While the global media is painting a medical apocalypse, sections of the Indian media fear that reporting the Central and State governments’ specious image management during this extraordinary viral outbreak will come with consequences. Meanwhile, front line health workers — doctors, nurses and trainees, who are under-equipped and not always fully appreciated — look like lambs to the slaughter. As the fight against more infections rages, stoic and selfless, hospital staff continue to do what they are trained to do.
Delays and data issues
In West Bengal, the medical fraternity claims that the State is reporting fewer cases as only a minuscule proportion of the population is getting tested. Recently, at least three healthcare workers, including interns, tested positive for the virus after delivering babies of COVID-19-positive mothers in the Kolkata Medical College and Hospital. The Gynaecology Department at the hospital was aware that the patients were COVID-19 positive, but were themselves tested for the disease only a week later. Such delays are dangerous.
West Bengal has acquired the dubious reputation of conducting the least number of COVID-19 tests among the larger Indian States (62.7 per million of population). To make matters worse, its methodology for aggregating ‘asymptomatic and those under observation’, ‘sick’ and ‘deaths’ leaves important questions unanswered. Doctors complain that the Standard Operating Procedure for COVID-19 death certification has not been followed. In Kolkata Medical College and Hospital, for instance, when doctors clinically assess a person to have died of COVID-19, and is yet to be lab-tested (test results may take up to two days), the bodies in their highly infectious states have been released to family members for last rites. No tests are being conducted posthumously outside of the specialised (Level 4) hospitals converted for treating COVID-19 positive patients, doctors say. With the testing rate low, we don’t know if there are COVID-19 deaths outside Level 4 hospitals. How many are succumbing in general wards, homes and villages? Who is checking?
West Bengal’s numbers come under further doubt as the State government is instructing doctors to be cautious while recording COVID-19 as the cause of death in the case of those patients who have other underlying medical conditions. This is not in keeping with international standard practices. In the U.K., doctors record a wider set as having succumbed to COVID-19, including deaths strongly suspected as being by COVID-19, even if no laboratory test has taken place, or if there are co-morbidities such as kidney, lung or heart disease. West Bengal authorities are telling doctors to do the opposite.
As more healthcare workers test positive, their calls for testing much more are stonewalled. Authorities, they say, have “no intention” of doing enough tests. This is unconscionable, a galling failure of the State government’s duty of care towards medical professionals and the public.
Then there is the newspeak: how do surveillance, quarantine and being under observation differ? Do these numbers (31,023<) include those in self-isolation? Who collects, collates and checks these figures from hospitals and District Collectors’ offices before they reach the panicking public? Is it only up to the hospitals to track COVID-19 deaths?
More questions than answers
Is there bureaucratic delay in reporting or are there other unforeseen limiting circumstances such as a State budget shortage or delays from the Central government in releasing funds? If there are inevitable delays, how long will the delays be on average? Can the gaps be narrowed and closed for better estimates? Can the true numbers then be higher? There are many questions, but no answers. The lack of transparency indicate that true figures are being suppressed to appear low. Why is Mamata Banerjee’s Cabinet and the Centre unable to answer such specific questions even though citizens and businesses are eager to know?
Divya Guha is a Kolkata-based independent journalist