Attributing deaths to COVID19: Medicos call for strict adherence to labeling guidelines

Attributing deaths to COVID19: Medicos call for strict adherence to labeling guidelines
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With the number of deaths being attributed to COVID19 escalating, medicos have underlined the importance of strict adherence to "labeling guidelines" for declaring a death a result of COVID19 infection, especially in those with serious life threatening conditions.

Till Friday evening, as per information issued by J&K Government, 76 people in J&K had died of COVID19. However, many doctors in Kashmir have voiced concern over "casual approach" towards labeling of a death as a COVID19 death, arguing that each casualty needed to be evaluated and the exact etiology be arrived at before deciding these.

"Recently, a teenager was grievously injured in an 'assault' and had suffered a massive brain injury. He was admitted to hospital and routinely tested for COVID19," a doctor working in GMC Srinagar said.

He said that while the injured teenager died soon after his admission owing to his brain damage, his death was termed a COVID19 death by Government.

He said such instances were becoming more frequent with growing number of people testing positive while they are already in a critical condition due to an underlying disease or condition. "Someone died due to a road accident recently, someone died of cancer… how are these deaths COVID19 deaths even if the deceased were COVID19 positive?" he asked.

Another incident that a medico cited was of a Baramulla man whose swab sample taken a day before his death (on 9 June) had tested negative. "He had recovered from COVID19 and died of something else, the tests made that amply clear," the medico said. He said that in spite of this evidence, his death was attributed to COVID19.

Prof Parvaiz A Koul, head department of internal medicine at SKIMS and an influenza expert said there were laid down protocols and guidelines that needed to be followed strictly while attributing a cause to a death.

"Generally COVID19 related deaths should be labeled so, if the clinical spectrum is compatible with the described clinical syndromes with COVID," he said.

He cautioned that if that is not the case, it can be a "chance association" and may "interfere with correct estimates of mortality" of the viral infection.

He called for clinical evaluation of the cause of death as per clinical spectrum of COVID19. "By now we know what kind of presentation it (the disease) will have," he said adding that autopsies would be ideal but were rare.

Dr Naveed Nazir Shah, head department of Pulmunology at GMC Srinagar said that COVID-19 would be recorded as an "underlying cause of death" when leading to pneumonia, cardiac injury and clotting in the bloodstream, among others. "This is in accordance with ICMR guidelines for appropriate recording of deaths due to the disease, in J&K and across India," he said.

He said that deaths in which "coronavirus symptoms are present" would be called "probable COVID19 deaths" even if the test results are inconclusive.

He however said that as per WHO, "Persons with COVID-19 may die due to other conditions such as myocardial infarction (heart attack), accidents or other conditions and such cases are not deaths due to COVID-19 and should not be labeled as such".

COVID19, he said, may be influencing the death in these cases and not necessarily be the cause.

A senior health official said that it was not a clinical judgment "but J&K Government that labeled the deaths as COVID19 deaths."

"The administrations forward the list of deceased COVID19 positive people and they automatically become COVID19 fatalities in J&K," he said.

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