Not just missing COVID deaths, TN not recording WHO mortality codes

Many state hospitals are not recording a mandatory World Health Organisation (WHO) code 'U07.2' in COVID death medical certification, as per the guidelines of the Indian Council for Medical Research

A government hospital Dean told The Federal that they have just recently received the communication to use WHO mortality codes on death certificates issued by them. The Representational photo PTI

It’s not just massive under-reporting of COVID deaths that has come to light in Tamil Nadu. But more importantly, medical officials in many state hospitals are not recording a critical World Health Organisation (WHO) code ‘U07.2’ in COVID death medical certification, as per the guidelines of the Indian Council for Medical Research (ICMR).

This issue has been raised by Arappor Iyakkam, a Chennai-based NGO.

The organisation released a study on June 15 based on data collected from six hospitals, which claimed that Tamil Nadu state has most likely under-reported COVID deaths. The number of deaths was compared to the death certificates issued by these hospitals for the month of April and May for the years 2020 and 2021. And, the NGO found that the deaths had been under-reported by nearly 8.4 to 9.8 times. In absolute numbers, this would work out to be between 1,08,721 and 1,26,841 deaths, against the reported number of 12,943 in the past two months of April and May this year.

Also read: Tamil Nadu: Covid deaths come down; vaccination picks up pace


According to ICMR, ‘as long as the person dies after developing COVID or has been diagnosed with its symptom, the term ‘COVID’ must appear in the cause of death’. This was conveyed to the concerned authorities as WHO norms which had to be strictly followed while recording the cause of death.

There are two codes used for marking COVID related morbidities. The first is U07.1 for patients who died after testing positive for COVID, be it whether they had the symptoms or not and whether they had comorbidities or not. The second code is U07.2 for patients who died but their test result was negative or awaited or inconclusive. If their test is negative but they had COVID related symptoms, they should be marked ‘Clinically Epidemiologically diagnosed COVID-19’ with code U07.2.

If a patient’s COVID test result is awaited but symptoms are present, their diagnosis should be ‘Suspected COVID-19’ with code U07.2. Again, if a patient’s COVID test is inconclusive but COVID symptoms were present, they should be marked ‘COVID probable’ with code U07.2.

Moreover, importantly, people dying of the above two mortality codes shall have ‘COVID’ as underlying cause of death in their Medical Certification for Cause of Death (MCCD) certificates.

“But on the ground the reality is entirely different. The officials are recording just U07.1 and that too, in a limited number of cases. Code U07.2 is not being recorded at all and it is almost nil. There is anecdotal evidence which suggests that medical officials are not recording even the first code,” said Jayaram Venkatesan, convener of Arappor Iyakkam.

Also read: After a long lull, vaccination picks up in Tamil Nadu

While the MCCD is provided only by government hospitals, death certificates are issued by a statutory authority. “It must be understood that death certificates being a public document, do not have cause of death and the MCCD form is where the cause of death should be reported. Therefore, efforts must be taken to ensure that the MCCD certificate is issued as per the ICMR guidelines and WHO codes must be used,” he reiterated. But hospitals seem clueless about the MCCD certificates, and in cases where they are issuing the certificates they are missing out in including COVID as per ICMR guidelines which is all causing a lot of confusion and resulting in massive under-reporting of COVID deaths.

Also, the lack of proper MCCD will result in families who lost their dear ones to run from pillar to post to get compensation, pointed out Venkatesan.

Talking to The Federal, one of the Deans of a government hospital (who preferred to be anonymous) said that a communication was received by the hospitals to use WHO mortality codes in the death certificate just a couple of days ago.

The Dean said that the death certificates are issued by the medical records department. “However, we used to issue the preliminary certificates just by recording ‘COVID’ and ‘Non-COVID’. Later, we started issuing ‘COVID’ certificates for persons who died purely of COVID. If a patient who died having co-morbidities but not affected with COVID, they were given ‘Death not due to COVID but other co-morbidities’. Sometimes, a person who don’t have any co-morbidities and not affected with COVID may die during a surgery. So, for the sake of the safety of doctors and nurses, we used to take a COVID test. We record that kind of deaths as ‘incidental COVID’, said the Dean.

She added that their government hospital just issues death certificates and not the MCCD. Though, the MCCD is a document which has to be provided by the government hospital to patients who have died of COVID.