'Comorbidity category in COVID-19 deaths is baseless'

Creation of comorbidity category in COVID-19 death records has no scientific basis: Experts

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Recording of the COVID-19 deaths in the "comorbidity category" is an "artificial distinction without any scientific basis" that should not be encouraged, said medical researchers and public health specialists tracking the pandemic in India.

The death pattern in India so far matches with the trend seen around the world as elderly people with other ailments (comorbidity) fall prey to the virus more often.

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West Bengal is the first state that introduced such a category in its COVID-19 death records, raising eyebrows in the academic circle. 

Delhi followed suit but suddenly dropped the idea on May 20. 

"It is an artificial distinction. The World Health Organisation doesn't support it," said Giridhara R Babu, professor at the Public Health Foundation of India, Bengaluru.

Even if anyone killed by the pandemic virus had other disorders, the death certificate should mention the virus as the cause of the death while mentioning other conditions that he/she had, unless the cause of death was entirely different such as road accident, he noted.

"In medicine, the most recent disease, if it by itself is a known cause of death, should be the cause of death in death certificate with contributory cause as diabetes, chronic heart disease etc, which at the moment of death was not, by itself, cause of death," T Jacob John, one of India's foremost experts on virus and a retired professor of clinical virology at the Christian Medical College, Vellore told DH.

"If someone had clinically Covid-19 with at least three major criteria, and died, the cause of death is COVID-19," he said.

The experts are unanimous in their opinion that it is perfectly legitimate to carry out a post-death analysis to check how many of the deceased had other illnesses. This is precisely what Tamil Nadu did as it found that 84 per cent of COVID-19 deaths had some form of comorbidities.

"But there is no way to distinguish (between COVID-19 and comorbidity deaths). The global practice is to record the Corona deaths," said a senior Indian Council of Medical Research scientist, who did not wish to be identified.

"I really don't know why they (West Bengal and Delhi Govt) have created this. All deaths should be properly coded. In the COVID-19 context we need to be all the more diligent in attributing the correct cause of death," said Oommen John, a senior public health researcher from the George Institute for Global Health India.

"There is nothing unusual in the death pattern in India as the toll is more among the elderly people with comorbidities. It is the same trend everywhere," said the ICMR scientist.

More than 50 per cent Indians killed by the virus are above 60 years of age and nearly 40 per cent of them have an age between 60 and 75 years. Above 75, the death rate comes down to around 9 per cent.

Another 35 per cent of the deceased have an age between 45-60 years, according to the data compiled by the Union Health Ministry. Further, 73 per cent of the death cases had underlying comorbidities.

The elderly people (above 60 years of age) and people having co-morbidities are identified as high risk groups for Covid-19.