Kerala not reporting ‘nearly half’ of its Covid deaths, expert panel says process ambiguous

Govt-constituted panel's report says procedure of counting Covid deaths should be in accordance with criteria prescribed by WHO, ICMR. Kerala officials say not doing anything wrong.

File photo | Kerala Chief Minister Pinarayi Vijayan | Commons

New Delhi: Early into the pandemic, Kerala won praises for effectively tackling the novel coronavirus threat. But a superspreader event in July unravelled that success. Now, a state government-constituted expert panel has told Chief Minister Pinarayi Vijayan’s administration that Kerala is undercounting Covid-19 deaths in the state, ThePrint has learnt.

According to a report submitted by the panel to the government on 10 August, the process of counting Covid deaths in Kerala is “ambiguous”, because of a change in the criteria on 20 July, when the state decided to not include patients with comorbidities in the tally. ThePrint has seen the report.

While the panel didn’t submit a figure for the deaths that have been undercounted, ThePrint spoke to a group of doctors and medical experts in Kerala who have been maintaining a death tally based on media reports and official data available in public domain.

According to them, the state is not reporting nearly half of the Covid deaths. They said the “actual” Covid toll in Kerala as of Friday morning is 345. However, the official data puts this figure at 191, against a total caseload of 52,199. This suggests the state has underreported at least 154 Covid deaths so far.

In its submissions, the 11-member expert panel, which was constituted in March, has demanded that the Vijayan government reverses its decision, and the Covid tally in Kerala must be audited again.

Asked to comment on the expert panel’s report, Principal Secretary, Health and Family Welfare, Kerala, Rajan Khobragade evaded a direct comment on the allegation of undercounting. He said “these experts” should visit him and also all the hospitals first “and then speak”.

“In fact, not just in Kerala but (they should go) all over the country to see how Covid is being managed here,” Khobragade told ThePrint.

On 4 August, Health Minister K.K. Shailaja had denied the allegation that the government is hiding data. She said the state confirms Covid deaths in accordance with the World Health Organization (WHO) guidelines. But she also said the death of Covid patients can’t always be attributed to the virus infection.

What the panel said

In its submissions, the panel said changing “the criteria for inclusion on the list of Covid-19 deaths without proper explanation at a time when the coronavirus is claiming an increasing number of people” would raise suspicion in the minds of the public and the scientific community.

“The authenticity of the official information will be questioned,” the committee said.

It pointed out that the procedure should be in accordance with the criteria prescribed by the WHO and the Indian Council of Medical Research (ICMR).

Both the agencies have recommended that deaths should be included in the Covid tally, whether the coronavirus is the first or the second leading cause of death, it said.

“People who had Covid-19 were excluded if they had other illnesses at the time of their death. It also decided to re-examine samples of those who died while undergoing treatment for Covid-19,” the report said about the state of counting in Kerala after the change in criteria.

“The test may turn negative if the death occurs three or four weeks after a person is infected with the coronavirus. Such deaths are also excluded,” it added.

“There have been cases wherein a patient has just collapsed and died. Later, the said person was found to be Covid-19 positive, yet the name was not included in the Covid death count as his/her death was attributed to heart attack or stroke. The fact that the person may have had fever and breathlessness is overlooked,” said a member of the panel, who didn’t wish to be identified.

“Covid-19 can cause myocardial and cerebral ischemia and present itself as heart attack or stroke,” said Dr Arun N.M., a consultant physician at Welcare Hospital, Ernakulam, who is part of a group of doctors in Kerala who have been compiling deaths caused due to the novel coronavirus in the state.

ThePrint reached committee chairperson Dr Iqbal Bappukunju, who is a member of the Kerala State Planning Board, for a comment. He declined to speak.

Is change in criteria affecting tally?

A senior official part of the Kerala Covid-19 task force, which administers Covid management in the state, initially denied having received any report from the expert committee. But when probed further, he said it was more of a clarification to ensure guidelines are being followed.

“We are following WHO guidelines strictly… What would a state even get out of underreporting Covid-19 deaths,” asked the official, who didn’t wish to be named.

“There are instances of non-Covid deaths in Covid-positive patients and that is within such guidelines… And maybe Covid accelerated death in some other cases of chronic illness,” he said, adding that this comes to light only after a full medical report.

What independent doctors say about tally

In a detailed Facebook post Wednesday, Dr Arun explained how the state is undercounting Covid deaths.

Almost all states in India are undercounting Covid deaths and there are many innovative ways of doing this. Official…

Arun Nm यांनी वर पोस्ट केले मंगळवार, १८ ऑगस्ट, २०२०

Speaking to ThePrint, Arun said, “We have been compiling data based on media reports on Covid-19 deaths and we included all Covid-19 positive deaths except those caused by accident or suicides.”

He pointed out that for the period between 22 July and 13 August, the Kerala government’s official figures didn’t could 36 per cent of the Covid deaths. Between 14 and 17 August, 9 per cent Covid deaths in Kerala were not counted.

He added that Covid patients who died after taking plasma therapy, were also not included in the official death tally.

“These deaths… were not included in the total because say the last swab result just before the death was negative,” he told ThePrint.

For instance, a 72-year-old auto driver who died on 12 July at the Kollam Medical College was not included in the Covid tally as he tested negative a day before his death. It later emerged that 15 of his primary contacts were positive and a total of 47 Covid cases were traced through him.

Arun said plasma therapy can help adjust antibodies but that doesn’t mean the person has completely recovered.

“Seven such people were excluded like this and four of them were given plasma therapy for Covid,” added Arun. “All dengue patients who die will have a negative antigen test, but they are counted in dengue deaths. Same is not the case here,” he said.

Dr Sulphi Noohu, the Kerala vice-president of the Indian Medical Association, said it was important that the government didn’t dilute figures as it impacts Covid management. “It is crucial that things are looked at accurately to deal with the crisis as it’s not over yet.”