NEW DELHI (AP) – When Narayan Mitra died on July 16, a day after being hospitalized for fever and shortness of breath, his name never appeared on any of the official lists posted daily of those killed by coronavirus.
Test results later revealed that Mitra had actually been infected with COVID-19, as were his son, Abhijit, and four other family members in Silchar, in northeastern Assam, on India’s border with Bangladesh.
But Narayan Mitra is still not considered a coronavirus victim. The virus was considered a “random”
“He died because of the virus and there is no point in lying about it,” Abhijit Mitra said of the finding, which came despite national guidelines asking states not to attribute deaths to underlying conditions in cases where COVID -19 has been confirmed by test.
Such exclusions could explain why India, which has registered more than 5.1 million infections – the second largest after the United States – has a death toll of around 83,000 in a country of 1.3 billion people.
India’s health ministry has cited this as proof of its success in fighting the pandemic and a basis for easing restrictions and reopening the economy, after Prime Minister Narendra Modi ordered a strict shutdown of the entire population earlier this year.
But experts say the numbers are misleading and that India does not count many deaths.
“We count deaths by an unknown factor,” said Dr. T. Jacob John, a retired virologist.
The health ministry has brushed over previous allegations of a death toll, but it declined to comment this week on states reporting on all suspected and confirmed virus deaths.
It is difficult to determine exact figures during the pandemic: countries count cases and deaths differently, and testing for the virus is uneven, making direct comparisons misleading.
In India, the registration of mortality data was poor even before the pandemic hit. Of the 10 million estimated deaths each year, fewer than a quarter are fully documented, and only a fifth of these are medically certified according to national figures.
Most Indians die at home, not in a hospital, and doctors are usually not present to record the cause of death. This is more prevalent in rural areas where the virus is now spreading.
Dr. Prabhat Jha, an epidemiologist at the University of Toronto who has studied deaths in India, said countries should fail by overestimating deaths if they want to make progress in fighting the virus.
“It’s better to have an estimate than an underestimation,” Jha said.
The Ministry of Health’s guidelines reiterate this concern and ask states to register all suspected viral deaths, including “presumed deaths” – those who probably died of COVID-19 but were not tested for it.
However, these guidelines are advisory and many states do not comply. In Mahrashtra, India’s worst-hit state with more than 1 million cases, deaths are not registered at the meeting, Dr. Archana Patil, State Health Director.
Other states, such as Assam, have set up panels of doctors who distinguish between “real virus deaths” and those from underlying diseases. In some cities like New Delhi or Mumbai, these panels have occasionally added lost deaths.
But Dr. Anup Kumar Barman, who heads the panel in Assam, said the state does not include many deaths where the virus was “random” and not the cause of death. In Narayan Mitra’s case, he had several symptoms of his underlying neurological disorder, Barman said.
The Assam state followed the federal guidelines and only cited the virus in these deaths due to respiratory failure, pneumonia or blood clots, Barman added. However, the guidelines show these factors as cases of how the virus can kill and is not a restrictive checklist. Barman declined to answer any follow-up questions from The Associated Press.
The Assam state has registered over 147,000 infections, but fewer than 500 deaths per. Wednesday.
In the state of West Bengal, a similar panel was laid in May, and the state said it would subsequently follow federal guidelines. Of the 105 deaths among those who tested positive for COVID-19 in April, the panel found that 72 or nearly 70% were not caused by the virus.
PV Ramesh, who until July 8 led the COVID-19 leadership of the state of Andhra Pradesh in southern India, said coronavirus deaths “at home, in transit or while arriving at hospitals do not count.”
The lack of data also means that India’s ability to identify spikes in deaths from natural causes from previous years is tarnished. Problems with the number of deaths have given rise to concern in countries such as South Africa.
Meanwhile, courts have criticized some states like Telangana over transparency in sharing death data.
In addition, federal health ministry guidelines in May advised hospitals to perform autopsies in suspected COVID-19 cases to prevent exposure to the virus. Although the guidelines say the certification can be performed by doctors, experts said this also led to understated deaths.
The government’s emphasis on the low death toll despite the rising number of reported infections has resulted in people believing the virus was not necessarily fatal, leading to a “false sense of protection”, said Dr. Anant Bhan, who researches public health and ethics. in the city of Bhopal. This has led to people failing their guard by not taking precautions such as. Wearing masks or maintaining social distance, Bhan said.
Regional officials also felt pressure to fight deaths to show the health crisis was under control, Drs. SP Kalantri, director of a hospital in Maharashtra’s Wardha district. Initially, there were “subtle hints” from district officials to “count down the number” by reporting some deaths due to underlying diseases, he said.
Maharashtra state health director Archana Patil said this had initially been a problem in some districts, but officials have since been advised to report all deaths.
Meanwhile, crematorium workers have reported an increase in receiving bodies – whether from the virus or not.
At a crematorium in Lucknow, the capital of India’s most populous state, Uttar Pradesh, worker Bhupesh Soni said 30 people were cremated every day compared to five or six before the pandemic.
A cremation usually takes about 45 minutes, but Soni said there have been days he has been working for over 20 hours.
“It’s an endless stream of bodies,” he said.
Associated Press authors Biswajeet Banerjee in Lucknow, India and Indrajit Singh in Patna, India, contributed.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. AP is solely responsible for all content.