Thread by @just1doctorwala

I've seen a lot of people asking this question. It is a valid question & shouldn't be dismissed outright. However the answer to this is a little nuanced than straight forward. If you have a few minutes allow me to explain. I hope I don't step on any toes

https://twitter.com/kunfaaya/status/1248095051546165249?s=20

Let me start with the obvious
Ask yourself,
Honestly

Do you trust government institutions...
REGARDLESS of who the government of the day is?

If you are sick and can afford it, would you go to a Government Hospital or a Private hospital?

So it all boils down to TRUST DEFICIT

When you already have a trust deficit, add to the mix political, social, religious and cultural agendas...

What are you left with?

Let us put aside all that for now
Let us accept a few things

1. There is distrust of Governmental setups
2. Government spending on public health is EXTREMELY poor
3. As a result the public health care system cannot cope
4. Many people don't avail of these services
5. Reporting systems from these facilities of those who do are inaccurate

With all this in mind, let us take the current COVID19 pandemic we are facing

During the initial stages we as a nation were simply not prepared to handle it. Given the points I mentioned above, this is a fact which cannot be denied

As a result, testing rates were low

The health authorities were doing the best they could with the limited resources available

fact is we simply didn't have enough test kits or PPE or equipment etc

so they limited testing to very rigid criteria

Many cases were missed.

and this is where the question of deaths arises

unfortunately, this point should be taken as a fact

https://twitter.com/FreedomSutra/status/1248097138476802048?s=20

Many deaths would have happened
Based on this, 8.4 million people die every year in India which comes to 22,500 per day approximately.

and when we look at causes (image 2)
6.2% of deaths are pneumonia (respiratory infection)

and what are the common causes of death we are seeing in COVID19 confirmed cases?

This is in decreasing percentage
• Respiratory failure
• Septic shock, multiple organ failure
• Cardiogenic shock (acute myocardial injury or myocarditis)
• Others

So as you can see cause of death in COVID19 patients is varied. So how can we assess the COVID19 deaths? What is the "death rate" of COVID19? Why are we seeing such a difference between Italy, USA vs India

The BBC did a beautiful article to explain this

hence it is entirely plausible that many deaths did occur but were diagnosed as other causes of death. Since those patients were never tested we will never know whether their deaths were COVID19 related or not.

bottom line is

to get an accurate figure across a population, it is necessary to test not just symptomatic cases, but asymptomatic people too. Having that data would give an accurate picture of how the pandemic is affecting whole populations, not just the sick.

so MORE TESTING!

That is where we come to the current availability of Rapid Antibody Testing kits and the government declaration to allow private institutes to start testing. This will help ramp up the testing and we will definitely see an increase in numbers of infected and those who die from it

TL:DR version
1. We were not testing enough before. Deaths which happened during that time might have been labelled with other common causes.
2. We are ramping up testing now so deaths cannot be hidden anymore
3. number will go up

Thank you for your time 🙏

link to the BBC article if anyone wants to read further

bbc.com/future/article…

And here we go
More and more people are having their diagnosis changed to COVID19 simply because they are being tested now. This from ICMR

After Coronavirus Test Shift, Medical Body ICMR's Data Shows Big Change - NDTV ndtv.com/india-news/in-…