ICMR issues guidance for appropriate recording of COVID-19 deaths to create robust data

COVID-19 would be recorded as an "underlying cause of death" when leading to pneumonia, cardiac injury and clotting in the bloodstream, among others, according to the guidance issued by ICMR for appropriate recording of deaths due to the disease in India.

Explaining the public health significance of recording the cause of death in the COVID-19 pandemic, ICMR said COVID-19 is a new disease and is a pandemic affecting all communities and countries and a robust data is needed in India to measure the public health impact of the ailment and to plan for timely health interventions.

In its guidance for appropriate recording of COVID-10 deaths in India, the Indian Council of Medical Research (ICMR) said deaths with inconclusive test results, but in which coronavirus symptoms are present will be recorded as "probable COVID-19" fatalities.Deaths in which tests are awaited with the presence of symptoms will be recorded as suspected deaths, while those testing negative but have symptoms will be mentioned as clinically-epidemiologically diagnosed COVID-19, the guidance stated.

Its clinical presentation ranges from mild to severe, and fatality depends on the severity of the illness, associated comorbid conditions and age of patients. 

"Patterns of disease and patterns of death can come from only standardised recording of clinical disease history and cause of death, and therefore epidemiological surveillance of disease and death are important. 

"Robust data is needed from every district and state in India to measure the public health impact of COVID-19 and to plan for timely health interventions and protect communities.

"At the same time, other health conditions affecting populations need to be also monitored so that the health system is prepared for responding to the needs of the population,"' the document stated.

It lists forms where a health facility or a medical practitioner has to mention the sequence of events leading to death, which includes the immediate cause of death, cause of death antecedent to immediate cause, underlying cause of death and the manner of death, among others.

It is likely that COVID-19 is the underlying cause of death (UCOD) that leads to pneumonia in most of the deaths due to COVID-19.Patients may present with other pre-existing comorbid conditions such as asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes mellitus. These conditions increase the risk of developing respiratory infections, and may lead to complications and severe disease in a COVID-19 positive patient.

"These conditions are not considered as underlying cause of death as they have not directly caused death due to COVID-19. Also, a patient may has many comorbid conditions but only those that have contributed to death should be recorded," the guidance document stated.

The death toll due to COVID-19 rose to 2,206 and the number of cases climbed to 67,152 in the country on Monday, registering an increase of 97 deaths and a record jump of 4,213 cases in the last 24 hours, according to the Union health ministry.

The health research body also outlines the use of ICMR-NCDIR e-Mortality (e-Mor) software for recording the cause of death.The ICMR-NCDIR e-Mortality (e-Mor) software app aids in recording and reporting the cause of deaths as per the national standards of death reporting laid down by the Office of the Registrar General of India.

This software can be implemented by hospitals and district local registrar offices in a district (to record deaths occurring in residence). Institutions should register with ICMR-NCDIR or state authority for the provision of authorized login credentials, the document stated.

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