Covid-19 toll row: ICMR report calls for death audits in districts

Such audits would help identify preventable causes of death at community and hospital levels

In the ongoing row on the undercounting of the Covid-19 deaths, government medical researchers have asked district administrations to audit every death in a district to identify the gaps in surveillance, testing and diagnosis of the infection and upload the data in a dashboard to watch out for future hotspots.

Such death audits would not only help identify preventable causes of death at community and hospital levels but also flag drawbacks in patient management strategies such as the availability of ambulances and treatment.

The report, prepared by the ICMR’s National Institute of Epidemiology, Chennai, comes at a time when Bihar admitted to undercounting its Covid toll following a death audit undertaken in every district at the instruction of the Patna High Court.

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For the last three days, Maharashtra is reconciling its Covid toll as it added 6,490 Covid deaths in the last 72 hours. Madhya Pradesh and Gujarat governments are also under scanner for their death tolls.

Officials in the Union Health Ministry said states consistently reporting lower daily deaths have been asked to re-check their data.

“It’s a well-known fact that there shall always be a difference in mortality recorded during a profound and prolonged public health crisis such as Covid-19 pandemic and well-conducted research studies on excess mortalities, usually done after the event when data on mortalities are available from reliable sources,” they said.

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“Absence of data dashboard is one of the weakest components of India's Covid response. District and state-level dashboards may be updated daily. Street or village level analysis can be done to identify hot spots and plan fever camps. Count all deaths (irrespective of the cause) by district every week. Analyse the data by age/gender/rural/urban, and update the same on the dashboard,” observed the NIE report.

The report also presents a toolkit for the district administration to prevent any future surge, with three parameters to guide their actions — test positivity rates, weekly change in cases and hospital bed occupancy. The control strategy recommended full localised lockdowns in districts when oxygen or intensive care unit bed occupancy exceeds 75 per cent irrespective of other parameters.

The report also suggested the number of doctors and nurses required to run Covid-19 facilities. For instance, every 30 beds with oxygen can be managed by two doctors and four nurses for an eight-hour shift but managing 10 ICU and ventilator beds would require two doctors and two nurses along with adequate support staff. There should also be a backup team comprising 20 per cent of the total staff.

Since prolonged working hours in PPE can reduce working efficiency and lead to judgment errors, the NIE report suggested adequate rest and rotation for the posted staff.