Who Decides Death Cause? Heated Debate In Kerala House On Covid Fatalities

Who should decide whether a patient has died of Covid or not? This was a key point, among other things, that the Kerala Legislative Assembly debated aggressively today. While the opposition wanted the death confirmation protocol tweaked to leave the decision to the attending doctor, the government said it was following the World Health Organization's (WHO) guidelines.

The opposition insisted that nothing must be done to "deliberately portray low death rates" in Kerala.  

While the test positivity rate is coming down in the state, its daily death count remains high. Yet, the death rate is only 0.35 per cent compared to the national average of 1.18 per cent.

Today, five opposition MLAs moved a notice in the House for an adjournment motion to discuss, among other things, the "fear among people" amid the second Covid wave, the increasing number of deaths, and the unavailability of vaccines. Most importantly, they said the 'death confirmation protocol' must be changed.

"Usually when a death takes place, it is supposed to be reported by the concerned medical practitioner. But here it's being approved by an audit committee, which hasn't even seen or treated the patient. And they decide which is a death caused due to Covid," the Indian Union Muslim League's Dr MK Muneer said.

Expressing happiness over Kerala being ahead on many parameters in the matter, he said there must be a system to report the death count "efficiently and truthfully".

Dr Muneer also raised concerns over alleged unavailability of critical-care beds during the peak of the second wave and about vaccine distribution between districts. He pledged his unconditional support to the government's Covid containment efforts.  

Kerala's new Health Minister, Veena George, however, shot back saying the efforts of the state's health workers must not be devalued with such criticism.

"This allegation that the death count or death rate is being kept a secret is baseless. It negates all efforts of the health sector of Kerala. It needs to be withdrawn," Ms George said as the treasury benched applauded while the opposition went into an uproar.

"In my hand is the WHO document on how Covid-related deaths need to be reported. This is what Kerala follows," she said.

Explaining the protocol, she said if a person enroute to work dies in an accident, the body is taken to a hospital and a Covid test performed on it. Now even if its result is positive, the cause of death is the accident, not Covid, she said. Citing another example of a person who dies after a jackfruit falls on his head was. Even if, on testing, he found to be Covid-positive, the cause of death is not the disease but the head injury, she said citing the WHO guidelines.

"If there is a Covid death in a hospital…a medical board or a doctor must report. A medical bulletin will be released and sent to the state level, where a board will take the final decision. This decision is not on arbitrary grounds, but based on guidelines of the WHO," the Health Minister explained.

Following her response, the Speaker did not grant permission for the adjournment motion. The opposition, however, was up in arms against Ms George's answer.

"We are pointing out some issues. Because that's our duty. There was no reason for such outrage from their end," said Mr Satheesan of the Congress. He said others, including doctors' associations and medical experts, had also raised concerns over the matter.

"If we do not include everyone who has died of Covid, their families will not get various compensations or benefits. We need to know the correct numbers to facilitate the right protocol," the Leader of the Opposition said.

According to the Indian Council of Medical Research guidelines, it's a doctor who is to decide on deaths linked to co-morbidities, not a managing committee, he said.

He cited the example of one Biju, a leader of the Democratic Youth Federation of India, an associated youth wing of the Communist Party of India. The man had recovered and tested negative for Covid, but was later put on a ventilator following post-Covid complications.

"The cause given for his death is cardiac arrest. His name is not in the Covid death count," Mr Satheesan alleged. "Deaths involving cancer patients who recovered from covid or those who have turned Covid-negative but later die due to stroke, heart issues etc are not being counted."

Earlier, Health Minister George had also stated that while at the national level, for every 22 COVID-19 cases, only one was being reported, in Kerala the ratio was 1:3. She said capacity building through the past year, along with containment efforts, had kept the death rate in check in the state.

The Assembly also unanimously passed a resolution seeking free vaccines from the Centre in a time-bound manner.