A massive data reconciliation exercise in Maharashtra has found that at least 1,328 deaths of Covid-19 positive patients went unreported across the state. Of them 862 are Covid-19 deaths in Mumbai, which the Brihanmumbai Municipal Corporation (BMC) had not reported.
While the unreported deaths have led to the Opposition questioning the intent of the government and whether “it is an attempt to hide facts”, top state officials have insisted that they will remain transparent, and report all deaths once the final figures are matched.
The reconciliation process is long drawn-out, and will continue for the 1.10 lakh cases Maharashtra has recorded. But until Tuesday 1,328 deaths had been updated officially to Covid deaths, taking the state’s toll from the pandemic to 5,537.
As a result of the updating, the death rate has now jumped from 3.7 per cent to 4.8 per cent.
Once a patient dies, the process to confirm a Covid-19 death may take several days. There can be various reasons for a Covid death to go unreported.
The process of reporting cases in Mumbai
Once a Covid-19 positive patient dies in a hospital, the hospital is supposed to upload the information within 48 hours, and send an e-mail to BMC’s epidemiology cell. “We try to report at the earliest. The information on death is important to convey at once to police and to the BMC,” Dr V Ravishankar, chief operating officer at Lilavati hospital, said.
Once the information has been uploaded, the medical documents of the patient are provided to the BMC. These documents — the patient’s case history, contact history, co-morbidities, and details of treatment — go to a seven-member death committee set up by the BMC. The death committee meets daily, or sometimes twice a week, depending on the number of pending cases.
“We go through all medical papers, check what other ailments the patient has, and then confirm whether the death was caused due to Covid-19,” a committee member said. This information is relayed to the BMC epidemiology cell. Data entry operators with the epid cell are supposed to upload each patient’s details in what is called a ‘line list’.
A line list is like an Excel sheet that has all Covid-19-related details of a patient — name, address, date of report, district, and the outcome. The ‘outcome’ means the present status of the patient, which could be ‘recovered’, ‘still infected’, ‘hospitalised’, or dead.
Each patient’s details have to be manually fed by data entry operators on a centralised portal. In other districts, a death committee may or may not be present. If there is no committee, a hospital directly informs district health office which reports that case on portal.
How the process evolved as cases surged
At the beginning of the pandemic a trial-and-error method was adopted to report cases and deaths. The reporting process changed several times until May, when the central government brought in an online portal called CV Analytics, which is now the source of the final figures on Covid-19 cases and deaths.
In the early days, when the caseload was small, each case was manually reported by each district to the state government. In March, Mumbai had just two laboratories. Across state there were four. The process of reporting was simple and easy, fewer than a dozen cases were getting diagnosed every day, and it was only once in a few days that a death occurred. The information was updated in real time.
The state reported to the National Centre for Disease control (NCDC), and labs reported to the Indian Council of Medical Research (ICMR). But then, differences started emerging in the tally of the two organisations.
In April, the surge in cases began. The number of labs was increased, and private laboratories started testing. Private hospitals too, started admitting Covid-19 patients. The central government asked all states to report on an NIC portal linked with the ICMR portal to have one source of information. “But there were several technical issues and data was not getting uploaded on their portal,” a state health official said. In May, after the CV Analytics portal was introduced, all states were asked to feed data on it. This also meant shifting existing data to CV Analytics.
The exercise in reconciliation of numbers
Since May, there has been a mismatch in Covid-19 cases and deaths that have been reported by districts to the state government, and the final figures uploaded on the ICMR portal through CV Analytics.
“We have asked each district multiple times to reconcile the data. There was a mismatch possibly due to duplication in patient names. Mumbai remained the only district that had not performed data reconciliation. Every day its reported cases, and the cases private labs reported to us differed,” a state health official said.
So the state began a reconciliation exercise to have uniform reported figures. By June 6, when the exercise was over, state officials found that the ‘outcome’ — that is, recovered, still infected, or dead — for 451 patients had not been updated in the line list of Mumbai. An inquiry showed that all these people belonged to Mumbai, that they had died, but had not been included in the official tally. It slowly emerged that there were more deaths across Maharashtra, apart from Mumbai, that had ‘unreported deaths’.
Last week, a meeting was held between the state and the BMC to discuss the “discrepancy”. Officials present at the meeting asked the BMC “to come clean”, but BMC officials insisted on reporting these deaths in a staggered manner in order to avoid spreading panic in the public.
On June 11, Maharashtra Health Secretary Dr Pradeep Vyas wrote to all districts to reconcile each patient’s case details and upload the data. The deadline to finish this exercise was 5 pm on June 15. It will take a few days to process this data.
As of Tuesday, based on updated data that all districts had fed into the system, 1,328 deaths were found to have gone unreported. Mumbai’s unreported figures rose to 862.
After Mumbai, Thane has 146 unreported deaths, Pune 85, Solapur 51, Aurangabad 33, Jalgaon 34, Nashik 28, Akola 14, Raigad 14, Dhule 12, and Palghar 11. Fourteen other districts have unreported deaths in single digits.
Maharashtra’s death toll touched 5,537 on Tuesday. As the process of reconciliation continues, more unreported deaths are expected to emerge. Maharashtra currently has 1.13 lakh cases. Chief Secretary Ajoy Mehta has stated that once this exercise is over, the updated death and case numbers will be publicly shared. Health secretary Dr Pradeep Vyas told The Indian Express, “We have no intention to hide deaths.”
But what could be the reasons for the unreported deaths?
It could be just a lack of resources, and the staff having more dumped on their plate than they could chew through.
State epidemiologist Dr Pradeep Awate had said that the huge case load can lead to human errors and delays in reporting figures. He has insisted it was possible that deaths, which took place between April and now, were not reported due to the lack of data entry operators and the huge workload.
But several public health experts and Opposition leaders have alleged that it is possible the BMC attempted to hide the huge death toll in order to statistically bring down the fatality rate.
In the last two months, several complaints have emerged where the death certificates of Covid-19 positive patients have listed ‘natural death’ as the primary cause of death. MLA Rais Shaikh has said that several patients have died outside hospitals for the want of hospital beds. “In some cases we will never know whether it was a Covid-19 death, as no swabs were taken,” he said.
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Leader of Opposition Devendra Fadnavis has said this was “a clear attempt to hide facts”, and demanded that Maharashtra follow the ICMR protocol and report all Covid-19 deaths officially.
As per ICMR guidelines, the deaths of all Covid-19 patients will be labelled as a Covid-19 death, unless the patient has succumbed to an accident, terminal illness, suicide, or poisoning.
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