COVID-19 deaths in Prayagraj: In city where nearly 1,200 died in April, authorities cite protocol for not registering their deaths

Over the past year, according to Uttar Pradesh government records, Prayagraj has recorded under 800 deaths. Meanwhile, the state has confirmed a total of 14,80,315 COVID-19 cases (with 2,45,736 active ones) and a total of 15,170 deaths. The ground reality in Prayagraj is quite different, with cemeteries and crematoria there testifying to a far larger number of deaths: As many as 1,194 bodies were cremated at a large crematorium in Prayagraj between 1 and 30 April.

According to a member of the crematorium's management, some of the bodies also belonged to non-COVID victims. Regardless, what accounts for the nearly 900 extra bodies at a crematorium where the normal number of bodies per month is around 300. In order to get to the bottom of the matter, this correspondent spoke to the management of crematoria and cemeteries, ambulance drivers, health experts and government official.

A number of people quizzed about the second wave of COVID-19 point to 20 April as the date on which the death toll rose. According to data released by the district administration, 12,061 COVID-19 tests were conducted in Prayagraj on that day. The total number of positive cases was 2,122, while 1,697 patients were discharged. A total of 13 deaths were recorded. The number of deaths recorded by the government from 20 April to 7 May was 259, with a peak of 25 cases on 30 April.

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If we assume that the toll provided by the government official is correct, then another question arises: Why did the district administration not increase the number of tests to fight the second wave? The average number of tests conducted between 20 April and 7 May was around 11,710. The highest number of daily tests was recorded at 15,599 on 30 April and the lowest on 7 May at 9,333. Despite the arrival of the second wave of COVID-19, the rate of testing has not really increased. According to Census 2011, the total population of the Prayagraj district is 59,54,390, whereas the total population of the city is 11,12,544. At 11,710 tests per day, there's no chance of making so much as a dent in the district's population.

The COVID officer at Prayagraj's SRN Medical College, Dr Mohit Jain said that there are no hospitals as well-equipped as this one in the neighbouring six to seven districts. As a result, this hospital also carries the burden of other districts. "In such a situation, our hospital has 525 COVID-19 beds. If any patient is in serious condition at a private or government hospital, s/he is referred to us here. That is why the tolls you see coming from our hospital are the highest in the area."

Jain continued, "In spite of not having space, we try and accommodate all patients and send accurate numbers to the district administration. The deaths registered at Rasulabad, Daryaganj and other such crematoria are a result of people's own mistakes. After antigen tests came back negative, people considered themselves healthy despite being told that they were 'COVID-19 suspects' and in need of home isolation."

And as their health began to deteriorate, the COVID officer added, they began to arrange for oxygen at home instead of going to the hospital. "There are many such patients. And by the time they reach the hospital, it is too late, and eventually they die. As a result, the government does not have a record of COVID-positive patients, and so, the data relating to deaths falls short."

Kameshwar Nishad, who has been managing the cremation process at Rasulabad Crematorium for several years now, said, "The situation is comparatively normal now. Otherwise, from 1 to 30 April, 1,194 bodies were brought to the crematorium. Most of these bodies came in between 20 and 30 April. The situation is similar in five other crematoria in the city. On normal days, around 300 bodies used to be brought every month. But then, they started to bring in 30 to 40 bodies every day. And then this number soon increased to 50 or 60."

"On 24 and 25 April," he continued, "The number of dead bodies increased to 100. You can guess this by the number of cremated bodies in the crematorium. On 24 and 25 April, 20 to 25 pyres were burning at one time. On normal days, we used to supply 40 quintals of wood per month, but when the death toll increased in April, we supplied around 150 quintals for pyres. Actually, among the bodies coming here, no one was being treated. They used to come from home. So, whether or not they were infected with COVID-19, I cannot say, but this number was much higher than the deaths on normal days."

A pyre burning at the Phaphamau Crematorium. Firstpost/Mohammad Sartaj Alam

People of Prayagraj to whom this correspondent spoke said that funerals for COVID-19 victims from hospitals took place at the Phaphamau Crematorium. The owner of an ambulance transporting the body of a COVID-19 victim said that when coronavirus deaths were at their peak, he transported three to four dead bodies a day. Another ambulance worker said, "Ten days ago, I delivered 60 to 70 dead bodies to the cemetery and crematorium in a week. These bodies were not from the hospitals."

Dimple Panda used to conduct funerals on the cremation grounds of Panda Phaphamau. He said, "Initially, when the corpses of COVID-infected people started coming to Phaphamau, the superintendent of police asked us, members of the Panda community, not to come here. We were also afraid because we have a family. But on 26 April when the mother of a government official succumbed to COVID-19, I was called to perform her last rites."

He continued, "We conducted her last rites from a distance. At that time, five pyres were burning in front of me. Since then onwards, I sit at the 'Isnan Ghat', where I complete the rest of the ritual after the funeral. Every day, 10 to 15 people come to me after the cremation of their corona-infected patient at 'Isnan Ghat' located nearby. This number does not mean that only 10 to 15 bodies come for last rites. Actually, after the funeral, people voluntarily complete the bath at the 'Isnan Ghat' with the help of other Pandas of their choice."

During the second COVID-19 wave in Prayagraj, undercounting of deaths has been witnessed as in other districts of Uttar Pradesh. Chairman of the Kala Danda Cemetery at Prayagraj, Javed said, "This graveyard of ours is a part of Waqf. I've never seen such a situation here. This time the number of infected was larger than in the previous wave. People could not get to an OPD facility when they had early symptoms, such as a cold and cough. When their symptoms worsened, they needed oxygen and were unable to find beds in the hospital because the district administration was not ready for this situation."

"After the death of the patients who somehow got beds in the hospital, the hospital sent their bodies," he elaborated, "During the first COVID-19 wave there was a protocol, under which bodies were sent to the cemetery. This time the bodies went home first. They were given the last bath as per Islamic rituals and as a result, the infection spread, leading to an increased number of deaths at home. If there is no death registered in government records, how will this large number appear in the records of the district administration?"

He maintained that the large number of deaths was down to COVID-19. In normal times, 30 to 35 bodies used to be brought to the cemetery, but the number ballooned to 15 per day during the second wave. "There are 10 more cemeteries in Prayagraj, where around 50 bodies are being buried daily. If these deaths aren't due to COVID-19, what is the reason for a curfew in the city?" asked Javed.

A member of the Daryaganj Crematorium management said, "COVID-infected bodies that come from the hospital are not cremated here. We send them to Phaphamau. Most of the bodies come to us after deaths at home. The situation has worsened since 20 April. Earlier, we used to have 30 to 35 bodies a day, but the number has spiked. Now 80 bodies come every day. Whatever bodies were cremated here, we had to manage without a PPE kit. The question is, who will give us a kit? In such a situation, in the name of safety, we all go home and take a bath with hot water and wash clothes in hot water and Dettol, leaving the rest to God."

The Rasulabad Cemetery in Prayagraj. Firstpost/Mohammad Sartaj Alam

A private practitioner by the name of Altaf told this correspondent that he had not seen such a situation in his 20 years as a professional. "A parent brought his 17-year-old son to the hospital where I work, and started pleading for us to save his life. I asked him to admit his son to a government hospital, because the order is that oxygen will be given only to government COVID-dedicated hospitals. Hearing this, he started weeping, so I checked the boy and found that he died due to low oxygen. I have not seen such a death in my career."

"I lost my grandfather due to a lack of oxygen," he continued, "In Prayagraj, the cost of refilling oxygen was once Rs 300, but in the second wave of COVID-19, the figure rose to Rs 500. While an oxygen cylinder costs Rs 8,500, it goes for Rs 40,000 on the black market. This has only happened due to a lack of control by the district administration over such a situation. I am a doctor, and for me whether it is one death, 100 or 1,000, a death is a death. It is imperative for the administration to open the eyes in time, or during the third wave, you (referring to reporters) will come again and ask for death figures the same way."

This correspondent then reached out to Dr Rishi Sahay, the district COVID-19 nodal officer about the published data that paints an inaccurate picture of the actual number of deaths. "The peak period of COVID-19 in our district has been from 20 to 25 April. Apart from the ones [who lost their lives] in hospital, those who were in our regular touch on the basis of positive case report and died in home isolation, were cremated at Phaphamau," he said.

"This number was under our supervision under the COVID-19 protocol and was made public every day. But, the figures of people who were at home was very high; they did not get a fever and were neither tested nor investigated. Their health deteriorated and they died. We presumed that such people were COVID-positive. But, we did not have evidence of that. We could not take such people under the COVID protocol," added Sahay.

"We were helpless," he continued, "People talk about undercounts, but we never hide anything. Actually it is a technical thing that people do not understand. If people had symptoms of COVID-19 on the basis of X-rays and CT scans, they were kept in the COVID ward. Then they died. They were never investigated as COVID patients, and so they were not registered as such on our portal. That is why they aren't counted on the COVID-19 record. A number of such deaths give people the wrong impression that we are hiding data."