Modi non operendi?
He was re-elected.
Alas, this is at best indirect. Modi’s (partial) defeat MAY be because Indians see how the rallies have helped the second wave along, or it MAY be just politics as usual.
I’ve been saying all along that this virus isn’t quite deadly ENOUGH. If it were as quickly deadly as, say, Ebola, people wouldn’t (I hope) be messing about with calling it a hoax or with resisting vaccination. Of course, if I’m correct, then it just means that Covid-19 has hit humanity in a different kind of “sweet spot” for being a pandemic.
A series of reposts:
COVID-19 deaths are being underreported across India, an investigation by The Wire Science has found. Such non-reporting falls broadly into two categories.
In the first category, a city counts only those deaths of patients who tested positive for the virus – i.e. ‘confirmed COVID-19 deaths’ – in its official toll. When patients who have symptoms of COVID-19 but aren’t tested, test negative or have an inconclusive result die, their deaths aren’t included.
While epidemiologists refer to such deaths variously as ‘suspected COVID-19 deaths’, ‘probable COVID-19 deaths’ and ‘clinically diagnosed COVID-19 deaths’ – based on several criteria – this article will use the blanket term ‘suspected deaths’ for all of them.
Despite there being other ways to diagnose COVID-19 patients, most Indian states are not reporting suspected deaths. The Wire Science spoke to municipal officials, health-department officials and officials from the Integrated Disease Surveillance Programme in seven states and union territories: Maharashtra, Gujarat, Telangana, Tamil Nadu, Uttar Pradesh, Madhya Pradesh and Puducherry, all of whom said they weren’t including suspected deaths in their published COVID-19 death tolls.
Suspected deaths make up a major blindspot for India because all nucleic acid tests used to confirm COVID-19, like CBNAAT and RT-PCR, sometimes return false negatives. So even a patient who is infected with the virus can test negative. More than 30% of RT-PCR results can be falsely negative depending on when the patient’s sample was collected.
Another issue with not reporting suspected deaths is that several states still conduct too few RT-PCR tests, ergo many infections may never be confirmed. When some of these people die, not counting them among COVID-19’s victims can deflate the disease’s death toll.
(To be continued)
For these reasons, a clinical diagnosis, which a doctor makes based on a person’s symptoms, along with other signs, like a telltale haze on X-rays or CT scans and low blood-oxygen levels, is a more dependable way to identify COVID-19 patients, John said.
“For all diseases, clinical diagnosis is fundamental, more so in an epidemic. Lab testing is additional evidence.” According to him, “Between clinical criteria and a lab test, the former is more reliable, unless both tally.”
Given these facts, several countries have recognised that counting suspected deaths is crucial to getting a true picture of COVID-19’s impact. In April, for example, the US Centres for Disease Control and Prevention asked American states to start reporting “probable deaths” apart from confirmed deaths as well. Probable deaths are deaths among patients with COVID-19 symptoms, who have lived in or travelled to an area with community transmission, and who don’t have positive results from nucleic-acid tests.
The second category – confirmed deaths
While not reporting suspected deaths seems to be the norm in all states, it’s not the only kind of undercounting happening in India. Some states are also not counting many confirmed deaths. Instead, they have been attributing a fraction of such confirmed deaths to comorbidities – pre-existing conditions the patient may have had, like diabetes, cancer or AIDS, that worsen the effects of COVID-19. These so-called “deaths due to comorbidities” are then excluded from these states’ death tolls.
To understand why ascribing a confirmed COVID-19 death to comorbidities is a problem, we need to understand how doctors record the causes of deaths.
Typically, for a certain fraction of deaths, doctors issue a medical certificate of cause of death (MCCD). This document lists the chain of events, culminating with mortality. A doctor writes the immediate cause of death as the first step in this chain. For COVID-19 patients, this is often acute respiratory distress syndrome (ARDS), the condition that manifests as breathlessness. Next, the doctor mentions the antecedent cause of death – the condition that led to the immediate cause of death. For a COVID-19 patient, this could be pneumonia, an inflammation of the lungs’ air sacs, which in turn leads to ARDS.
Lunch À la Modi.
Populists and autocrats never learn. Nor do the people that elect or support them. Never ends well.
April 12, 2017
August 08, 2017
August 01, 2017
September 22, 2017