COVID-19 death certification does not record lack of oxygen, says epidemiologist.
The Centre’s claim in the Rajya Sabha on Tuesday that a lack of oxygen did not lead to deaths of COVID-19 patients was hollow and callous, public health experts said.
Public health expert and epidemiologist Chandrakant Lahariya said that technically no COVID-19 death would be recorded as “due to lack of oxygen,” but the experience of patients and the fact that the availability of oxygen would have saved lives meant that the Centre should have chosen its words with care.
“They will be recorded as COVID deaths and a lack of oxygen will never be noted as an immediate cause. However, oxygen is necessary for treatment and the failure of the system to provide it has to be acknowledged. The Centre’s bureaucratic response is contrary to the public experience and a more empathetic view was required. Not doing so means we run the risk of repeating mistakes,” Dr. Lahariya said.
Malini Aisola, Convener, All India Drug Action Network, described the Centre’s position as “absurd” and reflective of a refusal to acknowledge the toll of the second wave, because of colossal failures to prepare and respond. “Oxygen shortage was undeniably a direct factor in causing numerous deaths — not limited to hospitals, but even patients who became stranded in homes and were struggling to get admission in hospitals,” she told The Hindu. “There is a reality that cannot be erased from public memory — of hospitals owners making daily appeals for oxygen supplies, to media and to courts, and sharing death tolls due to oxygen running out.”
“The statement made in Parliament that there were no deaths reported by States caused by oxygen shortage is surprising and appalling. Policymakers at both the Centre and in States should not be hiding behind guidelines on death reporting which might not have included specific questions around oxygen shortage. It is well documented that oxygen stock-outs were a trigger and a key underlying reason for several deaths. We owe it to those who lost their lives to be transparent about what were proximate causes of these deaths, fix accountability, and work on ensuring that such a scenario never recurs in our health system,” said Anant Bhan, researcher, Global Health, Bioethics and Health Policy.
Minister of State for Health Bharati Pawar had said in her written response on Tuesday that States had not “specifically reported” instances of people dying due to lack of oxygen. While this is officially true, many States—and this includes both government and private hospitals—have admitted to an oxygen shortage during the second wave and hospital staff reveal a different story.
Maharashtra Health Minister Rajesh Tope on Wednesday said that there was no record in the State of any death due to shortage of oxygen during the two waves of the pandemic. “We have never said that because of shortage of oxygen a COVID-19 patient has died in any hospital in the State… There is no record of any such case, nor have I made any statement to this effect… The fatalities that have occurred were due to co-morbidities or other medical ailments.”
A Maharashtra official on condition of anonymity said, “A death due to ‘oxygen deficit’ usually occurs in cases of choking or drowning and is considered culpable homicide not amounting to murder. If one says COVID-19 patients have died in a hospital due to oxygen shortage, then it would involve a police or government probe and a case would have to be lodged.”
‘No case in TN’
Not a single person has died due to oxygen shortage in Tamil Nadu, Tamil Nadu Health Minister Ma. Subramanian claimed, while noting that the State had faced acute shortage in May when the daily requirement of oxygen shot up from 230 MT to over 500 MT.
However, a number of doctors, who were on duty during the peak of the second wave, recounted that many patients with COVID-19 waited endlessly outside hospitals due to lack of oxygen-supported beds. Doctors, who were working the wards, had a different story. “Some of them even died while waiting in ambulances,” a young doctor who worked in a zero-delay ward said.
“We had patients dying due to oxygen shortage during the crisis.Ventilators and C-PAP machines were not able to deliver the required amount of oxygen because of short supply,” said a government doctor in Chennai. Another doctor pointed out that a few patients died of hypoxic brain injuries caused by a shortfall in oxygen supply.
Vimala Thomas, Director, Telangana Institute of Medical Sciences, Gachibowli, Telangana said on May 11 that the deaths were part of natural progression of the disease and complications, and not due to shortage of oxygen.
The Uttar Pradesh government did not admit to any deaths due to scarcity of oxygen, but admitted facing shortage of oxygen in several instances. On April 18, CM Adityanath after a review meeting with senior officials instructed them to take immediate steps to ensure uninterrupted supply of medical oxygen to patients amid reports of shortage in some places.
Twelve patients, including a doctor, died at Batra Hospital, a private hospital in Delhi, on May 1 as it ran out of liquid medical oxygen and oxygen cylinders and there was no oxygen in the hospital for more than an hour. On April 23, Sir Ganga Ram Hospital, said that 25 severely ill patients had died in 24 hours in the hospital and they were facing an oxygen shortage.
(With inputs from bureaus)