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Why those COVID-19 deaths do not figure on ‘oxygen shortage’ list

Covid death or no death, accounted or un-accounted death, reported or under-reported figures, controversy is going around in the country since first wave of the coronavirus pandemic. It is unlikely to die down soon.

Now, the central government’s reply in the Rajya Sabha on Wednesday has triggered a fresh controversy as the health ministry said no death due to lack of oxygen reported had been specially reported by any state or Union Territory.

This written reply came under sharp criticism people referring to the nationwide second wave of Covid-19 pandemic in April and May this year.

Opposition leaders were quick to attack the central government. The Congress threatened to bring privilege motion in Parliament over the statement. Politics may have its own compulsion.

Health is a state subject. In this case, the central government appears to have only compiled and released the data, shared by states — whether related to Covid-19 cases, deaths or vaccination.

There was a crisis, which country witnessed during the second wave of Covid-19 pandemic. The long queues to refill oxygen cylinders, multiple SOS calls by hospitals for oxygen supply, pleas from states to raise their oxygen quota or pain of the patients moving from pillar to post to get even a bed in any hospital made a deep imprint on people’s mind.

This crisis befell when numbers suddenly started shooting up in the month of April. The demand for medical oxygen in the country peaked to nearly 9,000 MT (metric tonnes) as compared to 3,095 MT during the first wave in 2020. Even the Supreme Court forced to term it “a national crisis”.

But the question that is being debated or examined is that why the states have not reported any oxygen shortage related death.

What Experts Believe
Experts say it is a very dynamic call to establish any Covid-19 death due to lack of oxygen supply as the actual medical cause for death, as normally mentioned in a death certificate, might be different due to multiple reasons.

A former Indian Medical Association (IMA) president and owner of a private hospital in East Delhi, said how could one write shortage of oxygen as the cause for death when the patient passed away due to cardiac arrest.

However, the former IMA chief maintained that the fact remained that at least 15-20 per cent of deaths could have been prevented as these deaths actually happened due to oxygen supply mismanagement.

Dr SCL Gupta of the Batra Hospital in Delhi said, “Death happened due to oxygen crisis, but it’s a purely technical issue that how states or hospitals mentioned any Covid-related death.

Medical oxygen is required in other critical ailment also but here the problem is that how you are going to mention it in medical term, said Dr Gupta adding, “But it is all happening between states and the Centre”.

Other Cases of Oxygen Shortage
As per experts the most common set of neurological symptoms seen with Covid-19 is toxic metabolic encephalopathy or TME. It comes with a 24 per cent increase in risk of death in patients hospitalized due to infection by SARS-CoV-2.

Neurological damage is known to accompany severe infections, which generate toxins as the immune system overreacts (sepsis), kidneys fail (uremia), and oxygen delivery to tissues is compromised (hypoxia), experts say. These processes cause TME, with symptoms ranging from confusion to coma.

Oxygen is also commonly prescribed for lung cancer patients with advancing disease. Indications include hypoxemia and dyspnea. Reversal of hypoxemia in some cases will alleviate dyspnea. Oxygen is sometimes prescribed for non-hypoxemic patients to relieve dyspnea.

When you have heart failure, your heart does not pump blood as well as it should. So, it does not send enough oxygen-rich blood to the rest of your body.

Oxygen therapy increases the amount of oxygen sent to your body’s tissues. This helps reduce your heart’s workload. And, in most cases, critical Covid-19 patients died due to cardiac arrest.

Jaipur Golden Deaths: Case Study
The City Jaipur Golden Hospital reported 21 deaths on the intervening night of April 23-24 in Delhi. The news sent shock waves across the city and national media. Several hospitals in Delhi including Sir Ganga Ram Hospital, Max Hospital, Shanti Mukund Hospital, Batra Hospital reported short-supply of medical oxygen.

Matter reached the Delhi High Court as six aggrieved families moved a plea through their counsels Sahil Ahuja and Siddhant Sethi. The government constituted a four-member committee headed by Prof (medicine) Naresh Kumar of the Maulana Azad Medical College and the Lok Nayak Jai Prakash Narayan Hospital.

The panel had to examine the case-sheets of all such patients and to determine whether the cause of death was due to shortage of oxygen. The hospital sent information pertaining to the 21 such patients whose deaths occurred in their hospital on April 23 and 24, in response to the mail from the Director General of Health Services (DGHS).

Following the order passed by a high court bench of Justices Vipin Sanghi and Rekha Palli, the Delhi government had directed hospitals and nursing homes to send details of patients whose death occurred due to shortage of oxygen.

  • After examining the records, the committee observed that all the reported patients were suffering from Covid-19 and the deaths occurred in over a seven-hour period.
  • It found that almost all of them were already very sick and critical, either from the time of admission or during the course of their stay in hospital even prior to the evening of April 23.
  • Many of the reported patients had one or multiple co-morbidities such as heart-related ailments, diabetes, hypothyroidism and hypertension, the committee said.
  • All these patients were receiving some form of oxygen therapy or ventilator support during their hospital stay, the committee said in its report.
  • The report said that case records showed that all these patients were given supplemental oxygen till resuscitation or death and that there was no mention of shortage of oxygen in any of the case sheets.
  • The cause of death in all 21 cases has been uniformly mentioned as respiratory failure in the pro forma submitted by the hospital.
  • However, the cause of death recorded in case-sheets was different from the cause mentioned in the submitted pro forma. There was no mention of oxygen shortage in either of the submitted pro forma or in the case sheets.

Shortage of drug was recorded in case-sheet of one patient. However, shortage of oxygen, if any, was not recorded. In situation where even drug unavailability was recorded, the committee wonders why the shortage of life saving oxygen, if any, was not recorded, the report said.

Now, the experts say if someone is saying that patients were getting supplementary oxygen supply, how anyone is going to establish whether the patients were actually getting the required oxygen flow or not.

Required availability or supply and reduced supply just to avoid complete breakdown are two different things. Reduced flow, just to buy some time, could be prove fatal for critical patients, the experts say. India Today

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