2020-06-28 17:51:00
mortality

Bengaluru: To understand patterns of covid-19-related deaths as well as prevent misreporting of the cause of death, the National Centre for Disease Informatics and Research of the Indian Council of Medical Research (ICMR) has prepared a mortality software for all states. As of Sunday, 16,103 people had died in India due to the virus.

The primary objective of this tool, which uses the World Health Organization’s International Classification of Disease Covid-19 codes, is to measure the public health impact of the pandemic in every district in India.

The e-mortality software, or E-Mor, will record the clinical disease history of every patient to understand the impact of co-morbidities when the virus attacks the body. The NCDIR has put out detailed guidelines for doctors, hospitals and nursing homes to appropriately handle covid-19-related deaths in India.

Currently, the data from the local birth and death registrars does not clearly indicate the cause of death. “There is no optimal death audit system now,” said NCDIR director Dr Prashant Mathur. “There are many gaps in recording and reporting deaths. Majority of the death certificates coming from the district registrars of births/deaths say death due to cardio-respiratory arrest. By itself, this is not the cause of death. It is just the mode of dying. Often, the final cause of death is recorded wrongly and there is no system for anyone to go back and check as most states do it manually. Patterns of disease and death can come from only standardised recording of clinical disease history of the patient. In a pandemic situation, epidemiological surveillance of disease and death are important,” he said.

While acute respiratory failure is the mode of dying in a covid-positive patient, there may be other pre-existing co-morbid conditions, such as chronic obstructive pulmonary disease (COPD) or 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-positive individual. “Unlike a manual system of mere recording of death, the software will help understand the sequence of every covid death, which is crucial to flatten the curve,” said Dr Mathur.

The software, he said, will guide hospitals and healthcare workers to go into the underlying causes of death due to covid-19. Unlike the current manual system of recording deaths, the new system has drop downs, which require recording the actual cause of death along with co-morbidities. This will help researchers measure the public health impact of covid-19, do a mortality audit for each of the 739 districts in the country, plan for timely health interventions, and protect communities.

The software was piloted in 25 select hospitals across India. While the Karnataka government has decided to implement the e-mortality system in all its hospitals to monitor covid spread, Tamil Nadu and Rajasthan have evinced interest.

“It is crucial to strengthen death surveillance as there are gaps in data. Medical certification of cause of death (MCCD) in Karnataka is done manually and cause of death data from hospitals is not available. With cases and deaths surging in Karnataka, we will implement the e-mortality software to evolve strategies for containing the pandemic,” said Karnataka’s health minister B Sriramalu.

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