Asia’s hidden deaths: corona virus fatalities are being covered up and under counted

Public is at risk because the true picture of the spread of Covid-19 in India and Pakistan is unknown, doctors warn

(The Telegraph)— The directions on the doctors’ duty rota at Murshidabad Medical College Hospital were quite clear. Printed beneath the list of shifts were instructions on what to do if a patient died of Covid-19 while in the West Bengal hospital.

“In case of Covid positive – No mention of Covid in death certificate,” the order said. The rota leaked to the Telegraph is part of a deliberate strategy by the Indian state of West Bengal to hide the scale of deaths from the new corona virus, doctors claim.

Medics are being told not to test patients who may have Covid-19 symptoms, while someone can only be classified as having died from the disease by a secretive committee made up of government-appointed doctors.

Similar subterfuge is alleged to be underway in other parts of India, as states lie about their death tolls so ruling parties can point-score against political rivals over their containment of the virus.

The cover-ups are endangering the public and skewing tallies of the real toll of the disease, doctors say. Meanwhile in neighboring Pakistan, doctors told the Telegraph that deaths were being under counted because of stigma around the disease and public resentment at strict burial regulations.

People were unwilling to go to hospital with even severe Covid-19 symptoms because if they died, mourners at their funeral would be strictly limited. As a result people were choosing to die unrecorded at home, doctors said.

Five months since the emergence of the new disease, the lack of large numbers of deaths in South Asia has been one of the biggest puzzles of the global pandemic.

 

Pakistan and India, which between them are home to a fifth of humanity, were expected to be dangerously vulnerable. Poor healthcare, densely populated cities, communal living and existing lung disease were expected to make the countries particularly susceptible. Instead, official death tolls have been surprisingly low.

While deaths are continuing to gradually mount in each nation, neither country has seen the exponential take-off in fatalities witnessed in countries including America, the UK and now Brazil. By May 22, India had reported only 3,435 deaths and Pakistan only 1,017 compared with 95,000 in America.

The difference has led ministers to conclude the virus is somehow acting less virulently, perhaps due to a younger population, or the heat. But doctors on both sides of the border told the Telegraph that significant numbers of deaths may also have been hidden, either deliberately, or because they are not being picked up in official statistics.

A doctor working in a government hospital in North Bengal’s Cooch Behar district said: “We were ordered to strictly refrain from using the word ‘Corona’ in the death certificates until it gets a nod from the state government’s opaque committee.

“This is a violation of directives given by the World Health Organisation. Our chief minister is treating this pandemic as gastroenteritis or a headache which gets cured on its own. She forgets that the more we hide the numbers, the more we are risking the lives of the even larger section of society.”

Another doctor in South Bengal claimed Kolkata medical colleges and hospitals were unofficially instructed by the state government to perform low testing, to reduce the recorded number of Covid cases. Doctors said they would lose their jobs if they challenged the instruction or complained in public.

Residents near the city of Barrackpore, 30 miles north of Kolkata, accuse officials of using the local crematorium in the middle of the night to secretly dispose of bodies. Local people fearing infection have begun a 24-hour neighborhood watch after individuals wearing protective equipment (PPE) turned up at 1.30am to bring a dead body to the Rashmoni Ghat crematorium.

“It was 1.30am when two individuals wearing PPE arrived with a dead body to the crematorium. Although they claimed that the person had died of diabetes, they had no answer for why were they wearing PPE to cremate a diabetic patient,” explained one resident. A surge in deaths had meant a steep rise in bodies to cremate, a worker in a Kolkata crematorium said.

“Each body takes three hours to burn completely, and we used to cremate 15 to 20 bodies usually in a week, prior to the arrival of Covid. But now we receive that number of dead bodies in a single day. If this situation continues, then I am afraid that the furnace will eventually breakdown due to its overuse.”

The huge amounts of power needed to run the furnace meant officials have instead begun burying bodies, he said.

He said: “The fudging of data, not going for tests and suppression of facts have complicated the situation and endangered the front-line warriors.”

In Delhi, death tolls from different authorities have been dramatically different. The municipal corporations of North and South Delhi this week have told the Delhi government that they have recorded 426 corona positive cremations or burials.

Yet, the Delhi government’s official health bulletin put the city’s Covid deaths at 194. Doctors in Pakistan’s Khyber Pakhtunkhwa province said deaths were being under counted because of a distrust of hospitals and stigma around the disease.

Funerals for those who die of Covid-19 are performed under strict restrictions, allowing only a handful of family mourners. Dr Suhail Ahmed, of the provincial doctors’ association, said people were avoiding taking patients to hospital.

“Many people don’t bring their patients to hospitals and preferred to let them die in homes to be able to perform their funeral and burial ceremonies according to the cultural and religious traditions,” he said.

The province saw Pakistan’s first deaths and has the highest toll in the country. Dr Muhammad Akram, who works in a Mardan hospital, said: “There are community-based deaths of the Covid-19 patients, all of which went unreported, but enabled the relatives to perform their funerals and burials, the way they wanted,” he said.

When patients did die in hospital there were reports of bereaved relatives trying to bribe officials to have the bodies released for big funerals, international health officials said. Dr Fazal Maula in the province’s Malakand district, said one angry family had attacked a ward because staff had refused to hand over a body of a Covid victim.

“As far I know, 50 per cent of Covid-19 victims are dying in their homes and the trend is rising,” he said. “But the people don’t want an unceremonial burial. They want big and well-attended funerals,” he said.

Provincial officials denied people were dying at home uncounted, however. Health secretary Syed Imtiaz Hussain said: “We are receiving all patients and in case of their passing away, they are buried in accordance with the guidelines.”

Ministers have said official death tolls are accurate. Officials in Karachi said there were likely to be uncounted deaths in the community, but said the numbers were not thought to be enough to significantly shift the overall death toll.

 

Uncertainty over numbers is hindering epidemiologists trying to determine the progress of the outbreaks in South Asia. One international health official said there were attempts to adjust burial practice guidelines so more burials are recorded.

As both Pakistan and India now ease up lock downs which have caused extreme economic hardship, a lack of reliable death data will add to uncertainty about the result of that relaxation.

Dr Mishal Khan, an epidemiologist and associate professor at the London School of Hygiene and Tropical Medicine, said:  “Among public health people there is a strong feeling that accurate death info is going to be really useful to see the impact of increasing population mingling, although there doesn’t seem to be a good source of this information.”

 

 

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