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Tuesday, September 22, 2020

As Covid-19 patient dies at home, big gaps in Telangana’s protocols come to life

The task of handling bodies of COVID cases or suspects in GHMC limits is subcontracted to a private agency. But this works primarily in cases of COVID-related deaths in hospitals. Also, there are only 20 ambulances for transporting bodies for cremation or burial, and a shortage of body handlers too is often complained about

Written by Rahul V Pisharody | Hyderabad | Updated: August 4, 2020 10:33:33 am
The municipal administration and urban development (MAUD) department of Telangana had on April 2, 2020, through a memo, constituted a committee for disposal of suspected or confirmed cases of COVID-19 bodies and issued the operational guidelines.

Suryaprakash Rao died at his residence on the outskirts of Hyderabad in the early hours of July 28. But that was just the beginning of a rather long ordeal for the family of the 82-year-old, a diabetic who had tested positive for novel coronavirus four days earlier along with his daughter-in-law and two grandchildren. His son was already undergoing treatment for the disease at a corporate hospital.

After the death was confirmed by personnel attached to the 108 ambulance services, the family members informed the local Keesara police station and the call center of Greater Hyderabad Municipal Corporation. They were then directed to officials at Nagaram municipality as the locality they resided in, they were informed by the call center executive, was now part of the municipality and not GHMC. Jurisdictional contradiction was just the beginning of it.

“We were clueless on how to go about the final rites. The municipal officer was informed, an Anganwadi worker later called and took details but no one showed up or told us what to do,” says Kadam Rakesh, a nephew of Rao. According to him, Rao had expired when the family members checked on him at around 4.30 am that day. “His oxygen levels were slowly dropping the previous day and despite attempts, we could not find a bed for him at any private hospital because of his age. We didn’t expect things to go this bad. Now I realise we should have taken him to a government facility,” regrets Rakesh, who is in the medical equipment business.

When they contacted the municipal office as advised by the call center executive, things started getting clearer. Everything that could go wrong for them had already started to go wrong. The municipal officer could not find the names and details of the five COVID positive patients in their database. This was necessary to proceed with the disposal of Rao’s body.

The task of handling bodies of COVID cases or suspects in GHMC limits is subcontracted to a private agency. But this works primarily in cases of COVID-related deaths in hospitals. Also, there are only 20 ambulances for transporting bodies for cremation or burial, and a shortage of body handlers too is often complained about. In the case of the municipality or gram panchayat, it is the local body’s responsibility to send their men and follow all safety precautions. In Rao’s case, the local body’s records did not have details of the patient.

“A couple of days after my cousin was hospitalised, four other family members presented symptoms. They got themselves tested at a private diagnostics center at Karkhana on July 24, and got their results the next day,” explains Rakesh, adding that even after four days the municipality did not have the details on their database. “No official had contacted us after test results came positive. No home isolation kits were provided,” he adds.

When contacted by indianexpress.com, the district medical and health officer (DMHO) of Medchal-Malkajgiri district, Dr. B Veeranjaneyulu, pointed out that there are nearly 7,000 active COVID-19 patients in home isolation in his district. They are provided home isolation kits for 17 days. A government doctor visits the patient on day one of quarantine to assess the medical condition and thereafter monitors their health via daily telephonic interactions. If they present serious symptoms, he said, they are shifted to either Gandhi Hospital, Telangana Institute of Medical Sciences (TIMS), or a private hospital (Mamata Medical College for the district) identified by the state government.

Coronavirus deaths, corvid patients funeral, Coronavirus patients last rites, Covid funeral photos, coronavirus India, Indian express photos, Delhi funeral photos, Funeral guidelines, Indian express The data shows that 540 persons have succumbed to the disease, and 53.87 per cent of those were deaths due to comorbidities

However, as none of these happened in the case of Suryaprakash Rao and family, and with no response from the officials, the family contacted ‘Feed The Needy’, a group of volunteers who offer as service a dignified funeral, especially for COVID-19 victims. “Knowing well that the deceased person was COVID positive, our body handlers had to wrap the body and place it in a body bag for shifting to the crematorium,” says Sai Teja, one of the 10 IT professionals behind the initiative.

“As a layman, I want to know what I should do if a COVID patient dies at home. Because there is no standard operating procedure available, who should I inform? Whose responsibility is it to ensure that the body is wrapped properly after taking all precautions?,” asks Teja. According to him, he had to request the intervention from two IPS officers to get the body cremated that evening.

“The local police asked us to get a NOC from the family as they are quarantined at home and could not accompany the body. At the crematorium, they wanted a police constable to accompany the body. They asked for communication from the municipality as well. All this trauma is apart from the exorbitant charges levied at the cremation ground,” explains Teja, who is also vice-president of NGO, Forum Against Corruption.

The municipal administration and urban development (MAUD) department of Telangana had on April 2, 2020, through a memo, constituted a committee for disposal of suspected or confirmed cases of COVID-19 bodies and issued the operational guidelines. This comprised “preparedness of government and private hospitals dealing with COVID-19 cases, and preparedness of COVID-19 dead body handling, and transport facility for shifting from hospital to the place of cremation or burial”.

The memo copy undersigned principal secretary Arvind Kumar, also explains the process of “handling of family and relatives of the deceased COVID-19 suspect or positive case, and also preparedness for burial and cremation ground in detail”. However, there has never been an order regarding the handling and disposal of the body of a deceased COVID patient at home.

What all went wrong?

The DMHO blames a possible delay in communication of report from the private diagnostic center to the health department headquarters in Hyderabad and then to the district administration and municipality. “In the case of the death of a COVID patient or suspect in the municipality’s jurisdiction, it is the responsibility of the municipality to safely dispose of the body. They should engage municipal workers and take all precautions in handling the body. In rural areas, it is the responsibility of the Gram Panchayat,” he explains.

Since in this case the municipal officials did not have details of the five patients updated in their database, as alleged by the family, the DMHO alleged that private diagnostic centers were not duly uploading or updating reports of COVID positive cases with the state, an allegation that the state health department has also raised earlier.

To answer Teja’s question on a standard protocol to be followed in home deaths, an official who is part of the MAUD’s committee for disposal of suspected/confirmed cases of COVID-19 dead bodies told [indianexpress.com](https://indianexpress.com/) on condition of anonymity that the earlier mentioned protocol applies to incidents of deaths recorded at homes, too. “Who categorises the deceased as a COVID suspect is important. If it is a physician, there is no problem and the protocol in handling the body should be followed.” Asked who should be contacted in such a case of death at home, he did not have a clear response and directs to the GHMC Helpline number 040-21-11-11-11.

“There is a fear among people that all deaths due to other ailments and prevailing morbidities are related to COVID-19. The problem (if a standard helpline number is announced) is that everyone would start calling the GHMC for disposal of bodies then,” he says.

As per government records, Telangana has 66,677 positive cases of COVID-19 as of August 1. While 18,547 are active cases, as many as 12,001 are in institutional or home isolation. The data shows that 540 persons have succumbed to the disease, and 53.87 per cent of those were deaths due to comorbidities. It is not clear if Rao’s death at home, after having tested positive for the virus, will be accounted for COVID fatalities.

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