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Wednesday, May 27, 2020

ICMR: Categorise cause of death, focus on sequence of events

Apart from outlining three categories to identify causal sequence of death for proper surveillance, the guidelines stress that the logical sequence of events must be clearly articulated in the records.

Written by Karishma Mehrotra | New Delhi | Updated: May 11, 2020 7:22:58 am
ICMR: Categorise cause of death, focus on sequence of events The immediate cause is the “disease, injury, or complication that caused the death, not the mode of dying”. (Express File Photo by Partha Paul)

In new guidelines on recording Covid-19 related deaths, the Indian Council of Medical Research (ICMR) has directed medical practitioners to list Covid-19 as an “underlying cause of death” when leading to Acute Respiratory Distress Syndrome (ARDS), cardiac injury, pneumonia and other primary causes of death.

The fresh direction, arriving as India’s Covid-19 death count surpasses 2,000 people, outlines a new standardised form where medical practitioners have to categorise the death’s immediate cause, antecedent cause, and other significant conditions in separate columns.

Apart from outlining three categories to identify causal sequence of death for proper surveillance, the guidelines stress that the logical sequence of events must be clearly articulated in the records.

“It is likely that Covid-19 is the underlying cause of death (UCOD) that lead to ARDS or Pneumonia in most of the deaths due to Covid-19 (test positive and symptoms positive). In these cases Covid-19 must be captured (under antecedent cause),” the guidelines say.

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The immediate cause is the “disease, injury, or complication that caused the death, not the mode of dying”. The antecedent cause is the morbid condition(s) that “gave rise to the immediate cause”. The other significant conditions are those that “contributed to the death but are not related to the disease or to the condition causing it”.

The guidelines state: “Patients may present with other pre-existing comorbid conditions such as chronic obstructive pulmonary disease (COPD) or asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes mellitus. These conditions increase the risk of developing respiratory infections, and may lead to complications and severe disease in a Covid-19 positive individual. These conditions are not considered as (underlying cause of death) as they have directly not caused death due to Covid-19.” The guidelines stress that only those conditions that have contributed to death should be recorded.

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In the wake of states like Delhi, Maharashtra and West Bengal deploying divergent metrics of determining Covid-19 death, the ICMR guidelines attempt to streamline mortality surveillance in the country.

“Patterns of disease and patterns of death can come from only standardised recording of clinical disease history and cause of death, and therefore epidemiological surveillance of disease and death are important. Robust data is needed from every district and state in India to measure the public health impact of Covid-19 and to plan for timely health interventions and protect communities…,” it states.

The ICMR also published guidelines for conducting COVID-19 autopsies, outlining that “deaths in hospital and under medical care due to Covid-19 is a Non-MLC (non medico legal) case and doesn’t require postmortem examination and the required certification of death is being done by treating doctors”. In case of a suspected Covid-19 death that is labelled a medico legal case by an emergency doctor, forensic autopsy may be waived.

In a final release on Sunday, ICMR announced that the National Institute of Virology has developed and validated the indigenous ELISA test for antibody detection of Covid-19. ICMR has teamed up with Zydus Cadila for mass production.

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