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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 â i.e. âconfirmed COVID-19 deathsâ â in its official toll. When patients who have symptoms of COVID-19 but arenât tested, test negative or have an inconclusive result die, their deaths arenât included.
While epidemiologists refer to such deaths variously as âsuspected COVID-19 deathsâ, âprobable COVID-19 deathsâ and âclinically diagnosed COVID-19 deathsâ â based on several criteria â this article will use the blanket term âsuspected deathsâ 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 werenât 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 patientâs 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-19âs victims can deflate the diseaseâs death toll.
For these reasons, a clinical diagnosis, which a doctor makes based on a personâs 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.
âFor all diseases, clinical diagnosis is fundamental, more so in an epidemic. Lab testing is additional evidence.â According to him, âBetween clinical criteria and a lab test, the former is more reliable, unless both tally.â
Given these facts, several countries have recognised that counting suspected deaths is crucial to getting a true picture of COVID-19âs impact. In April, for example, the US Centres for Disease Control and Prevention asked American states to start reporting âprobable deathsâ 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 donât have positive results from nucleic-acid tests.
The second category â confirmed deaths
While not reporting suspected deaths seems to be the norm in all states, itâs 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 â pre-existing conditions the patient may have had, like diabetes, cancer or AIDS, that worsen the effects of COVID-19. These so-called âdeaths due to comorbiditiesâ are then excluded from these statesâ 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 â the condition that led to the immediate cause of death. For a COVID-19 patient, this could be pneumonia, an inflammation of the lungsâ air sacs, which in turn leads to ARDS.
B UTTONS almost 4 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 almost 4 years ago
Now for Rodneyâs real challenge. Three kids that really donât want to take their shots.
dcdete. almost 4 years ago
Hmm, I wonder if this was the historical moment of the invention of needle nose pliers.
Doug K almost 4 years ago
Most of the shots were right in the nose.
Doug K almost 4 years ago
The person on the left had never gotten a shot in that cheek before.
KenseidenXL almost 4 years ago
Sniper dart gunsâŠ.
whahoppened almost 4 years ago
The need was sure there (for needle-nose pliers).
me_the_polish_gull almost 4 years ago
If only vaccination could exist in Black Death epidemicâŠ
Sanspareil almost 4 years ago
Sir Rodneyâs most prominent attribute, would of course be the object of his aiming apparatus!
Walrus Gumbo Premium Member almost 4 years ago
Take that anti-vaxxers!
littlejohn Premium Member almost 4 years ago
I didnât know that the people of Id where into nose piercing?
jagedlo almost 4 years ago
Stealth vaccinations?
Dr_Zinj almost 4 years ago
Goodness gracious! Id has a higher vaccination rate than the U.S.
tripwire45 almost 4 years ago
Governmentâs idea of delivering the COVID vaccine?
Zebrastripes almost 4 years ago
Mass inoculations on the flyâŠ..incomingâŠ.
vaughnrl2003 Premium Member almost 4 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 almost 4 years ago
The invention of the Gatling Vaccinator.
Moonkey Premium Member almost 4 years ago
This should have been a Wizard job.
lgusy almost 4 years ago
I feel as if we dodged a bullet. I think some former guy would like this plan to get people vaccinated.
Cincoflex almost 4 years ago
ouch! headshot!
ms-ss almost 4 years ago
We really need that here. We are still wearing masks because of all the idiots who wonât get vaccinated.
paranormal almost 4 years ago
You could use CupidâŠ
geese28 almost 4 years ago
Please donât give the cdc any more ideas siiigh
Tootsie Premium Member almost 4 years ago
Thanks for reminding people to get their Covid-19 vaccinations. I got mine.
dsatvoinde Premium Member almost 4 years ago
Todayâs strip is kind of on the nose. Well done!!
TheLetterista.com almost 4 years ago
Time for the torches and pitchforks!
WCraft almost 4 years ago
Sure glad the variant they gave me went in the arm and not somewhere in the face or head!
Lightpainter almost 4 years ago
SoâŠ.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 almost 4 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 â i.e. âconfirmed COVID-19 deathsâ â in its official toll. When patients who have symptoms of COVID-19 but arenât tested, test negative or have an inconclusive result die, their deaths arenât included.
While epidemiologists refer to such deaths variously as âsuspected COVID-19 deathsâ, âprobable COVID-19 deathsâ and âclinically diagnosed COVID-19 deathsâ â based on several criteria â this article will use the blanket term âsuspected deathsâ 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 werenât 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 patientâs 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-19âs victims can deflate the diseaseâs death toll.
(To be continued)
briangj2 almost 4 years ago
(Continued)
For these reasons, a clinical diagnosis, which a doctor makes based on a personâs 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.
âFor all diseases, clinical diagnosis is fundamental, more so in an epidemic. Lab testing is additional evidence.â According to him, âBetween clinical criteria and a lab test, the former is more reliable, unless both tally.â
Given these facts, several countries have recognised that counting suspected deaths is crucial to getting a true picture of COVID-19âs impact. In April, for example, the US Centres for Disease Control and Prevention asked American states to start reporting âprobable deathsâ 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 donât have positive results from nucleic-acid tests.
The second category â confirmed deaths
While not reporting suspected deaths seems to be the norm in all states, itâs 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 â pre-existing conditions the patient may have had, like diabetes, cancer or AIDS, that worsen the effects of COVID-19. These so-called âdeaths due to comorbiditiesâ are then excluded from these statesâ 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 almost 4 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 â the condition that led to the immediate cause of death. For a COVID-19 patient, this could be pneumonia, an inflammation of the lungsâ air sacs, which in turn leads to ARDS.
https://science.thewire.in/health/india-mccd-comorbidities-covid-19-deaths-undercounting/
tcayer almost 4 years ago
Drop a bunch of coins on the ground and fire when they bend over to pick them up!
Faith Blackwell Premium Member almost 4 years ago
I feel like this is what weâre coming to. monarchy and no choice. quite sad.
WentBrown almost 4 years ago
Hahahaha!
aussie399 Premium Member almost 4 years ago
Yep. Uncle Joe invented them