As of Sunday, 47 persons have died in Tamil Nadu after being infected by the coronavirus. According to reports released by the state government, most of these patients had pre-existing medical conditions that deteriorated their health. And now the Tamil Nadu Health Department is apparently set to argue that their deaths cannot be classified to be a result of COVID-19.
Speaking to Times of India's Pushpa Narayan, Health Secretary Beela Rajesh has stated that most people who died of COVID-19 had severe co-morbidities and that the state could not confirm what killed them. On Sunday, Tamil Nadu also received a revised format for death declaration from the Indian Council for Medical Research (ICMR) asking for details on co-morbidities and is currently hoping that protocols will be revised in such a way that people with co-morbidities will not be included as COVID-19 deaths.
However, speaking to TNM, experts and health officials argue that reclassification of these deaths would be both incorrect and dangerous.
"If coronavirus infection resulted in death now, whether they had brain tumour or leukemia, it is a COVID-19 death. The known risk factors of increasing mortality is age above 55-60 and co-morbidities. Anybody who dies with the infection, is to be classified as 'due to coronavirus'," says Dr Jacob John, who formerly headed ICMR’s Centre for Advanced Research in Virology, and Christian Medical College (CMC), Vellore professor emeritus.
A senior health official who spoke to TNM under the condition of anonymity, points out that such a move would be dangerous, as it will bring down the number of deaths attributed to the virus.
"So people will end up taking the infection very lightly. And this is not acceptable, especially in situations where elderly people are involved," he points out. "Our system is not about the survival of the fittest. We need to protect the vulnerable," he adds.
The World Health Organisation (WHO) guidelines, as of now, provides two ways in which the deaths following a COVID-19 infection can be reported.
According to its guidelines, "There is increasing evidence that people with existing chronic conditions or compromised immune systems due to disability are at higher risk of death due to COVID-19. Chronic conditions may be non-communicable diseases such as coronary artery disease, chronic obstructive pulmonary disease (COPD), and diabetes or disabilities."
If the patient had existing chronic conditions, like the above, COVID-19 is reported as the first cause of death and then the second part will contain the co-morbidities.
And if doctors believe that the death may have been influenced by COVID-19 but caused by another disease or an accident, those would be registered as the cause of death and the case declared a non-COVID -19 death.
But not all health officials are on board with this.
"Let's say I am a cancer patient and I could die in 6 months. I then get coronavirus, and my death is accelerated. I die within weeks. Cancer may be the primary cause but this doesn't mean that it is not a COVID-19 death. For the layman's eye a few months may not mean anything. But for a family that could make a huge difference when it is their own father or mother," says the senior official. "This is the reason we are working so hard to protect persons with terminal illness or other problems. Take diabetes for instance. By itself, the disease will not kill you, but if you are infected with COVID-19, it could take a dangerous turn. Reclassifying such cases as non-COVID deaths would undermine all the work and awareness we are spreading."