COVID-19: Health Ministry says it has always advised States to conduct death audits in their hospitals


They have also been asked to report any cases or deaths that could have been missed with a district and date-wise details so as to guide a data-driven decision-making, it says

Given the robust and statute-based Death Registration System in India, while some cases could go undetected as per the principles of infectious disease and its management, missing out on the deaths is unlikely, said the Health Ministry in a release issued on Thursday while responding to allegations about “missing COVID deaths”.

“This could also be seen in the case fatality rate, which, as on 31st December 2020, stood at 1.45% and even after an unexpected surge observed in the second wave in April-May 2021, the case fatality rate today stands at 1.34%,’’ said the Ministry.

It added, moreover, that the reporting of daily new cases and deaths in India followed a bottom-up approach, where districts report the number of cases and deaths to the State governments and to the Union Ministry on a continuous basis.

As early as May 2020, to avoid inconsistency or confusion in the number of deaths being reported, the Indian Council of Medical Research (ICMR) issued ‘Guidance for appropriate recording of COVID-19 related deaths in India’ for correct recording of all deaths by States/UTs as per ICD-10 codes recommended by the World Health Organisation for mortality coding.

The Ministry said that Health Minister Mansukh Mandaviya had refuted allegations of hiding COVID-19 deaths and said that the Central government only compiled and published data sent by the State governments.

“The Ministry has been repeatedly advising stakeholders through formal communications, multiple video conferences and through deployment of Central teams for recording of deaths in accordance with laid down guidelines. The Health Ministry has also regularly emphasised the need for a robust reporting mechanism for monitoring district-wise cases and deaths on a daily basis. States have been advised to conduct thorough audits in their hospitals and report any cases or deaths that could have been missed with a district and date-wise details so as to guide a data-driven decision-making,” it said.

The release noted that during the second wave, the entire health system was focused on effective clinical management of cases requiring medical help, and correct reporting and recording could have been compromised which was also evident in a few States such as Maharashtra, Bihar and Madhya Pradesh reconciling their number of deaths recently.

In addition to this reporting, the robustness of the statute-based Civil Registration System (CRS) ensures all the births and deaths in the country get registered. The CRS followed a process of data collection, cleaning, collating and publishing the numbers, which although was a long time-consuming process, ensured that no deaths were missed out.

The Ministry said that there had been some recent media reports alleging that India’s toll of excess deaths during the pandemic could be in millions, terming the official COVID-19 death toll as ‘vastly undercounted’.

Sero-positivity

In these news reports quoting findings from some recent studies, U.S. and European countries’ age-specific infection fatality rates had been used to calculate excess deaths in India based on the sero-positivity.

The Ministry said that the extrapolation of deaths had been done on an audacious assumption that the likelihood of any given infected person dying was the same across countries, dismissing the interplay between various direct and indirect factors such as race, ethnicity, genomic constitution of a population, previous exposure levels to other diseases and the associated immunity developed in that population.

Furthermore, the sero-prevalence studies were not only used to guide strategy and measures to further prevent the spread of infection to the vulnerable population but were also used as another basis to extrapolate deaths.

The studies also have another potential concern that the antibody titres may diminish over time, leading to underestimation of true prevalence and corresponding overestimation of Infection Fatality Rate.

Further, the reports assumed that all the excess mortality figures were COVID-91 deaths, which was not based on facts and totally fallacious. Excess mortality was a term used to describe an all-cause mortality figure and attributing these deaths to COVID-19 was completely misleading.

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