Two malaria victims had Covid too, BMC in a fix over labelling deaths

MUMBAI: The city’s first two malaria victims of the year had tested positive for Covid-19 as well. The presence of dual diseases in the deceased has put the civic body in a quandary and prompted it to seek the state’s opinion on whether to label them as malaria or Covid-19 deaths.
After a year of zero malaria deaths, the city had reported two casualties in the past few weeks. Malaria cases have also doubled between June and July.
The Indian Council of Medical Research (ICMR) norms state death in an individual with a Covid-positive report should be counted as a coronavirus death. In this case, though, the civic body has called these deaths as suspected malaria for now, and is awaiting an evaluation by the death audit committee.
“During monsoon, we had expected to see such deaths, and guidelines are needed to report such fatalities where both diseases could be present. We will wait to see what the clinical experts have to say here in terms of the attributable cause of death,” said Dr Daksha Shah, BMC’s deputy executive health officer.
She added fatalities where the cause of death is evidently not Covid but the individual had a positive report have been categorized under ‘other causes’. Mumbai has nearly 300 deaths in that category.
Doctors, meanwhile, said the presentation, transmission and even progression of Covid and malaria in patients is quite distinct.
Physician Dr Hemant Thacker said of the six malaria patients undergoing treatment under him, one has tested positive for Covid as well. “In my opinion, Covid is mostly coincidental. Also, malaria is caused by a parasite that attacks blood cells, whereas Covid is a viral infection and affects respiratory and endothelial cells. They really have no scientific reason for coexistence,” he said. “The complications caused by the diseases too are varied,” said Thacker.
Physician Dr Pratit Samdani, who too has treated several combinations of Covid and malaria, has a word of caution though. “The D-dimer (blood test to check for serious blood clots) could be high in malaria patients too like in Covid. While in Covid, we would start them on blood thinners, in malaria we should strictly refrain from doing so,” he said.
State officials said they have developed treatment guidelines for the combination of Covid and dengue.
“We were yet to see the joint presentation of malaria and Covid, but we will look into this now,” said Dr Mahendra Jagtap, state entomologist.
So far, the state has only laid down guidelines for carrying out mosquito-control measures in containment zones.