Several deaths labelled as non-Covid cases
Source: Chronicle News Service

Imphal, June 06 2021: Even as reports of underreporting Covid related deaths are cropping up in different parts of the country, there are allegedly several death cases among Covid positive patients in the state, which the authority labelled as non-Covid fatalities.

The official fatality count was 872 as per the government report released on Thursday.

However, there are also several death cases in which the patients were found to be positive for Covid-19 but the causes of death assigned as non-Covid.

Many of these missing cases do not come out in the public.

Occasionally one or two such cases surface up from time to time and the pandemic-weary people often ignore them as insignificant.

In the first wave, The People's Chronicle came across around 10 such cases but the reasons for labelling them as non-Covid death remain unknown.

Recently, this daily got an official list of non-Covid death cases containing names of five patients, who died within a span of 24 hours.

TPC came across the document while enquiring about the death of a seven year-old Covid positive girl, who died after one hour of reaching JNIMS with complaints of shortness of breath, but was not reflected in the Covid bulletin issued by IDSP and Common Control Room.

As per WHO guidelines, all death cases of Covid-19 patients should be recorded as Covid deaths except for casualties related to poisoning, suicide, accidents and terminal diseases on the premise that any of the immediate cause of death might be triggered or induced by Covid-19 infection.

Death of a person, who tested negative in any of the tests but clinical study shows symptoms similar to Covid-19 should be labelled as 'suspected Covid', the WHO guidelines said.

ICMR also follows the WHO protocols but certain numbers of death cases are being filtered out across the country and experts cited this filtration as one of the many reasons for underreporting Covid related death cases in the country.

The document TPC got did not mention the causes of death but it has a column for symptoms and diagnosis under which the entries were made as cardio respiratory arrest, type 1 respiratory failure and cardiac arrest along with co-morbidity (if any) and Covid-19 positive.

There is also a column labelled as 'History' and observations recorded under the column are loose stool, difficulty in breathing, body ache, loss of appetite, general weakness, shortness of breath, cough and fever.

These five death cases, which included the 7-year-old girl, were labelled as non-Covid by the Death Audit Committee responsible for auditing death case reports submitted from different hospitals or health authorities.

On the other hand, report published in British Medical Journal (BMJ) said that cardiac arrest is common in critically ill patients with Covid-19 and is associated with poor survival, particularly among patients aged 80 or older.

Other studies also suggest that sudden cardiac death in COVID-19 patients is not common, but it is a major concern.

COVID-19 patients who suffer cardiac arrest either in or out of hospital are far more likely to die than patients who are not infected with the coronavirus.

In particular, women have the highest risk of dying.

They are nine times more likely to die after suffering a cardiac arrest in hospital, according to research published in the European Heart Journal.

Associate professor of medicine at Harvard Medical School, Duane S Pinto writes in his article published in Up-ToDate: "In some patients, the heart may be affected, and this can occur in individuals with or without a prior cardiovascular diagnosis.

Evidence of myocardial injury, as defined as an elevated troponin level, is common among patients hospitalized with COVID-19, with putative causes including stress cardiomyopathy, hypoxic injury, ischemic injury (caused by cardiac microvascular damage or epicardial coronary artery disease), and systemic inflammatory response syndrome (cytokine storm)" .

In this regard, a highly placed source said that the audit committee assesses the death case reports submitted from different sources on daily basis and classifies them as Covid or non-Covid death cases based on the report.

Interestingly, cremations of those non-Covid deaths are conducted by following Covid protocols since they were diagnosed with Covid-19 and most of them died with the virus inside them.

The source did not mention the exact number of death cases, which have been treated as non-Covid, but said that two to five such cases are filtered out as non-Covid deaths almost every day during the peak of the second wave.

By the calculation, there are possibilities of nearly 100 death cases of Covid patients categorised as non-Covid though many of them might be eligible for labelling as Covid death if the WHO guideline is considered.

A healthcare professional, whom The People's Chronicle talked to, said that Covid-19 is a new viral infection and there are still many more to be learnt about it.

Pneumonia leading to fibrosis in the lung is a common complication in Covid but there are also several uncommon or rare complications involved with Covid-19.For instance, gastrointestinal infection is also one of the complications of Covid-19 and can lead to death in severe cases but such cases are not widely reported.

Deaths due to cardiac arrest in Covid-19 patients with no history of heart condition also occur sometimes.

While further studies are needed to establish the link with Covid-19 infection and cardiac arrest, isolated cases of such incidences cannot be ignored, the professional explained.

Speaking to TPC on the condition of anonymity, another senior official of the health department expressed that it is important for the government authority to let the information go public and maintain transparency while keeping aside the reason for labelling them as non-Covid and filtering them out during the audit.

Hiding or not disclosing the numbers will only deepen suspicion among the public while disclosing them and maintaining transparency will help in educating the public and getting their cooperation in the fight against the pandemic.

TPC contacted an official of IDSP but he refused to give any comment on the issue.

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