India’s COVID-19 death toll will significantly increase once all the applications for ex gratia compensation are processed
Almost all the states have begun accepting applications for ex gratia compensation of Rs. 50,000 for COVID-19 deaths. States have issued guidelines establishing district-level committees for redressal of grievances & grant of compensation. If the Kerala experience is any indication, the COVID-19 death toll across the country will significantly increase once the process is complete.
Recently, the Supreme Court (SC) approved the Union Government’s announcement of payment of Rs. 50,000 as ex gratia compensation to the next of kin of those who died of COVID-19. The SC added that no State should deny the ex gratia compensation to the kin of persons who died of COVID-19 on the sole ground that the death certificate does not mention COVID-19 as the cause of death. Following the apex court’s orders, States have begun issuing notifications and setting up committees with respect to the issuance of death certificates & granting ex gratia compensation.
4.64 lakh persons have reportedly died in India due to COVID-19
Globally, the COVID-19 pandemic has claimed the lives of more than 51 lakh persons as of 16 November 2021, since the outbreak in late 2019, according to the World Health Organization’s dashboard. India has reported the second-highest number of deaths in the world with over 4.64 lakh deaths due to COVID-19 as of 17 November 2021. These death numbers are contested, and questions have been raised in multiple quarters about the actual number of deaths due to the pandemic. It is in this context the announcement of ex gratia compensation assumes importance as many deaths which may not have been recorded as COVID-19 deaths earlier may come to light increasing the overall death toll.
India declared the pandemic as a Notified Disaster & is providing assistance under SDRF
In March 2020, at a time when the cases began to increase in the country and little was known about the coronavirus & the disease, the Ministry of Home Affairs declared the pandemic a ‘Notified Disaster’ for the purpose of providing assistance under State Disaster Response Fund (SDRF). Noting this, pleas were heard in the Supreme Court seeking compensation for families of persons who lost their lives due to the coronavirus disease or complications related to it, as Section 12 of the Disaster Management Act (DMA), 2005 has a provision of minimum standards of relief to be provided to the persons affected by the disaster, including ex gratia assistance on account of loss of life.
SC asked NDMA to come up with uniform guidelines for ex gratia compensation
The Union Government initially informed the apex court that payment of ex gratia compensation to all deceased persons due to COVID-19, is beyond the fiscal affordability of the Governments, as the finances of State Governments and the Central Government are under severe strain, due to the reduction in tax revenues and increase in health expenses on account of the pandemic. However, the Supreme Court noted that some states such as Bihar were paying Rs. 4 lakhs as ex gratia assistance to the family members of the persons who have died due to the COVID-19 pandemic, while Karnataka was paying Rs. 1 lakh, and Delhi was paying Rs. 50,000. To avoid discriminatory treatment, the court held that it would be appropriate for the National Disaster Management Authority (NDMA) to recommend uniform guidelines while providing for the minimum standards of relief in the form of ex gratia assistance on account of loss of life, as mandated under Section 12 of the DMA Act.
The procedure for issuance of the death certificate for COVID-19 related death has been simplified
Furthermore, the Court also added that there was a need for a simplified procedure for issuance of a death certificate/official document in the case of a COVID-19 related death. In other words, the death certificate is to be issued to the family members of the deceased who died due to COVID-19 stating the cause of death as “Died due to COVID-19”, including if their death must have been due to other complications resulting from COVID-19. As per the guidelines issued by Union Health Ministry & ICMR, and NDMA, the following four types of cases have been listed to be treated as COVID-19 deaths.
- Cases that are diagnosed as COVID-19 positive through a positive RT-PCR/Molecular Tests/RAT or clinically determined through investigations in a hospital/in-patient facility by a treating physician, while admitted in the hospital/in-patient facility.
- Cases where the death takes place outside the hospital/in-patient facility within 30 days from the date of testing or from the date of being clinically determined as a COVID-19 case, will be treated as a death due to COVID-19.
- COVID-19 case while admitted in the hospital/in-patient facility and who continued to be admitted beyond 30 days and died subsequently.
- COVID-19 cases which are not resolved and have died either in the hospital settings or at home, and where a Medical Certificate of Cause of Death (MCCD) in Form 4 & 4A has been issued to the registering authority, as required under Section 10 of the Registration of Birth & Death (RBD) Act, 1969, shall also be treated as COVID-19 death.
It should be noted that irrespective of the cause of death mentioned in the death certificate if a family member satisfies the eligibility criteria listed above, no State can deny the ex gratia payment of Rs. 50,000 provided the required documents are furnished.
The guidelines also add that States/UTs must set up a grievance redressal committee at the district level, comprising government officials, medical experts, and a subject expert for issuing the COVID-19 death certificate. In case of grievances with respect to death certificates, the committee will come up with remedial measures including the issuance of an amended certificate. The grievances should be disposed of within 30 days of submission.
States including Kerala, Telangana, and UP have issued relevant guidelines
Following the issuance of fresh guidelines for declaring COVID-19 deaths, many States including Kerala, Uttar Pradesh, Odisha, Telangana, Himachal Pradesh, Chhattisgarh, have issued guidelines for the issuance of COVID-19 death certificates, setting up of COVID-19 Death Ascertaining Committee (CDAC), and application for the ex gratia compensation. All these States have constituted CDACs at district levels. The District Disaster Management Authority has been authorized by the states to disburse the ex gratia compensation. The applications for the compensation are to be submitted at the District Magistrate.
The Kerala government has launched a portal for filing online applications from 10 October onwards. In fact, the state also provides an option for persons who already have death declaration documents, to apply for the death certificate in the new format prescribed by the Union Health Ministry.
Nonetheless, there is still some uncertainty with respect to the Government’s new guidelines. The basis of verification of the appeals to ascertain if the death was due to COVID-19, is still not clear. We wrote to the Directorate of Health Services of Kerala seeking clarification and this story will be updated when a response is received.
Overall COVID-19 death toll likely to increase
As noted earlier, all the states would have to revise their COVID-19 death figures based on the number of applications filed for ex gratia compensation over the next few months. The families of victims whose death may not have been counted in the official death toll are expected to come forward and submit the application for ex gratia compensation. The actual death toll due to COVID-19 in each of the states would only be clear once this entire process is complete. All this means that the overall death toll due to COVID-19 will likely increase in every state as witnessed in the case of Kerala.
About 1 in 5 deaths in Kerala is reported following the new guidelines
Since 22 October 2021, Kerala has been reporting deaths due to COVID-19 in three different categories. The daily COVID-19 bulletin categorizes deaths into the following groups
- Number of deaths reported on that day
- Number of deaths declared through appeal (as per G.O.(Rt) No.2110/2021/H&FWD dated 29 September 2021)
- The number of deaths through the declaration of pending deaths of cases up to 18 June 2021 when the cases were reported offline (as per G.O.(Rt) No.2219/2021/H&FWD dated 14 October 2021, to ensure that the delayed and incomplete data reported by Hospitals are also recorded online).
The state has reported a total of 36,087 deaths as of 16 November 2021 since the outbreak of COVID-19. This number includes 3625 deaths declared through appeals and 3779 deaths that were reported in the offline mode before 18 June 2021. In other words, if the option for filing appeals for getting a COVID-19 certificate and recording pending deaths had not been available, the state would have reported 7,404 fewer deaths due to the pandemic which is about one-fifth of the total deaths in the state. Close to 20% of the deaths would have gone unreported if not for the new mechanism. According to the state’s COVID-19 death information system dashboard, over 24,499 appeals have been received of which 7816 have been processed and 16,683 are still in progress. If these pending numbers are any indication, the overall death toll in Kerala could increase significantly once the processing of all pending appeals is complete.
Under-reporting is the least in Kerala compared to other states
It should be noted that Kerala is the state which had the least undercounting of COVID-19 cases in the country, according to an analysis of ICMR’s serosurvey. While states such as Uttar Pradesh detected 1 case in 100, and Bihar detected 1 case in 134, Kerala detected 1 in 6 cases and Maharashtra detected 1 in 12 cases. This implies that the actual deaths and rate of infection in the country is significantly higher than what gets reported.
If the Kerala experience is any indication, the COVID-19 death toll across the country will significantly increase once the process of filing appeals and disbursement of compensation is complete.