The state is facing a loss of credibility as it records a huge backlog of COVID-19 deaths.
NS COVID-19 death reconciliation exercise in Kerala, happening since October 22, has been a revelation of sorts. The exercise has added 10,678 more deaths to the state’s official COVID-19 fatality list, accounting for 26.7% of the total 39,955 COVID-19 deaths announced in the state so far (as of November 29). This makes Kerala the state with the second highest COVID-19 toll in India. These are startling figures, considering that the State Death Authorities Committee has so far received over 26,000 appeals for inclusion of names in the death list, of which less than 7,000 have been included after scrutiny.
The entire exercise has punched a hole in the state’s pandemic narrative of being one of the best containment strategies, as evidenced by a steady and low case fatality rate. Such stories of exceptionalism are always viewed with suspicion by epidemiologists and public health experts. And while the state would be commended for taking the death reconciliation exercise seriously, the loss of credibility is something that would be hard to live with. The question being asked is whether the state administration has ever seen the true picture of the impact of the pandemic. This is because while many cautious public health experts and physicians point to discrepancies in reporting of deaths, the wide disparities in mortality rates between districts and the fact that many patients are at home need to be addressed. were dying. The state remained in denial.
Some public health experts point out that for a state that prides itself on the robustness of its health system, its infrastructure, and the efficiency and expertise of its human resources, it is likely to present itself as an extraordinary story for short-term political gains. This attempt was immoral. Perpetuating this myth, the state had to deviate from the only goal it should have focused on, that of reducing the mortality rate.
There were several things the state did right during the pandemic – it increased testing and surveillance facilities, invested in improving hospital infrastructure and ensured there was no shortage of oxygen supply. At the peak of the second wave, the state managed to keep transmission levels low, so as not to burden hospitals.
But the vast data gaps due to improper death reporting and the government’s refusal to acknowledge that people dying in homes or brought dead to hospitals after apparently ‘recovering’ from COVID-19 were all COVID-19 patients. There were 19 deaths that not only hid the true impact of the pandemic from the public, but also robbed the state of an opportunity to re-examine how COVID-19 care pathways could be improved.
As one epidemiologist pointed out, the state has all kinds of data at its disposal. But beyond secondary data analysis, which is excellent, little has been done on the field to rectify the problems identified. The state had identified that over 30% of COVID-19 patients in home isolation were dying at home or in transit due to cumulative delays in hospital admissions. Was this knowledge put to good use to reduce mortality? Why does the state continue to record an average of 20-30 COVID-19 deaths per day, despite high vaccination coverage and declining levels of hospitalizations and ICU stays? Are there issues in the quality of care that are not being addressed? Are some of these avoidable deaths? “The fatality of severe COVID-19 cases, which are managed by invasive mechanical ventilation in our public hospitals, is almost 100%, which is unacceptable,” says a senior doctor. There are only two nurses per shift in the ICU for 20-25 patients, he says, adding that “more lives could have been saved if more attention had been paid to the training and development of dedicated critical care teams for the ICU.”
maya.c@thehindu.co.in
,