Kerala undercounts COVID-19 deaths after changing criteria for the kinds of deaths to be included in list

Even as the number of COVID-19 cases continue to spiral up in Kerala, the state has been undercounting the number of deaths due to the virus. The official count of deaths is 129, but according to independent verification of deaths in the state, the actual numbers stand at 242. The members of the expert committee, which was appointed by Chief Minister Pinarayi Vijayan, too have been protesting the exclusion of many COVID-19 deaths from the list.

Several doctors, who have been independently compiling deaths due to COVID-19, have stated that the maximum number of deaths (44) have taken place in Thiruvananthapuram, followed by Ernakulam (29) and then Malappuram and Kozhikode with 24 deaths each. “We have complied the list from daily news reports across all media. We have all the details and the corresponding reports of these 242 persons,” said Dr Arun N, who practices general medicine in Palakkad.

However, government records state that in Thiruvananthapuram, there were only 24 deaths; a difference of 20 deaths between the two lists. In Ernakulam, state records show 20 deaths, a difference of 9 deaths. In Malappuram, there’s a difference of 13 deaths as the state has recorded only 11 deaths and in Kozhikode, there is a difference of 10 deaths.

There’s a mismatch within government figures too. The health department’s figures show that there were 34 deaths as of July 31 in Thiruvananthapuram, but the government’s figure stands at 22. This means between July 31 and August 13, according to the government, only 2 more people have died in the state capital.

Both Pathanamthitta and Kottayam have the fewest number of deaths on both lists. According to newspaper reports, there have been 4 and 5 deaths respectively, but government statistics show 1 and 2 deaths respectively.

In a meeting, the expert committee members had stated that people would question the authenticity of the data being put out by the government as it has suddenly changed the criteria for the kinds of deaths to be included in the COVID-19 list. The committee includes Dr B Ekbal, member of the State Planning Board and Dr Aravindan, a public health expert.

National Herald called Dr Ekbal and the health secretary Rajan Khobragade, but both declined to speak on the issue.

“Kerala government should not be hiding numbers. No matter what the primary cause of death is, if the person has been tested and proved to be COVID-19 positive, that has to be counted as a COVID-19 death. If a patient has terminal cancer, Kerala government states that the person died of cancer. According to the definition, if a person tested positive for COVID-19, it should have been counted as a COVID-19 death. The government of Kerala is using a layman’s definition for COVID-19 death certification,” explained a public health expert who did not want to be identified.

The Kerala government had changed the criteria for recording COVID-19 deaths on July 20. The changed criteria stated that names of those who had comorbidities would be excluded from the list of COVID-19 deaths.

According to World Health Organisation guidelines, a death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of COVID-19. COVID-19 should be recorded on the medical certificate of the cause of death for all decedents where the disease caused, or is assumed to have caused or contributed to death. Even the Indian Council of Medical Research states that a death should be registered as COVID-19 death if it is the first or second cause of death.

“I cannot comment on the difference in death numbers as I’m not sure Kerala government is distorting death numbers. If the Kerala government keeps the deaths numbers intentionally low, it’s a gross mistake. They shouldn’t do that. It’s not fair towards the future generations. If they say the deaths are fewer, then the whole data will be distorted. Then fewer people will take preventive measures. No government should be doing it as such data is being recorded for history,” said Dr Sulphi Noohu, state vice president of Indian Medical Association.

“The question to be asked is, has any COVID-19 positive case not been acknowledged by the Kerala government. If that is the case, then that is a serious matter,” underscored the public health expert.

Kerala registered 1,564 new COVID-19 cases on August 13, taking the total number of cases to 39,708. Of these, 434 are from Thiruvananthapuram, 202 each from Palakkad and Malappuram, 115 from Ernakulam, 98 from Kozhikode, 79 from Kasaragod, 75 each from Pathanamthitta and Thrissur, 74 from Kollam, 72 from Alappuzha, 53 from Kottayam, 31 from Idukki, 27 each from Wayanad and Kannur.