A puzzle over definition

One of the main issues in determining whether a person died due to COVID-19 is the definition of COVID death itself. A COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case. Cases where there is a clear, unrelated alternative cause of death (e.g. trauma, suicide) are not COVID deaths.

However, COVID sets off a cascade of potentially fatal afflictions and while pneumonia and respiratory distress are the commonest outcomes, many patients die later at home of acute myocardial infarction or stroke. These deaths are actually a continuum of COVID and cannot be seen as unrelated incidents.

The State claims to classify COVID deaths based on World Health Organisation’s and the Indian Council of Medical Research’s (ICMR) guidelines.

The ICMR is clear that even if a COVID-positive person has comorbidities, “that should not be listed as the underlying cause of death; the cause of death remains COVID-19”.

While the WHO document essentially says the same thing, the statement that to be defined as a COVID death “there should be no period of complete recovery from COVID-19 between illness and death” gives room for confusion and misinterpretation.

The State had conveniently taken cover behind this loophole in the WHO document to eliminate many COVID-related deaths from the list.

“Belgium has one of the highest COVID death rates in Europe, because their list includes all probable and suspected COVID deaths. U.K. is capturing data of people who are COVID-positive and who die within 28 and 60 days separately. Ideally, Kerala should be doing the same because that is the most scientific way to capture the impact of a pandemic,” a public health expert said.

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