COVID19 Mortality: Myths Vs. Facts 27-07-2021
India follows ICMR guidelines which are based on WHO recommended ICD-10 codes for correct recording of all COVID-19 deaths
The robustness of statute based Civil Registration System (CRS) ensures institutionalized registration of births and deaths in the country
Given that the CRS has been implemented for decades in India, missing out on COVID-19 deaths unlikely
There have been some media reports, based on a yet-to be peer-reviewed study which was uploaded on MedRxiv recently, alleging that at least 2.7 to 3.3 million Covid-19 deathshappened during the two waves of Covid-19 in India, quoting three different databases ‘pointing towards at least 27% excess mortality over a year.’
The report further ‘concludes’ that India’s COVID death rate may be about 7-8 times higher than the officially reported toll and claims that ‘most of these additional deaths are likely to have been due to COVID-19.’ Such mis-informed reports are totally fallacious.
It is clarified that the Union Government has been transparent in its approach to COVID data management and a robust system of recording all COVID-19 related deaths already exists. All States and Union Territories have been entrusted with the responsibility to update the dataon a continuous basis.
In addition to this reporting by States/UTs, the robustness of statute based Civil Registration System (CRS) ensures all the births and deaths in the country get registered. The CRS follows process of data collection, cleaning, collating and publishing the numbers, which although is a long drawn process, but ensures no deaths are missed out. Because of the expanse and the amplitude of the activity, the numbers are usually published the next year.
The Union Health Ministry has also been repeatedly advising States and UTs through formal communications, multiple video conferences and through deployment of Central teams for recording of deaths in accordance with laid down guidelines. States have been advised to conduct thorough audits in their hospitals and report any cases or deaths that could have been missed with a district and date-wise details so as to guide a data-driven decision making.
Moreover, as early as May 2020, to avoid inconsistency or confusion in the number of deaths being reported, Indian Council of Medical Research (ICMR) had also issued ‘Guidance for appropriate recording of COVID-19 related deaths in India’ for correct recording of all deaths by States/UTs as per ICD-10 codes recommended by WHO for mortality coding.
During the peak of the 2nd wave, the health system across the country was focused on effective clinical management of cases requiring medical help due to which correct reporting & recording of COVID deaths could have been delayed but later was reconciled by the States/UTs. Given the robust and statute-based Death Registration System in India, while some cases could go undetected as per the principles of Infectious Disease and its management, missing out on the deaths is unlikely.
It is a well-known fact that there shall always be some differences in mortality recorded during a profound and prolonged public health crisis such as COVID pandemic.Well conducted research studies onmortalities are usually done after the event when data on mortalities are available from reliable sources. The methodologies for such studies are well established, the data sources are defined as also the valid assumptions for computing mortality.