Why states/UTs didn’t report Covid deaths due to lack of O2 despite ‘oxygen shortage’ crisis

As the second Covid wave ravaged India, shortage of oxygen emerged as a major crisis. But Union govt told Parliament that ‘no state/UT had reported death due to oxygen shortage’.

Representational image | Suraj Singh Bisht | ThePrint

New Delhi: Days after the central government triggered a row by saying “no state or union territory had reported any death due to oxygen shortage during the second wave of Covid-19 pandemic”, Delhi-based doctors told ThePrint that many patients had died because of the crisis situation surrounding the gas.

However, the controversy surrounding the government’s statement — made in Parliament last week — seems to stem from the way deaths are officially recorded. Doctors in the national capital told ThePrint that even when lack of oxygen is the underlying trigger, it is the reaction it brings about — for example, cardiac arrest — that is recorded as the fatality cause on a patient’s death certificate. 

As the second Covid wave ravaged India earlier this year, the shortage of oxygen — a crucial resource for patients as the novel coronavirus is known to target the lungs — emerged as a major crisis around the country.

There were multiple reports of patients left gasping for breath, even dying, after being turned away by hospitals. Medical facilities often asked patients’ caretakers to arrange oxygen cylinders on their own, and discharged or transferred patients amid the shortage.

In Delhi, two hospitals — Batra Hospital and Jaipur Golden — reported mass casualties after they reportedly ran out of oxygen. Similar reports also came in from other parts of the country, including Karnataka. 

While the hospitals insist the deaths occurred because of an oxygen shortage, the Delhi government’s attempts to get a conclusive answer haven’t yielded a result yet. 

In May, the Delhi government formed a panel to investigate all deaths attributed to oxygen shortage. 

However, in June, the Arvind Kejriwal-led Aam Aadmi Party (AAP) administration announced that the central government had rejected the proposal for the committee’s formation.

Earlier, based on the conclusion of another panel, set up on the order of the Delhi High Court, the UT administration had told the court that oxygen shortage could not be ascertained as the cause of death in the Jaipur Golden Hospital case. 

Even so, the Delhi government said this month that it was a preliminary report that would have been investigated in detail if the first panel mentioned above hadn’t been scrapped.

ThePrint reached Dr Manisha Verma, the Additional Director General for media and communications in the Union health ministry, through calls and messages, but there was no response by the time of publishing this report. An email sent Saturday to the official ID of the health ministry did not elicit a reply either. 

In a statement issued Thursday, the Union health ministry clarified that it has “always advised states to conduct death audits in their hospitals and also report any cases or deaths that could have been missed”. “India has a robust system of recording Covid-19 deaths,” it said.

Those difficult days

Dr S.C.L. Gupta, medical director of Batra Hospital, told ThePrint of a haunting memory from the days of the second wave peak. 

“I still remember family members of patients telling us that had we let them know in time, they would have arranged the oxygen on their own. But the fact is the oxygen wasn’t coming from the sky, it had to come from the state,” he said. “If it were to come from the sky, we could have also got it. The hospital ran out of its reserve stock of oxygen as well.” 

Dr B.L. Sherwal, medical director at the Rajiv Gandhi Super Speciality Hospital (RGSSH) who also oversees operations at a few other government hospitals, said that to believe no deaths took place due to oxygen shortage was like living in a state of denial.

“We had to discharge patients due to limited stock of oxygen,” he said, adding that the hospital discharged 150 patients on 21 and 23 April, the days the facility experienced “the maximum amount of shortage of oxygen”. 

The hospital, Dr Sherwal said, tried to guide these patients on where they could go next, barring those who were in a condition to go home. 

Dr Dhiraj (who goes by one name), the medical superintendent of Saroj Super Speciality Hospital, which suffered times when its “oxygen supply completely ran out”, called for an inquiry. 

“While I understand it is a difficult task to establish that deaths occurred particularly due to oxygen shortage, one cannot overlook that the shortage contributed to the increasing number of deaths in the second wave,” he said. 

Dr K. Baluja, medical director of Jaipur Golden Hospital, did not respond to ThePrint’s calls or messages.

‘No formal process’

Since health is a state subject, the recording of a Covid death follows this chain: The hospital notifies the state/UT, which then informs the central government that puts the data together. 

Dr Sherwal said there “is no formal process that is followed to report a death caused due to oxygen shortage”. 

“However, say a Covid patient who faces this dies of cardiac arrest… that is something one states [on the death certificate]. In other cases, perhaps the blood pressure suddenly dropped or shot up, so shortage of oxygen can add to this, but one can’t state this in a death certificate.”

Talking about the process of notifying deaths, he said, during the first wave last year, Delhi hospitals submitted details of Covid fatalities to an audit committee that subsequently became defunct. 

“Then, we have been uploading the details of Covid deaths on the Delhi government portal, after which the state forwards it to the Union government as per protocol,” he added. 

Dr Gupta added: “Since there has been no protocol to mention deaths caused due to oxygen shortage specifically, we haven’t been able to state that, because at the end of the day, that patient was also a Covid patient,” he said. 

If a Covid patient died of a cardiac arrest, for example, the cause of death would be stated as “cardiac arrest in Covid patient”, he added.

Dr Gupta said he would be more than willing to share these specific details if the government seeks them. 

“Everyone is aware that this entire narrative around oxygen shortage has become a political blame game, with deaths caused due to it being debated,” Dr Gupta said.

Weighing in on the ongoing row, Sherwal added that one could not blame either the Delhi government or the Centre. Neither did the Centre seek specific details on deaths caused due to shortage of oxygen, nor did the UT provide any such specific details, he added. “But at the same time, people witnessed it for themselves… deaths due to limited reserve of oxygen across the national capital,” he said.

ThePrint reached AAP chief media coordinator Vikas Yogi and party spokesperson Jasmin Shah by calls for a comment on this report, but no response was received till the time of publishing. In a statement made on 21 July, Delhi Health Minister Satyendar Jain said there had been many deaths due to oxygen shortage in the national capital and accused the Centre of “rubbing salt into wounds”. 

“We formed an audit committee for oxygen to provide compensation to victims, which was dissolved by the Centre through the Lieutenant Governor. If the committee had been there, then the exact data would have been found. We will appeal to the L-G to allow us to run the committee,” Jain said.

(Edited by Sunanda Ranjan)