Dying with the virus is not the same as dying from the virus but reliable data still missing

Earlier there was mere talk, now increasingly leading newspapers are publishing reports that Covid mortality in recent days has been much higher than the official estimates ( estimates approved by the Government). This can be seen in reports published in such leading newspapers as The Hindustan Times, Bhaskar (a leading Hindi daily ) and outside India, the New York Times.

The Hindustan Times (24 April, 2021, Chandigarh edition ) has carried a well-researched report by Shruti Tomar from Bhopal , which reported, “At least 824 people have been cremated or buried in Bhopal with Covid-19 protocol in the last 12 days , according to the administration of crematoriums and graveyards in the city, but the state’s official Covid-19 death toll in the same period is 34.”

Further this report gives reasons why these figures differ, “ Families of the victims, health department officials and workers at crematoriums and graveyards in the city say that a majority of these 824 people—a number confirmed by the state government –were those who exhibited symptoms consistent with Covid-19 but couldn’t be tested due to shortage of kits and long delays in labs. The state government said these 824 cases were treated as “suspected” Covid—19 cases and weren’t added to the official tally because none of the patients had any report confirming that they were suffering from Covid-19.”

On April 26 Dainik Bhaskar ( Chandigarh edition) published a report under special arrangement with the New York Times. This report stated that the actual number of recent Covid deaths is much higher than official estimates and at official level the number is deliberately understated . This report quotes an expert Bhramar Mukherji of Michigan university as stating that the actual number of recent Covid deaths in India is 2 to 5 times higher than the official estimate. The difference in estimates in the context of Bhopal given here is somewhat similar to that mentioned in the HT report given above.

Another report in the Hindustan Times dated April 23 ( Chandigarh edition ) by Leena Dhankhar and Archana Mishra on the situation in Gurugram said that the health department reported 8 Covid deaths on April 20-21 while as many as 106 last rites were performed as per Covid protocols during these two days. The report said officials attributed the differences to protocols followed by the Municipal Corporation of Gurugram (MCG).

As alarming news of Covid-19 deaths in some parts of the world appear day after day, people suffer increasing stress. However it needs to be re-emphasized that the best way of minimizing damage in the middle of severe uncertainties is to avoid panic and to ensure availability of very reliable and latest data so that policy response is based on this. It is important to set up transparent systems which have the ability to get and select the best possible advice on the basis of the latest and reliable data, without getting influenced by any narrow-minded interests and pressure groups. Even the opinion of those senior scientists which is different from existing policies should be considered, even though this may not be accepted eventually.

Some other reports from various countries have been suggesting that as several hospitals charge much more for COVID 19 patients there may be a tendency in some private hospitals to diagnose more patients as COVID patients even though they may be suffering from other diseases with similar symptoms. This is particularly true of those rich countries with insurance based health systems where much higher payments for Covid payments are assured. This may also be true of several hospitals in India as reports of very high charging for COVID 19 have been received time and again. However where governments are keen to avoid too high a mortality count on account of COVID, this tendency of hospitals may come in conflict with the inclination of the government leading to a rather peculiar situation and adjustments.

Senior scientists such as Dr. Jason Oke of Oxford University have pointed out that the mere presence of Covid virus in a dead patient’s body is not evidence enough that this was the cause of death or the main cause of death. As this scientist along with Dr. Carl Heneghan says, “ Dying with the disease ( association) is not the same as dying from the disease ( causation)” ( CEBM Research Evidence Service).

Failure to make this simple but important distinction may be responsible for a lot of confusion and overestimates, as is also evident from the writings and video recordings of very senior scientists like Dr. Sucharit Bhakdi of Germany ( Institute for Medical Microbiology and Hygiene).

In this context some facts well-known in the scientific circle but which could not find adequate space in popular and media debates on this issue need to be better known. Much before the advent or identification of COVID 19 it has been well-known that ‘mild’ corona viruses infect tens of millions of people every year in world. In the USA these have been known to account for 3% to 11% of those hospitalized with lower respiratory infections each winter. These ‘mild’ corona viruses have been implicated in several thousands of death every year worldwide, though the vast majority of these were not documented with precise testing at that time. In the case of elderly persons in nursing homes, risks were found to be much higher even at that time.

As senior scientists have pointed out, in some people who die from viral respiratory pathogens more than one virus is found upon autopsy and bacteria are often superimposed . Hence a positive test for corona virus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.

Keeping in view these factors some scientists have been drawing attention to the need for a lot of caution to avoid overestimating Covid-19 deaths. This is necessary both to avoid panic and panic-driven unduly harsh measures.

Hence in popular debates and even in some scientific discussion bias can be found due to various reasons and special efforts have to be made to ensure that policy is really responding well to the actual reality. In several countries doubts have been raised by some prominent scientists regarding the policy response and the success in making timely corrections depends on the ability and the willingness to examine carefully the objections and doubts which come from sources which have a generally credible record. Democracy in science is a very important issue and this has been seriously tested in recent times.

The big influence of huge private profit interests in the entire health sector cannot of course be denied and it would be really surprising if this influence did not make its presence felt at the time of the biggest health crisis. The challenge precisely is to establish systems which can provide evidence based policy which best serves public interest, ignoring and resisting all the powerful pulls and pressures. If transparent systems based on availability of reliable data are maintained, not only is government policy helped directly by this, but in addition several independent experts are able to give their opinion on this basis and this also can be carefully considered by the government to improve its policy response.

The writer is a journalist and author. His recent books include Planet in Peril and Protecting Earth for Children. Views are personal