A “mis-classification” of Covid-related deaths by hospitals and state governments can be unhelpful in India’s efforts to form strategies to fight the pandemic, one of the country’s top doctors has said. For a better picture of mortality in these circumstances, they must perform a death audit to reconfigure the numbers, according to Dr Randeep Guleria, Director of the All-India Institute of Medical Sciences (AIIMS) Delhi.
His comments come amid reports and allegations of various state government underplaying the number of deaths. In Madhya Pradesh, for instance, there seemed to be a mismatch between official figures and the number of last rites performed in April.
“Let’s say a person dies of heart attack, and if he had Covid, then Covid may have caused the heart attack. So, you may have mis-classified this as a non-Covid death…as a cardiac problem, rather than directly linking it to Covid,” Dr Guleria told NDTV.
The Kerala Legislative Assembly recently debated who should decide if a patient has died of Covid or not.
“There is a need for all hospitals and states to do a death audit…because we have to know what are the causes of mortality and what can be done to bring down our death rate. Unless we have clear data, we will not be able to develop a strategy to decrease our mortality,” the veteran doctor said, hinting at preparing for the next wave of Covid-19.
He spelt out two reasons — the virus’s mutation and human behaviour — why the pandemic has had multiple waves across the globe and especially in India. The virus evolves because that is in its nature. However, human tendency to lower the guard once infection and death numbers plateau also paves the way for future waves, he pointed out.
Referring to breakthrough infections — when someone contracts the disease even after receiving either dose of the vaccine — the AIIMS chief said the current data on the phenomenon was limited.
“Our concern is that you may get infected but you should not get severe disease. The vaccine should protect you against that…By and large, the vaccine is holding out by preventing severe disease,” he said.
Since most aspects of COVID-19 and the vaccines against it are still relatively new, Dr Guleria said, the matter of duration of the gap between doses, especially for the AstraZeneca-developed Covishield, was still being studied. Going by the medical community’s present understanding, he said, 12-13 weeks’ time was “good enough”, although this may change as new data emerges.
The UK, which had fully vaccinated almost a third of its population by May had extended the interval between the AstraZeneca vaccine doses to up to 12 weeks.
One key difference between the first and second waves of the pandemic in India was, according to him, the return of some patients of the latter with symptoms even weeks after recovery. This, he said, needs to be examined, too.
“Normally we see Covid symptoms last around four weeks. In some it may last up to 12 weeks. Most patients may have symptoms up to 6-8 weeks,” he said.