknow, the capital of India’s most populous state, Uttar Pradesh, worker Bhupesh Soni said 30 people were cremated every day, up from five or six before the pandemic.

A cremation normally takes about 45 minutes, but Soni said there were days he worked for more than 20 hours.

“It’s an endless stream of bodies,” he said.


Associated Press writers Biswajeet Banerjee in Lucknow, India, and Indrajit Singh in Patna, India contributed.


Follow the coverage of the AP pandemic at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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