Sep 17, 2020
As Indias virus cases rise, so do questions over death toll
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NEW DELHI (AP) — When Narayan Mitra died on July 16, a day after being admitted to the hospital for fever and breathing difficulties, his name never appeared on any of the official lists put out daily of those killed by the coronavirus.
Test results later revealed that Mitra had indeed been infected with COVID-19, as had his son, Abhijit, and four other family members in Silchar, in northeastern Assam state, on India’s border with Bangladesh.
But Narayan Mitra still isn’t counted as a coronavirus victim. The virus was deemed an “incidental” factor, and a panel of doctors decided his death was due to a previously diagnosed neurological disorder that causes muscle weakness.
“He died because of the virus, and there is no point lying about it,” Abhijit Mitra said of the finding, which came despite national guidelines that ask states to not attribute deaths to underlying conditions in cases where COVID-19 has been confirmed by tests.
Such exclusions could explain why India, which has recorded more than 5.1 million infections — second only to the United States — has a death toll of about 83,000 in a country of 1.3 billion people.
India’s Health Ministry has cited this as evidence of its success in fighting the pandemic and a basis for relaxing restrictions and reopening the economy after Prime Minister Narendra Modi ordered a strict lockdown of the entire population earlier this year.
But experts say the numbers are misleading and that India is not counting many deaths.
“We are undercounting deaths by an unknown factor,” said Dr. T. Jacob John, a retired virologist.
The Health Ministry has bristled at past allegations of an undercount in fatalities, but it refused to comment this week on whether states were reporting all suspected and confirmed virus deaths.
Determining exact numbers during the pandemic is difficult: Countries count cases and deaths differently, and testing for the virus is uneven, making direct comparisons misleading.
In India, recording mortality data was poor even before the pandemic struck. Of the 10 million estimated deaths each year, fewer than a quarter are fully documented, and only one-fifth of these are medically certified, according to national figures.
Most Indians die at home, not in a hospital, and doctors usually aren’t present to record the cause of death. This is more prevalent in rural areas, where the virus is now spreading.
Dr. Prabhat Jha, an epidemiologist at the University of Toronto who has studied deaths in India, said countries should err on the side of overestimating deaths if they want to make progress in fighting the virus.
“It is better to have no estimate than an underestimate,” Jha said.
The Health Ministry guidelines echo this concern, asking states to record all suspected virus deaths, including “presumptive deaths” — those who likely died of COVID-19 but weren’t tested for it.
But those guidelines are advisory, and many states don’t comply. In Mahrashtra, India’s worst affected state with more than 1 million cases, suspected deaths aren’t recorded in the tally, said Dr. Archana Patil, the state’s health director.
Other states, like Assam, have created panels of doctors who differentiate between “real virus deaths” and those from underlying illnesses. In some cities like New Delhi or Mumbai, these panels occasionally have added missed deaths to the tally.
But Dr. Anup Kumar Barman, who heads the panel in Assam, said the state is not including many fatalities where the virus was “incidental” and not the cause of death. In Narayan Mitra’s case, he had more symptoms of his underlying neurological disorder, Barman said.
Assam state was following the federal guidelines and was citing the virus only in those deaths due to respiratory failure, pneumonia or blood clots, Barman added. But the guidelines list these factors as instances of how the virus can kill and are not a restrictive checklist. Barman refused to answer any follow-up questions from The Associated Press.
Assam state has recorded over 147,000 infections but fewer than 500 deaths as of Wednesday.
In West Bengal state, a similar panel was shelved in May and the state said it would subsequently follow federal guidelines. Of the 105 deaths of those testing positive for COVID-19 in April, the panel found found that 72, or nearly 70%, weren’t caused by the virus.
P.V. Ramesh, who until July 8 headed COVID-19 management for Andhra Pradesh state in southern India, said coronavirus deaths “at home, in transit or while arriving at hospitals don’t get counted.”
The gaps in data also mean that India’s ability to identify spikes in deaths from natural causes from previous years is spotty. Problems in death counts have raised concerns in countries like South Africa.
Meanwhile, the courts have criticized some states, like Telangana, over transparency in sharing data about fatalities.
In addition, federal Health Ministry guidelines in May advised hospitals against conducting autopsies in suspected COVID-19 cases to prevent exposure to the virus. Although the guidelines say the certification can be done by doctors, experts said this also was leading to undercounting deaths.
The government’s emphasis on the low death toll despite the rising number of reported infections has resulted in people thinking the virus wasn’t necessarily fatal, leading to a “false sense of protection,” said Dr. Anant Bhan, who researches public health and ethics in the city of Bhopal. That has led to people letting their guard down by not taking precautions such as wearing masks or maintaining social distance, Bhan said.
Regional officials also felt pressure to play down deaths to show the health crisis was under control, said Dr. S.P. Kalantri, director of a hospital in Maharashtra’s rural Wardha district. Initially there were “subtle hints” from district officials to “play down the numbers” by listing some deaths as being caused by underlying diseases, he said.
Maharashtra state health director Archana Patil said this had been a problem in some districts at first, but officials since have been advised to report all deaths.
Workers at crematoriums, meanwhile, have reported an increase in receiving bodies — whether from the virus or not.
At a crematorium in Lucknow, the capital of India’s most populous state, Uttar Pradesh, worker Bhupesh Soni said 30 people were being cremated every day, compared with five or six before the pandemic.
A cremation normally takes about 45 minutes, but Soni said there have been days when he has worked for over 20 hours.
“It is an endless flow of bodies,” he said.
Associated Press writers Biswajeet Banerjee in Lucknow, India, and Indrajit Singh in Patna, India, contributed.
Follow AP pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
News Source: newsbrig.com
India Proposes Extending Suspension of Bankruptcy Filings
Outrage over lack of charges in Breonna Taylors death turns into protests across the US Americas most successful employee-owned companies India Proposes Extending Suspension of Bankruptcy Filings
(Bloomberg) -- India’s corporate affairs ministry is proposing to extend a suspension of new bankruptcy filings that has been in place since earlier this year, people familiar with the matter said.© Bloomberg Buildings rise into the Mumbai skyline as seen from the Imperial residential towers in the Tardeo area of Mumbai, India, on Monday, July 21, 2010.
The proposal is to extend the halt on new bankruptcy cases for another six months past its currently scheduled ending point this week. It must get final approval from Finance and Corporate Affairs Minister Nirmala Sitharaman, according to the people, who asked not to be identified because the details are private.
The suspension has helped financially strapped borrowers hit by the pandemic stay out of court, as the government seeks to cushion an economy already contracting at the worst pace in decades from more damage. But the move has challenged banks, already saddled with one of the world’s worst bad-debt ratios, with further delays in clawing back money they are owed.
There have been concerns that any extensions to the bankruptcy halt could make lenders balk at extending credit to businesses in Asia’s third-largest economy. The nation had already been grappling with a shadow banking crisis that started in 2018, and keeping money flowing to borrowers who need it is key to reviving growth.
A spokesman for the corporate affairs ministry didn’t respond to calls made during business hours.
Prime Minister Narendra Modi’s government in June had promulgated an ordinance prohibiting initiation of fresh insolvency proceedings against pandemic-hit companies for six months starting March 25.
India’s Revamp Plans Mask World’s Worst Bad Loan Ratio: Chart
Finance Minister Sitharaman had said last week that the bankruptcy law aimed to keep the companies as going concerns rather than liquidating them. As such, given the fact that businesses have been hit hard by the virus outbreak, it would be difficult to find buyers if a large number of companies are forced into bankruptcy for resolution, she said.
There were 2,108 corporate insolvency cases as of June 2020, of which some 1,094 cases have breached the 270 days time limit for resolution, government data show.
(Updates with data on pending insolvency cases in final paragraph)
For more articles like this, please visit us at bloomberg.com
©2020 Bloomberg L.P.
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