COVID-19 deaths are being underreported across India, an investigation by The Wire Science has found. Such non-reporting falls broadly into two categories.
In the first category, a city counts only those deaths of patients who tested positive for the virus – i.e. ‘confirmed COVID-19 deaths’ – in its official toll. When patients who have symptoms of COVID-19 but aren’t tested, test negative or have an inconclusive result die, their deaths aren’t included.
While epidemiologists refer to such deaths variously as ‘suspected COVID-19 deaths’, ‘probable COVID-19 deaths’ and ‘clinically diagnosed COVID-19 deaths’ – based on several criteria – this article will use the blanket term ‘suspected deaths’ for all of them.
Despite there being other ways to diagnose COVID-19 patients, most Indian states are not reporting suspected deaths. The Wire Science spoke to municipal officials, health-department officials and officials from the Integrated Disease Surveillance Programme in seven states and union territories: Maharashtra, Gujarat, Telangana, Tamil Nadu, Uttar Pradesh, Madhya Pradesh and Puducherry, all of whom said they weren’t including suspected deaths in their published COVID-19 death tolls.
Suspected deaths make up a major blindspot for India because all nucleic acid tests used to confirm COVID-19, like CBNAAT and RT-PCR, sometimes return false negatives. So even a patient who is infected with the virus can test negative. More than 30% of RT-PCR results can be falsely negative depending on when the patient’s sample was collected.
Another issue with not reporting suspected deaths is that several states still conduct too few RT-PCR tests, ergo many infections may never be confirmed. When some of these people die, not counting them among COVID-19’s victims can deflate the disease’s death toll.
For these reasons, a clinical diagnosis, which a doctor makes based on a person’s symptoms, along with other signs, like a telltale haze on X-rays or CT scans and low blood-oxygen levels, is a more dependable way to identify COVID-19 patients, John said.
“For all diseases, clinical diagnosis is fundamental, more so in an epidemic. Lab testing is additional evidence.” According to him, “Between clinical criteria and a lab test, the former is more reliable, unless both tally.”
Given these facts, several countries have recognised that counting suspected deaths is crucial to getting a true picture of COVID-19’s impact. In April, for example, the US Centres for Disease Control and Prevention asked American states to start reporting “probable deaths” apart from confirmed deaths as well. Probable deaths are deaths among patients with COVID-19 symptoms, who have lived in or travelled to an area with community transmission, and who don’t have positive results from nucleic-acid tests.
The second category – confirmed deaths
While not reporting suspected deaths seems to be the norm in all states, it’s not the only kind of undercounting happening in India. Some states are also not counting many confirmed deaths. Instead, they have been attributing a fraction of such confirmed deaths to comorbidities – pre-existing conditions the patient may have had, like diabetes, cancer or AIDS, that worsen the effects of COVID-19. These so-called “deaths due to comorbidities” are then excluded from these states’ death tolls.
To understand why ascribing a confirmed COVID-19 death to comorbidities is a problem, we need to understand how doctors record the causes of deaths.
Typically, for a certain fraction of deaths, doctors issue a medical certificate of cause of death (MCCD). This document lists the chain of events, culminating with mortality. A doctor writes the immediate cause of death as the first step in this chain. For COVID-19 patients, this is often acute respiratory distress syndrome (ARDS), the condition that manifests as breathlessness. Next, the doctor mentions the antecedent cause of death – the condition that led to the immediate cause of death. For a COVID-19 patient, this could be pneumonia, an inflammation of the lungs’ air sacs, which in turn leads to ARDS.
B UTTONS over 3 years ago
Rodney needed to take a shot at delivering the shot. He distributed more shots in one shot that Gavin with many shots.
SamuelMeasa over 3 years ago
Now for Rodney’s real challenge. Three kids that really don’t want to take their shots.
dcdete. over 3 years ago
Hmm, I wonder if this was the historical moment of the invention of needle nose pliers.
Doug K over 3 years ago
Most of the shots were right in the nose.
Doug K over 3 years ago
The person on the left had never gotten a shot in that cheek before.
KenseidenXL over 3 years ago
Sniper dart guns….
whahoppened over 3 years ago
The need was sure there (for needle-nose pliers).
me_the_polish_gull over 3 years ago
If only vaccination could exist in Black Death epidemic…
Sanspareil over 3 years ago
Sir Rodney’s most prominent attribute, would of course be the object of his aiming apparatus!
Walrus Gumbo Premium Member over 3 years ago
Take that anti-vaxxers!
littlejohn Premium Member over 3 years ago
I didn’t know that the people of Id where into nose piercing?
jagedlo over 3 years ago
Stealth vaccinations?
Dr_Zinj over 3 years ago
Goodness gracious! Id has a higher vaccination rate than the U.S.
tripwire45 over 3 years ago
Government’s idea of delivering the COVID vaccine?
Zebrastripes over 3 years ago
Mass inoculations on the fly…..incoming….
vaughnrl2003 Premium Member over 3 years ago
So I guess cupid was otherwise occupied? I imagine the pandemic boom will start ramping up soon. I wonder if they will be called Boomers or Doomers?
Beaker over 3 years ago
The invention of the Gatling Vaccinator.
Moonkey Premium Member over 3 years ago
This should have been a Wizard job.
lgusy over 3 years ago
I feel as if we dodged a bullet. I think some former guy would like this plan to get people vaccinated.
Cincoflex over 3 years ago
ouch! headshot!
ms-ss over 3 years ago
We really need that here. We are still wearing masks because of all the idiots who won’t get vaccinated.
paranormal over 3 years ago
You could use Cupid…
geese28 over 3 years ago
Please don’t give the cdc any more ideas siiigh
Tootsie Premium Member over 3 years ago
Thanks for reminding people to get their Covid-19 vaccinations. I got mine.
dsatvoinde Premium Member over 3 years ago
Today’s strip is kind of on the nose. Well done!!
TheLetterista.com over 3 years ago
Time for the torches and pitchforks!
WCraft Premium Member over 3 years ago
Sure glad the variant they gave me went in the arm and not somewhere in the face or head!
Lightpainter over 3 years ago
So….who runs around actually pressing the plunger on these? NONE of them have been vaccinated yet. Right now, they could just pull them out.
briangj2 over 3 years ago
COVID-19 deaths are being underreported across India, an investigation by The Wire Science has found. Such non-reporting falls broadly into two categories.
In the first category, a city counts only those deaths of patients who tested positive for the virus – i.e. ‘confirmed COVID-19 deaths’ – in its official toll. When patients who have symptoms of COVID-19 but aren’t tested, test negative or have an inconclusive result die, their deaths aren’t included.
While epidemiologists refer to such deaths variously as ‘suspected COVID-19 deaths’, ‘probable COVID-19 deaths’ and ‘clinically diagnosed COVID-19 deaths’ – based on several criteria – this article will use the blanket term ‘suspected deaths’ for all of them.
Despite there being other ways to diagnose COVID-19 patients, most Indian states are not reporting suspected deaths. The Wire Science spoke to municipal officials, health-department officials and officials from the Integrated Disease Surveillance Programme in seven states and union territories: Maharashtra, Gujarat, Telangana, Tamil Nadu, Uttar Pradesh, Madhya Pradesh and Puducherry, all of whom said they weren’t including suspected deaths in their published COVID-19 death tolls.
Suspected deaths make up a major blindspot for India because all nucleic acid tests used to confirm COVID-19, like CBNAAT and RT-PCR, sometimes return false negatives. So even a patient who is infected with the virus can test negative. More than 30% of RT-PCR results can be falsely negative depending on when the patient’s sample was collected.
Another issue with not reporting suspected deaths is that several states still conduct too few RT-PCR tests, ergo many infections may never be confirmed. When some of these people die, not counting them among COVID-19’s victims can deflate the disease’s death toll.
(To be continued)
briangj2 over 3 years ago
(Continued)
For these reasons, a clinical diagnosis, which a doctor makes based on a person’s symptoms, along with other signs, like a telltale haze on X-rays or CT scans and low blood-oxygen levels, is a more dependable way to identify COVID-19 patients, John said.
“For all diseases, clinical diagnosis is fundamental, more so in an epidemic. Lab testing is additional evidence.” According to him, “Between clinical criteria and a lab test, the former is more reliable, unless both tally.”
Given these facts, several countries have recognised that counting suspected deaths is crucial to getting a true picture of COVID-19’s impact. In April, for example, the US Centres for Disease Control and Prevention asked American states to start reporting “probable deaths” apart from confirmed deaths as well. Probable deaths are deaths among patients with COVID-19 symptoms, who have lived in or travelled to an area with community transmission, and who don’t have positive results from nucleic-acid tests.
The second category – confirmed deaths
While not reporting suspected deaths seems to be the norm in all states, it’s not the only kind of undercounting happening in India. Some states are also not counting many confirmed deaths. Instead, they have been attributing a fraction of such confirmed deaths to comorbidities – pre-existing conditions the patient may have had, like diabetes, cancer or AIDS, that worsen the effects of COVID-19. These so-called “deaths due to comorbidities” are then excluded from these states’ death tolls.
To understand why ascribing a confirmed COVID-19 death to comorbidities is a problem, we need to understand how doctors record the causes of deaths.
(To be continued)
briangj2 over 3 years ago
(Continued)
Typically, for a certain fraction of deaths, doctors issue a medical certificate of cause of death (MCCD). This document lists the chain of events, culminating with mortality. A doctor writes the immediate cause of death as the first step in this chain. For COVID-19 patients, this is often acute respiratory distress syndrome (ARDS), the condition that manifests as breathlessness. Next, the doctor mentions the antecedent cause of death – the condition that led to the immediate cause of death. For a COVID-19 patient, this could be pneumonia, an inflammation of the lungs’ air sacs, which in turn leads to ARDS.
https://science.thewire.in/health/india-mccd-comorbidities-covid-19-deaths-undercounting/
tcayer over 3 years ago
Drop a bunch of coins on the ground and fire when they bend over to pick them up!
Faith Blackwell Premium Member over 3 years ago
I feel like this is what we’re coming to. monarchy and no choice. quite sad.
WentBrown over 3 years ago
Hahahaha!
aussie399 Premium Member over 3 years ago
Yep. Uncle Joe invented them