Explained: How Gujarat classifies Covid-19 deaths for disbursal of ex gratia

Here’s how definitions of Covid-19 death differ with different authorities in Gujarat, other states and at the national level.

How is Gujarat disbursing Covid-19 ex-gratia compensation?

Following the Supreme Court’s rebuke earlier this week, the process of disbursing Covid-19 ex-gratia compensation has now been decentralised in Gujarat to ensure maximise efficient disbursement. Based on the health department and district officials’ inputs, the state health department has provided each of the 33 districts with the details of those considered official Covid-19 deaths. The state’s official count of Covid-19 deaths is 10,089. The legal heirs are being identified by the district officials in coordination with district disaster relief teams and revenue department and, in case of multiple legal heirs, affidavits are being sought so as to avoid civil disputes.

While application forms to seek ex-gratia compensation have been made available at district collectorate offices, the cases of families of the deceased counted as official Covid-19 deaths are being given first priority. For example, in Ahmedabad, of the 3,411 official Covid-19 deaths (93 in rural and 3,318 in Ahmedabad municipal corporation jurisdiction), 840 forms were distributed among the eligible beneficiaries. Of these, 176 have returned the forms duly completed for further processing.

The state revenue department, on November 25, also notified that the ex-gratia amount has to be deposited in the bank accounts of the next of kin within 10 days of receipt of the application from the claimant.

Supreme Court’s directions

In May this year, the apex court had directed the National Disaster Management Authority (NDMA) to recommend guidelines for ex-gratia assistance to the family of those who died of Covid-19, thereby giving the NDMA the liberty to fix the amount of ex-gratia assistance.

The court, in its order, had noted that those who died due to other complications while being Covid-19 positive would also be eligible to be considered as ‘died due to Covid-19’.

However, the Gujarat government, through a resolution on October 29 appointed Covid-19 Death Ascertaining Committees (CDAC), which would decide who was eligible for compensation among cases where the Medical Certification of Cause of Death (MCCD) of the deceased was either not available with the next of kin or the MCCD does not mention Covid-19.

This, the SC saw as ‘an attempt to overreach’ its directions, and clarified to the Gujarat government that the ex gratia amount has to be paid on production of evidence of the deceased being Covid-19 positive and the death certificate showing that death occurred within 30 days of the positive test of diagnosis. This compelled the government to amend its resolution.

The amended resolution of November 21 submitted to the apex court said that apart from those who have mentioned Covid-19 as cause of death in their MCCD, others eligible for ex-gratia compensation include the next of kin of those whose RTPCR/RAT/molecular test indicated they were Covid-19 positive and may have died due to other complications within 30 days of testing positive, either at an institutional or non-institutional set-up. This would also include those who died by suicide within 30 days of testing Covid-19 positive although deaths due to accidents, poisoning, homicide, etc. are excluded. Apart from the prescribed tests, the deceased patient who may have also been diagnosed as Covid-19 positive through other clinical investigation, for example with a chest scan, would also be eligible for the compensation, provided there is documented proof of a medical practitioner diagnosing him/her as Covid-19 positive based on clinical investigations, along with submission of death certificate.

However, the Supreme Court is still displeased with the amended notification, which is now due for further amendment and simplification.

Who gets compensation and what does this mean for Covid-19 death figures?

In the beginning of the pandemic, the official bulletin was recording all deaths of those testing positive for Covid-19 as Covid deaths. However, a month after the pandemic broke out (April 2020), the state government decided to only classify deaths as caused due to Covid-19 where it was the immediate cause while leaving out such deceased who had comorbidities.

However, now with the notifications of ex-gratia compensation expanding the definition, the number of the ex-gratia claimants would increase manifold. Those qualifying as ‘died due to Covid-19’ under the ex-gratia compensation clause would include those who may have died due to other complications, say a heart attack while being Covid-19 positive, those who died following discharge from an institutional set-up owing to resolution of Covid-19 symptoms, those whose MCCD forms mention Covid-19 as an underlying cause of death or under ‘other significant condition’, those who continued to be admitted beyond 30 days and died, and several such scenarios.

The Gujarat health department under secretary Atul Patel said the department is in the process of bringing out ‘comprehensive guidelines’ so as to make the process as simple as possible and accounting for multiple scenarios, following Supreme Court’s opinion in an order of November 22 that the November 21 resolution of the health department requires ‘further modification and/or clarification’.

Congress’ claim

The main opposition, Congress, claims three lakh persons have died of Covid-19 in Gujarat and has demanded the government to pay Rs four lakh as ex-gratia to the families of each of these victims. The claim is perhaps based on responses to RTI applications on death registers from 68 of the 170 municipalities in Gujarat by the Reporters’ Collective, which estimate excess deaths in Gujarat to the tune of 2.81 lakh — an estimate that Congress MP Rahul Gandhi also cited in a video message on November 24.

Reacting to Gandhi’s statement, state government spokesperson Jitu Vaghani had said that there was a difference between who had died of Covid-19 and who had died during the Covid-19 pandemic.

Punjab Chief Minister Charanjit Chhani, too, tweeted on November 24 that he has urged the Prime Minister to ‘implement his previous order of disbursing ex gratia of Rs 4 lakh’, adding that his state government was ready to ‘commit to uphold the state’s share of 25 percent of the compensation amount per person’. Maharashtra Congress chief Balasaheb Thorat also wrote to Maharashtra CM Uddhav Thackeray making a similar demand.

The ICMR’s guideline of recording Covid-19 deaths

Covid-19 deaths were also subject to death audits in Gujarat as early as May 2020, after which other states and union territories also undertook a similar move. It was only after the deceased was deemed fit to qualify as ‘death due to Covid-19’ by the death audit committees that the number was being counted in the state’s official count. This was in contravention of ICMR’s advisory that had exemplified how ‘COVID-19 is reported to cause pneumonia/acute respiratory distress syndrome (ARDS)/cardiac injury/disseminated intravascular coagulation and so on,’ and while such complications may lead to death which might be recorded as immediate cause of death, it was likely that COVID-19 had led to such complications and thus ‘COVID19’ too should be captured in the ‘antecedent cause’ of MCCD forms.

ICMR in its guidelines had stated that ‘Robust cause of death information in a population is useful for understanding disease burden estimations, and explains trends in the health of populations.’

Definitions of Covid-19 death in other government compensation schemes

The insurance scheme under Pradhan Mantri Garib Kalyan Yojana Package covers health workers who lost their life due to Covid-19, and also accidental deaths, such as road accidents, of those who died while being on Covid-19 duty. The package also covers private hospital staff, retired staffers or volunteers, staff from local urban bodies, contract and daily wage staffers, ad hoc and outsourced staff requisitioned by state or central government hospitals, autonomous hospitals of Centre and states, AIIMS & Institute of National Importance and hospitals of Central Ministries specifically drafted for care of Covid-19 patients. For the deceased’s next of kin to claim the Rs 50 lakh package, an application is required to be submitted to the municipal commissioner or district collector, who in turn would issue a one-page certificate attesting to the veracity of the claims and upon confirmation from the health authorities/department concerned that the deceased indeed was on Covid-19 duty and lost his/her life while on duty. The certificate is then sent to the state health department which in turn is then sent to the insurance company, which disburses the amount. Beneficiaries of this package will also be eligible to claim the ex-gratia amount of Rs 50,000. Some states, such as Punjab, also had similar schemes for government employees, paying up to Rs 50 lakh, for those who died on the line of duty.

What have other state governments done?

Based on publicly available notifications, it appears scrutiny by CDAC except for death certificates explicitly mentioning ‘death due to Covid-19 is being followed as the norm at present. For example, in West Bengal, a similar system of scrutiny as implemented by Gujarat, appears to be in place as per a November 18 notification of the disaster management department. The notification states that claimants have to attach death certificate with their application wherein the certificate ‘certifies the cause of death to be Covid-19’ and the claims for Covid-19 deaths will be corroborated with the list of death certificates issued and authenticated by the chief medical officer of health, which will then be forwarded to the DDMA.

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In case of grievances, the CDAC in West Bengal will ‘propose necessary remedial measures including issuance of amended Official Document for Covid-19 death after verifying facts in accordance with guidelines…’

Union Territories of Puducherry and Andaman and Nicobar Islands, too, are following a similar method. The Telangana health department has also issued a government order dated November 8 that outlines a similar format. This uniformity is primarily owing to Government of India’s guidelines following the Supreme Court’s order to simplify guidelines ‘for issuance of official document relating to Covid-19 deaths’, wherein the GoI guidelines had made a provision of submitting a ‘petition’ to the district collector by the next of kin of the deceased for issuance of official document for Covid-19 deaths. Such petitions would be subject to scrutiny by the district-level committee, that is the CDAC, before the document is issued.