27/04/2020 5:36 PM IST | Updated 27/04/2020 5:40 PM IST

The Obvious Problem With West Bengal’s Coronavirus Death Toll

The Mamata Banerjee government has maintained that only 20 deaths in the state can be 'directly attributed' to Covid-19, but there's a problem here.

Chief minister of West Bengal Mamata Banerjee waves as she delivers a speech from her car in Kolkata on April 23, 2020.

Over the past couple of weeks, the Mamata Banerjee government’s handling of the coronavirus crisis in West Bengal has come under the scanner, with political blamegames, allegations of low testing and a confusion over numbers—of these, one of the most contentious issues has been the death toll in the state. 

According to a bulletin issued by the state government on Sunday, 20 people have died till now of COVID-19 in West Bengal. This is up from 18 announced on Friday.

However, a five-member panel that the West Bengal government had set up earlier in April said on Friday that there were 57 “COVID-19 linked deaths” in the state—of these 39 had co-morbidities, so the government maintained the same day that the number of deaths “directly related to the coronavirus” was 18.

If West Bengal actually reports 57 deaths due to COVID-19, it would be behind only Maharashtra, Gujarat, and Madhya Pradesh in terms of the death toll.

Why is this a problem?

The West Bengal government has repeatedly insisted that the 39 people in question have died because of the other underlying diseases they already had, not because of COVID-19. 

Apurva Chandra, who is leading an inter-ministerial team of the Union government on a Bengal visit to oversee how the state is handling the pandemic, has written a letter to state secretary Rajiva Sinha asking for an explanation on how they were declaring COVID-19 deaths. 

News18 quoted Chandra as saying in the letter, “The principal health secretary on April 23 gave some reasons for the establishment of the committee of doctors and also mentioned that if a COVID patient dies in a road accident, he cannot be said to have died of COVID. The IMCT (Inter-Ministerial Central Team) did not find the reason convincing as there is no comparison between a road death and a death in a hospital due to disease.” 

According to WHO guidelines, if a person has tested positive for COVID-19 or is suspected to have COVID-19, their death has to be categorised as a COVID-19 death. 

WHO defines deaths due to COVID-19 as: 

“A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma). There should be no period of complete recovery from COVID-19 between illness and death.

A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19.”

Like the West Bengal health secretary has said, even WHO agrees that a patient who has died in a road accident will not have to be categorised as a COVID death, but if a person with heart disease or lung disease who contracted the virus dies, it should be counted as “death due to COVID-19”. 

Amitava Nandy, a virologist, confirmed to Down To Earth that non-accidental deaths of those who have been infected by the virus are “conventionally listed as deaths resulting from COVID-19”. 

How the confusion began

It has been established by now that people with co-morbidities have a higher chance of dying of the coronavirus. 

The confusion in Bengal began when the government decided to scale down the number of deaths from seven to three in the beginning of April. The government later said that the four other deaths were because of co-morbidities. 

Arup Haldar, a physician and public health analyst, told Down To Earth, “An Italian study with 355 COVID-19 patients found only 0.8 per cent of dead people actually had no comorbidities indicating that the comorbidities are great benchmarks in assessing the true mortality catered by the virus.” 

Other states in India, as well as countries around the world, have been counting even the deaths of those with co-morbidities as COVID deaths.

The WHO suggests that “it is important to record and report deaths due to COVID-19 in a uniform way”. 

In the case of West Bengal, this has not happened. Even two days after disclosing that there were 57 COVID-related deaths, the state still maintains that the deaths of only 20 people can be directly attributed to the coronavirus.