The Indian Council of Medical Research (ICMR) has frowned upon the under-reporting of COVID-19 deaths and issued guidelines to ensure accurate recording. It said there were more deaths in Mumbai, but they were depressed by attributing many to the existing comorbidities (other diseases).

The National Centre for Disease Informatics and Research (NCDIR), a unit of the ICMR that runs the national cancer registry, in its guidance document showed how comorbidities in COVID-19 patients may enhance the risk of the disease, but it can't be termed as the underlying causes of death. It has also created India's first online platform to record hospital deaths.

Aligned with WHO's International Classification of Disease-10 on COVID-19 mortalities, the document says, “It is likely that COVID-19 is the underlying cause of death that led to acute respiratory distress syndrome or pneumonia in most deaths. In these cases, the virus must be captured as the underlying cause of death. Acute respiratory failure is a mode of dying."

The guidance adds that some patients may be present with pre-existing comorbidities like asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes. "These conditions increase the risk of developing respiratory infections and may lead to severe disease in a COVID-19 positive individual. These conditions are not considered the underlying causes of death, as they have directly not caused death due to COVID-19," the document notes. It says some states are auditing deaths and attributing many to comorbidities.

Sources said West Bengal tried such an auditing, triggering a controversy over under-reporting of the mortality. The auditing was later revoked.

Now, Brihan-Mumbai Municipal Corporation is learned to be auditing deaths with a potential risk of under-reporting, the sources added.