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Nationwide surveillance soon to assess undetected Covid-19 deaths


NEW DELHI: The Indian Council of Medical Research (ICMR) is set to start a mortality surveillance across India to assess whether Covid-19 is killing people outside hospitals who may be undetected and untested, The New Indian Express has learnt.

The surveillance exercise, which will continue through the pandemic period, will study the weekly death data compiled by the Health and Demographic Surveillance System and the death statistics of the Registrar General of India. It will capture and compare the mortality data of this year with the corresponding period of last year.

The project starts amid concerns that more people, than the reported official figure of 3,710, may have succumbed to the infection in the country. The fatality rate in the confirmed coronavirus cases as of now is 3 per cent in the country.

The exercise is being undertaken following recommendation by an expert group on Covid-19 surveillance and epidemiology constituted by the ICMR several weeks ago.

Sources in the ICMR and the research group said that the idea was to compare whether excess mortalities, than expected, are being reported in any part of the country.

“Usually 28,000 deaths occur in India every day but any change in the usual numbers could suggest a link with Covid-19. So we want to see how the death graph is moving during the pandemic period,” said an ICMR official.

“If there is an unusual spike in deaths suddenly, it can be further probed through district surveillance based on talking to the families etc on the circumstances leading to deaths and estimates can be made whether people are succumbing to Covid-19 quietly without clinical detection.”

A member of the expert group said that it has been suggested that the HDSS — a longitudinal surveillance system at multiple sites in the country that captures data related to health indicators, nutrition and mortalities - will be comprehensively used for the purpose.

“It has three major sites in India and several smaller sites that capture crucial data related to health and demography and the plan is that the ICMR will fund a project to keep a close watch on any excess mortalities being reported every month,” he told The New Indian Express.

Public health experts welcomed the move saying the exercise will not only help capture the excess deaths due to Covid-19 but also could also signal if people are dying due to other morbidities.

“Given the fact  only about 20 per cent deaths in the country are formally registered — this can be a crucial exercise to understand the true mortality picture due to the infection and disruption in other healthcare services,” said Dr. Sanjay K Rai who teaches community medicine at AIIMS, Delhi.

The project in the country is being planned even as the World Health Organisation, just a few days back, released a technical resource report “Revealing the Toll of COVID-19: A Technical Package for Rapid Mortality Surveillance and Epidemic Response” for the low and low and middle-income countries.

“... A focus on total mortality encourages the measurement of deaths occurring outside of a health facility, which can be the norm in many low and middle-income countries,” said the document.

“In some countries up to 70% of deaths may occur in the community, and therefore out of the reach of any likely COVID-19 testing or clinical case detection.”