Tamil Nadu: Amid Under-reporting of COVID-19 Deaths, Case Fatality Rises Two-Fold

There has been a sharp increase in Covid-19 deaths in Tamil Nadu as the daily toll has risen from 44 on April 19 to 365 on May 19. Yet, many factors show that there is a gross under-reporting of deaths, particularly the manifold increase in pressure on the crematoriums.

Many reasons contribute to the misreporting, and they are not peculiar to Tamil Nadu. The ICMR protocols for ‘cause of death’ are interpreted to undercount deaths due to Covid-19. Deaths that happen outside healthcare facilities and post Covid-19 deaths are not added to the Covid-19 tally. Deaths after false negatives and asymptomatic infections are another reason for misreporting deaths.

Even amid under-reporting of Covid-19 deaths, the case fatality rate has more than doubled in the past month. The state's current death toll is 18,734--the fourth highest in the country.

The test positivity rate, i.e. the percentage of people testing positive out of the total number of tests, has increased four-fold in the past month. The fewer the cases reported in comparison to actual infections, the higher the chances of more number of Covid-19 related deaths not being reported.

FATALITY RATE DOUBLED IN ONE MONTH

In the week between April 18 and 24, the average weekly case fatality rate (CFR) was 0.0679% when calculated against the average weekly active cases. The state was then reporting an average of 12,225 fresh cases per day and above 57 deaths every day.

The CFR has now increased to 0.1451%; even going by the under-reported government data, the CFR has more than doubled within a month’s time.

Image credit: Prakash R

The average daily cases climbed to 17,145 in the week between April 25 and May 1 along with 175 deaths, and the CFR climbed to 0.0924%. In the next two weeks the fatality rate increased to 0.1349% and 0.1597%.

A combination of reasons are being cited for the increased deaths, including delayed testing and admission, lack of access to medical care, and a more infectious mutation of the virus.

Over the past four weeks, the state’s active caseload has increased 3.5 times, but the pressure on the health system has also shot up along with it. The increased caseload and the state’s inability to provide healthcare for all in need have contributed to the reported deaths.

Many patients died awaiting beds for Covid-19 treatment; shortage of ventilators and liquid medical oxygen is another major challenge. There is also a shortage of doctors and nurses, particularly in Covid-19 hotbed Chennai, and it is a contributing factor to the deaths.

The increase in the state’s fatality rate comes amid the continuous warnings of under-reporting of both Covid-19 cases and related death, which implies that the actual fatality would be manifold.

VAST PROPORTIONAL DIP IN TESTS

An average of 1.58 lakh daily Covid-19 tests were performed over the past week in Tamil Nadu. The target, according to the National Institute of Epidemiology, is however double this number. Tamil Nadu is apparently testing only half the number of tests required to keep the spread of Covid-19 in check.

Image credit: Prakash R

The average test positivity rate (TPR) for the state has increased nearly five points from 15.96% in the first week of May to 20.52% this week. It was as low as 5% exactly a month ago.

Lower TPRs suggest that testing is more widespread, and higher TPRs suggest that many Covid-19 infections go unreported. Widespread testing helps bridge the gap between actual infected cases in the state and the cases reported, thereby it also helps in timely treatment of patients and reducing deaths due to Covid-19.

Epidemiologists point out that what proportion of people die from an infection is a very important quantity as it allows us to know how dangerous a disease is. These forecasting models are used to predict the need for oxygen, hospital beds, intensive care needs, the peak and duration of pandemic.

Experts also stress on the point that even though more testing implies more cases, the government should not feel ashamed about it, because only then the infection can be controlled and the death rate can be reduced.

CREMATORIUMS REVEAL TRUTH

Crematoriums in the Chennai region report around three to five fold increase in daily cremations in comparison to pre-Covid times. But, this increase is not reflected in the government’s daily Covid-19 death tally.

A report by DT Next on the increase in deaths in Chennai shows that the number of daily deaths has gone up to more than 700, which is a manifold increase from 150 per day during the pre-Covid period. The Chennai Corporation maintains 110 burial grounds.

Moreover, crematoriums are working for longer than 12 hours a day and taking up to 16 bodies. A proposal of operating the crematorium round the clock has also come up.

The Covid-19 death tally in Tamil Nadu has been above 350 in the past two days. Out of this, the Chennai region -- which includes Chengalpet, Tiruvallur and Kancheepuram districts -- reported above 160 deaths.

Amidst allegations of under-reporting of Covid-19 deaths in Tamil Nadu, the Madras High Court on May 17 emphasised the need for accurate reporting of such deaths to ensure adequate supply of drugs and oxygen proportionate to the severity of the virus’ spread in the state.

Tamil Nadu is presently under a stringent lockdown, which was imposed on May 18. If a person needs to travel from one police station limit to another, they will have to apply for an e-pass.