Over the last month, Tamil Nadu Health Minister C Vijayabhaskar and Chief Minister Edappadi Paliniswami have taken turns to trumpet the state's mortality rates, using the low number of deaths caused by COVID-19, as a symbol of the administration's success in handling the pandemic. As of June 9, the state's death count stood at 307, with a mortality rate of 0.7%, arguably the lowest in the country.
But a report in the Times of India on Wednesday, has raised questions over the number of deaths actually being publicly reported since the pandemic began. In fact the report suggests that there is a difference of as many as 236 deaths between the death register maintained by the Greater Chennai Corporation and the register managed by the state's Directorate of Public Health (DPH). The civic body has reportedly recorded 460 deaths due to COVID-19 till June 8, as opposed to the DPH's more modest claim of 224.
These new figures doubled the death rate to 1.5% and cast a shadow on the transparency in reportage of deaths by the Tamil Nadu government. A nine-member committee led by Dr P Vadivelan, Director of Public Health and Preventive Medicine has now been formed to carry out the reconciliation process to clarify the actual number of deaths in the state. They will be comparing death records with mortuary reports, hospital data and death certificates to clarify on the city's mortality rate.
But even as this correction process begins, experts and activists point out that these errors in death reportage are unacceptable. When TNM contacted multiple members of the newly-formed committee to understand how government and civic bodies in Tamil Nadu's capital failed to collate data on deaths, what emerged was a multifold problem stretching from the basic gathering of data from hospitals to miscommunication between two important government agencies fighting the pandemic.
Speaking to TNM, a committee member from the Public Health Department, alleged that the Corporation failed to revise protocols on recording deaths, despite the crisis in the state.
"The Chennai Corporation didn't understand the seriousness of the issue and didn't intimate the DPH about deaths. They usually take 21 days to register deaths but during a COVID-19 pandemic they are expected to inform us sooner, so that we can take necessary measures," alleges the officer.
He further points that the civic body has no expertise in handling a pandemic.
"The problem is that private hospitals that fall under their jurisdiction are directly informing the zonal officers from the Corporation about deaths and not the DPH. The priority of the civic body's health department is only development and sanitation. This is the first time they are handling disease control and fumbled," says the committee member. "We are having no problems with the rest of Tamil Nadu because it is handled by the DPH which has strong systems - primary, secondary and tertiary health care in place. In Chennai because the Corporation is autonomous we are unable to take complete control. Either they have to strengthen their systems or let us take over," adds the official.
The committee member explains that the Corporation must report to the state health department sooner.
"The government hospitals are under our jurisdiction, so we are able to get correct figures. The problem is with figures from private hospitals and home deaths," he says. "This is no longer routine procedure, it is a crisis situation," he warns.
Officials from the Chennai Corporation, however, deny that it was their duty in the first place to inform the DPH about deaths.
"The Department of Public Health and Directorate of Medical Education (DME) collect reports directly from hospitals about deaths. They then assess the situation and decide whether it is a COVID-19 death or not. So far, this is how the system is working. This is not the Corporation's fault," a senior officer tells TNM. "This is just a case of miscommunication," he claims.
When asked about where the discrepancies in deaths could have been recorded, the official says, "These could have been persons who were discharged and then died or people who die and then later, their results for COVID-19 are positive. We are working closely with the DPH now to examine every case and will update the list of deaths accordingly."
A former bureaucrat from the Public Health Department, however, disputes the Corporation's claim. On the condition of anonymity, he says that while every district in Tami Nadu has a Deputy Director of Health Services to inform the DPH about deaths, in Chennai this role is performed by the city health officer. Dr C Jagadeesan in the Chennai Corporation is currently occupying this role.
"This having been said, however, the media and public have been reporting several issues with data on death for over a month now," says the former bureaucrat. "The DPH itself should have appointed a committee to look into this at least two weeks back. What stopped them from analysing data when it was clear that there are discrepancies?" he asks.
Anti-corruption activist Jayaram Venkatesan also points out that a blame game at this stage of a pandemic is unacceptable.
"The Health Department cannot try to entirely shift the blame on the Chennai Corporation. A reconciliation process can be a solution if the difference in records is small. But when the figures are actually double what is being portrayed, how can this be regarded so casually?" he asks. "Moreover, they claim that government hospital death figures have no errors. But this is provably false," he adds.
On Tuesday, TNM had reported that at least two deaths in Chennai's Stanley Medical college and government hospital are yet to be reported in the state health department's bulletins.
Moreover, both the DPH and Chennai Corporation officials are constantly underplaying the number of COVID-19 deaths reported in the Perambur Railway Hospital. While reports have suggested that there are at least 20 deaths due to the virus, both government agencies claim that number stands between 5 and 8 at the railway hospital.
The Health Department has sent notices to hospitals and the Corporation asking them to ensure COVID-19 related deaths are reported to the Directorate of Public Health. The letter states that, "All COVID-19 deaths since March 2020 to till date to be shared. From now on all the COVID-19 deaths of Chennai Corporation have to be notified on a daily basis to his office by the identified officials (eg) city health officer/Health officer (VS)."
But the former bureaucrat from the Health Department says that the damage to reputation has already been done.
"This failure in reportage has put the entire health department's credibility at stake," he says."People will now question death figures and will think that the government is suppressing figures."
When TNM contacted Health Secretary Beela Rajesh, she did not confirm the number of deaths that have not been recorded in the state register. She however said, "The Health Department has been giving figures (publicly) of those who come to government hospitals and those reported by private hospitals. Reconciliation is being done for others like home deaths or unreported by other institutions. The time duration after the first positive test has to be seen too as the exit test is not there. We will inquire and revert on the specific allegations."