No government database yet on clinical details of those who succumbed to coronavirus in India
NEW DELHI: Over 1,300 COVID-19 patients have died in India so far but no central government agency has started collecting crucial clinical details about these patients yet, effectively denying clinicians and researchers pathways to unravel severe disease and deaths.
This, in effect, means that there is no database, as of now, to establish how exactly is COVID-19 killing those infected in India.
Many hospitals and doctors this correspondent spoke with confirmed that they are required to fill a two-page form, provided by the National Centre for Disease Control (NCDC) under the Union Ministry of Health and Family Welfare in case of admission of every COVID-19 patient and inform district health officials about the infection related deaths.
But they have not been asked to either record or submit the clinical details of those who are succumbing to the infection.
“The NCDC form we are supposed to fill and submit is largely for epidemiological purpose and asks for details like contact history of the patients and whether they have any underlying health conditions. But we are not being asked to register what exactly is killing a COVID 19 patient,” head of the critical care medicine department in a major corporate hospital in Delhi told The New Indian Express.
Another doctor treating COVID-19 patients said that the government asks for real-time update on death due to the virus and whether they had any co-morbid conditions.
Central government sources conceded that a research group on “Clinical Research” formed by the national task force on COVID-19 and the Indian Council for Medical Research (ICMR) had suggested collecting these details though a “death audit” but the project has not kicked off.
Efforts to reach out to Dr Randeep Guleria, director of AIIMS, Delhi and head of the group and Dr R R Gangakhedkar, head epidemiologist at the ICMR and a senior member of the group on the proposed project have been futile, as there has been no response from them.
World over, it has emerged that there are many ways through which COVID-19 kills and some of the reasons are cytokine storm or acute immune over reaction to the infection, severe pneumonia, clotting of blood that then affects various other crucial organs, kidney failure or heart attack.
But in India, the central government has not bothered gathering information on what happens in the bodies of patients when they finally fall prey to the infection.
“This is a huge opportunity lost and this way we will not know if there are any unusual patterns in COVID-19 related deaths in India,” said Dr Oommen John, an internal medicine specialist and a public health researcher.
“It's not much of an effort too. Someone in a hospital just have to feed the clinical details of a patient in a central database but the government should first ask for it.”
Dr Sanjay K Rai, who teaches community medicine at AIIMS, Delhi said that data, including clinical features of sick and very sick coronavirus patients are important to understand an emerging infectious disease.
“All the details related to the infection from every patient should be meticulously collected and put out in public domain so that doctors, researchers and other can make use good use of them,” he said, further adding that it's not happening in India.
Incidentally, a team of researchers from UK and China, in a study published on Sunday stressed on the need for clinical data pooling.
“Although very challenging under epidemic conditions, systemic data collection during clinical care and data analysis is therefore essential to understand the natural history of COVID 19 to inform clinical decision making along the entire care pathway.”
Doctors dealing with such patients in India pointed out that autopsy too could be a way to understand the reasons of death in India--but there is no ICMR guideline on that yet.
“We are yet to see a pattern in COVID-19 in the absence of clinical data pooling in India and may just be recording the deaths as number,” said Dr D K Singh, a critical care specialist and director of Regional Institute of Medical Sciences, Ranchi.