In the last 18 months, the pandemic has scripted a heart-rending tale of death across the world. The numbers are so large, they get counted as just that — numbers.
Over 47,77,503 deaths have been reported globally from the coronavirus, including 4,48,573 in India.
Each death takes away not just the individual — a mother, father or other family member. Sometimes it could be a family’s sole earning member. And that’s where the State comes in, providing some comfort by way of compensation.
Under the Supreme Court’s watch, the Centre outlined guidelines on defining a Covid-19-linked death and proposing ₹50,000 ex-gratia payment to the affected family. Expressing happiness with the measures taken so far, an SC order on this is expected this week.
Agreeing with the need for financial support, experts explain why “it’s never easy” to define death due to a single cause — Covid-19, in this case. “It is a good decision to go with the clinical judgement on death due to Covid-19, but this needs to reflect on the ground. Prevailing guidelines still rely heavily on RTPCR test positive diagnostic reports,” says Dr Ravi Wankhedkar, former national president, Indian Medical Association.
“There could be false negatives even with an RTPCR report. People recover and go back home, and die shortly thereafter. The family is put through trauma in getting insurance or assistance from Government schemes,” observes Dr Wankhedkar. If there are diagnostic reports to establish that the deceased had been treated for Covid-19, assistance should be extended, he adds.
Widening the ambit
The Centre has, in fact, included for compensation the families of those who died by suicide on being diagnosed Covid-19 positive, those who passed away at home after being treated for Covid-19 and discharged, and other such cases. It has, under the National Disaster Management Authority, outlined these situations. But it all hinges on the Health Ministry and Indian Council of Medical Research’s (ICMR) definition of ‘death from Covid-19’. And Dr Wankhedkar says this should reflect the change in approach directed by the SC.
Be it at the State level or countrywide, the reported death toll is much-contested, with health activists alleging under-reporting. Some States, however, revise their death tolls as and when hospitals report them. Maharashtra, Tamil Nadu, Bihar and Kerala have reconciled the mortality numbers — a move appreciated by public health experts as a step towards transparency.
Brihanmumbai Municipal Corporation (BMC) additional municipal commissioner Suresh Kakani explains that hospitals are busy with patient treatment, which is their priority. The paperwork and data update are done only after patient details are crosschecked to ensure there is no confusion, he said, indicating there was no other motivation.
Single cause or more?
On the difficulties involved in defining a death from Covid-19, he said that if the person had a co-morbidity such as cancer, diabetes or a heart problem, he said it was left to the clinical judgement of the treating physician.
Dr Rajeev Jayadevan, former president with IMA (Kochi), outlines the challenge in establishing death from one precise cause. Using a broad statistic, he says, if one crore people were followed for two months, 14,000 would die. Add to this the Covid-19 variable and “it’s never easy to establish that the death resulted directly from Covid-19,” he says.
A sick person could die in hospital from a heart stroke or lung problem, for example. And that fits the ‘death from Covid-19’ definition, he says on the added dilemma. “There’s no rule that a person can have only one disease at a time,” he points out, calling for a clear definition that would aid the doctor’s clinical judgement.
The problems involved in establishing death from Covid-19 and supporting the affected families will unfold as more people seek assistance. But, for the moment, the hope is, as the SC judge observed, the financial aid would indeed “wipe away the tears of many”.