COVID-19 deaths may be more than what’s reported: WHO

Is Delhi govt not counting deaths caused due to comorbidities as COVID-19 deaths?

By Banjot Kaur
Published: Thursday 11 June 2020

The death toll from the novel coronavirus disease (COVID-19) may actually be more than what is currently being reported, according to the World Health Organisation (WHO).

If countries went back to their COVID-19 medical records, there will be changes in the number of deaths, said Maria Van Kerkhove, WHO’s technical lead on COVID-19, replying to a query about deaths in Russia, on June 10, 2020.

“It has happened in the past with countries revising death numbers. We should recognise that a large number of deaths may be revised if it were to happen again,” she said.

Russia has fewer deaths (6,358), compared to the number of positive cases (493,000), something that has surprised experts across the world. The United Kingdom, by contrast, has 41,000 deaths and 290,000 cases, while Italy has 34,000 deaths and a little over 253,000 cases.

Kerkhove said this was not just about any one country: It applied to other countries too, once they decide to review medical records after they pass through high-intensity transmissions.

“So, we expect to see increased numbers in several countries,” Kerkhove added.

In Russia, a death is not classified as one resulting from COVID-19 if the patient had the disease, but also had other underlying health conditions (comorbidities).

A Russian reporter asked if this aligned with WHO guidelines at a virtual press conference.

Many countries counted COVID-19 deaths in real-time without taking comorbidities into consideration, something that may cause over-estimation of deaths, replied Michael Ryan, the executive director of WHO’s Health Emergencies Programme.

“So far, as standardisation of deaths is concerned, it is a complicated process. It is difficult to say what the primary cause of death is and what other factors contribute to it. It can be interpreted in different ways,” Ryan said, skirting the issue of whether Russia followed standard practise or not.

He, however, said low death rates in Russia were difficult to understand.

“Death numbers in Russia are unusual. Neither the age profile nor the pattern of underlying conditions in Russian population is much different than that of other European countries (which witnessed heavy death toll compared to Russia),” Ryan said.

Concerns over Delhi

This is important for India as well: The Delhi government has been under public scrutiny for allegedly under-reporting COVID-19 deaths.

The state bulletin of the Delhi government on June 9 — citing the death audit committee formed by the state government — stated cumulative deaths (905) were the ones where “primary cause of death was found to be COVID-19”.

It was not immediately clear if deaths of novel coronavirus patients who also suffered from comorbidities were counted as COVID-19 deaths or not.

ICMR guidelines clearly state that if a confirmed COVID-19 case had “comorbid conditions like heart disease / asthma / chronic obstructive pulmonary disease / type-2 diabetes”, COVID-19 must be documented as the “underlying cause of death”.

COVID-19 is reported to cause “pneumonia / acute respiratory distress syndrome (ARDS) / cardiac injury / disseminated intravascular coagulation and so on”, according to the guidelines.

These conditions must be listed as the “immediate cause of death”, with COVID-19 as the antecedent, irrespective of the presence of comorbidities.

The guidelines, however, do not classify anything as the “primary cause of death”, as claimed by the state government bulletin.

There were reports from a few states — including West Bengal — where comorbidities were not counted as COVID-19 deaths, as the number of those who contracted the disease increased across the country.

This was later rectified, however, with deaths from comorbidities now being counted as COVID-19 deaths.

West Bengal’s health bulletin now clearly lists the total number of COVID-19 deaths as well as those who died from comorbidities. Most states follow this practise.

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