At least 347 deaths of Covid-19 positive patients in last three months have been labelled as “non-Covid deaths” by the BMC, communication between the civic body and the state government has revealed. The 347 figure accounts for 10.6 per cent of officially recorded Covid-19 deaths in Mumbai until Wednesday.
As per Indian Council of Medical Research (ICMR), except deaths of Covid-19 positive patients due to poisoning, accident, suicide or terminal illness, all deaths have to be labelled as Covid-19 and reported to the government. The ICMR draws its guidelines from the World Health Organisation (WHO) that has simplified the procedure to mark a Covid-19 death, observing that the disease still remains complex and manifest in several ways, including acute respiratory distress syndrome and cardiac arrests.
Since March 17, when first Covid-19 death was recorded in Mumbai, eight deaths have been declared as “non-Covid deaths” or “deaths due to other causes” by BMC. Across Maharashtra, 14 such deaths have been labelled similarly.
The count of 347 more deaths in Mumbai emerged during data reconciliation procedure that the government had undertaken to have uniform figures between ICMR and its portal. A senior government official said BMC informed them that the 347 deaths have been categorised as “non-Covid”.
According to the BMC, a seven-member “death committee” scrutinised these 347 deaths and found these to have been caused by some other factor and not Covid-19. The committee included the KEM Hospital dean and senior professors from three government medical colleges in the city.
A senior health department official, who has now scrutinised the 347 cases, said at least 280 of these patients were on ventilator support when they died and were in need of oxygen, indicating classic Covid-19 condition. “We have asked all districts to declare all Covid-19 deaths to us. Those who were Covid-19 positive but died due to suicide, murder, accident, poisoning or terminal illness are then labelled separately. The BMC had not even informed us of these deaths until the reconciliation procedure found a gap,” the official added.
The reconciliation process found over 1,200 deaths unreported in Mumbai. On June 16, BMC added 862 unreported deaths to the official tally, taking the Covid-19 death rate from 3.7 to 5.2 per cent. This is much higher than the national average fatality of 2.8 per cent. It has, however, not included these 347 deaths.
Until Wednesday, Mumbai had recorded 61,587 cases, and 3,244 deaths due to Covid-19.
“We are only going by the death committee’s opinion. They informed us that these deaths occurred due to other health reasons. We have written to the state government and asked for its advice on these deaths,” said Suresh Kakani, additional municipal commissioner.
Senior BMC officials said they require a few more days to finish the reconciliation procedure. Kakani said less than 12,000 cases require reconciliation in the city. “There are about about 500 cases per ward pending. We have asked ward officers to provide each case update,” he added.
Several experts said ICMR and state guidelines make the process of Covid-19 death reporting simple, leaving no room for confusion.
Dr Avinash Supe, medical director of Hinduja Hospital in Khar, said if one dies of renal failure, and the patient is also Covid-19 positive, it would be tagged as a Covid-19 death. “This is according to rule 7.1 of the WHO, this applies to a heart patient,” he added.
Supe is the chairman of the death audit committee appointed by the Maharashtra government. He, along with seven others, audits all confirmed Covid-19 deaths in the Mumbai Metropolitan Region to advise government about intervention strategies. Before he receives a case paper, it goes through the BMC’s death committee that decides whether or not to label a death as a Covid-19 case.
A BMC death committee member said that if a terminally ill patient tests positive for Covid-19 and dies, they scrutinise the case papers and take a call on whether or not to declare it as a Covid-19 death. “In some cases, renal failure (leading to death) has been accepted as non-Covid,” the member added.
The ICMR has asked each state to report a death as a Covid-19 case even if the person has other co-morbidities such as diabetes, heart disease, asthma or chronic obstructive pulmonary disorder. “The cause of death is defined as all those diseases?, morbid conditions or abnormalities?, injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries,” the guidelines state.
Meanwhile, the BMC is in the process of reconciling all cases. Municipal teachers have also been roped in to call patients and their kin and take an update to confirm whether they have recovered, died or are actively infected. “In a day, they are calling over 1,200 patients,” a senior official said.
Each hospital has been directed to declare all its dead Covid-19 patients. A delay in reporting has been noted from mostly public hospitals that are short-staffed and overburdened.
The maximum pending death reports are from Somaiya Hospital, Sion Hospital and St George’s Hospital. On Thursday, for instance, Rajawadi Hospital shared information of 21 dead Covid-19 patients recorded over the last few weeks.
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