No clinical audit of the dead | The Daily Star
12:00 AM, May 08, 2020 / LAST MODIFIED: 12:36 AM, May 08, 2020

No clinical audit of the dead

Experts say crucial info for helping Covid-19 patients being lost

A total of 199 people have died of Covid-19 so far but the details of these deaths have not yet been examined, said health officials.

Though it is declared that the patients died of coronavirus, whether that itself was the main cause of death or if pre-existing, underlying conditions were, is not ascertained. This information, however, is crucial to treating coronavirus patients, said experts.

As these cases were not examined in details, what experts call a "clinical audit", the real cause of death remains unidentified, they said.

The Institute of Epidemiology, Disease Control and Research (IEDCR) is assigned to examine the cause of death in each of the cases, said the Directorate General of Health Services (DGHS).

"The organisation is busy with testing and that's why it could not concentrate more on research activities," said Abul Kalam Azad, director general of the DGHS.

"We have already instructed they concentrate more on this, aside from testing."

Since the beginning of the Covid-19 outbreak in the country, IEDCR was solely in charge of testing and identifying coronavirus patients.

Testing facilities were later decentralised but IEDCR continues to conduct testing with an immense workload at the moment.

Meerjady Sabrina Flora, IEDCR's director, said that it has not been possible to scrutinise the coronavirus fatalities.

"In the case of dengue patients, for example, a death review committee assesses the causes of death," she said.

Such a method is not being followed for coronavirus patients, she said.

"We are collecting data on comorbidity [the number of other conditions a patient has] for analysis but it is not being done in the same format as that of dengue patients for example."

However, experts said, while the IEDCR is mainly responsible for studying the disease and its effects, hospitals also have a role to play.

A clinical audit, or a death audit, is important because it gives an understanding to what happened and why from the patient's history and their treatment experience at hospitals.

Prof Muzaherul Huq, former adviser (Southeast Asia Region) at the World Health Organisation, said a clinical audit should be performed for all Covid-19 deaths.

"This should be done to identify the cause of death and also weaknesses in hospital services," he said.

The clinical audit helps go beyond the numbers of deaths and ratio of deaths to the number of case, to determine the inciting factors and take measures on how these deaths could have been avoided

The health specialist said if the exact cause of death is not identified, undertaking the proper intervention for patients will not be possible.

"We see that there have been no deaths of coronavirus patients in Vietnam, Nepal, Bhutan and some other countries," he said.

"So, what the actual cause of death is should be identified so as to act properly."

Experts said a committee can be formed to ascertain the cause of death pertaining to coronavirus victims.

Eminent medicine specialist ABM Abdullah said a good number of coronavirus victims died with severe and aggressive pneumonia and other complications, including old age.

Although, globally, the elderly have been the worst victims of Covid-19, in Bangladesh fatalities were found in almost all age groups; this requires a detailed analysis of the cause of death in each case, he said.


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