Coronavirus cases are rapidly increasing in Gujarat. More than 14,000 cases are being reported in the State daily while the healthcare sector is overwhelmed with high demands it is unable to meet. Furthermore, fatalities due to COVID are much higher than the State government’s official death toll. On April 15, Sandesh News aired a 50-minute interview with Gujarat Chief Minister Vijay Rupani. This video has been uploaded on YouTube in two segments. In the second segment at the 14-minute mark, the journalist asked, “There is one question that I must ask, please try to answer this question with an open heart so that the people of Gujarat gain some faith…Taking the example of Rajkot, the death toll is around 80. However, the government’s official death toll is very low. There is a large inconsistency between the toll and what is being reported by the government.” CM Rupani elaborated on the Indian Council of Medical Research (ICMR) guidelines related to recording deaths due to COVID-19. According to him, as per ICMR, the primary cause of death of COVID-19 patients who had pre-existing diseases like cancer and diabetes is not COVID-19. Rupani said, “As per ICMR, there are two reasons for the cause of death. The first is purely due to COVID and the second is due to comorbidity. For example, a patient who is 75 to 80 years old has cancer in the third stage. Their immunity is broken and if they get COVID and dies, then the cause of death is cancer as the primary reason and COVID is the secondary reason. Patients with 500 points diabetes are admitted. Therefore, the cause of death is diabetes and COVID is the secondary reason.” He added, “Therefore, a doctoral committee is formed to audit each death. They distinguish the cause of death as primary or secondary. For example, if 100 deaths take place and only 20 are reported (under COVID), then 80 are due to primary reason (non-COVID) and 20 is due to the secondary reason.” Gujarat CM gave the same statement to The Times of India on April 19 – “The method of recording COVID deaths has been stipulated by ICMR and all states, including Gujarat, are following it.” As per The Quint and Gujarat Samachar, multiple dead bodies are being simultaneously cremated in the State. The Print reported that the death tolls at Ahmedabad’s six crematoriums were at least 84 on April 16. However, the Health and Family Welfare Department of Gujarat reported just 25 deaths in the city. A day prior to The Print report, The Hindu reported that on April 16 state health bulletin recorded 78 deaths related to COVID-19. However, The Hindu found that at least 689 bodies were either cremated or buried following COVID-19 protocols on the disposal of bodies. India Today also looked into the allegations that Gujarat is under-reporting COVID-19 deaths. According to the channel’s on-the-ground assessment, the “toll could be a lot higher”. Reports from Varanasi, Bhopal, and Telangana exhibit a similar pattern. Alt News studied ‘Guidance for appropriate recording of COVID-19 related deaths in India’ (view PDF) by ICMR and the National Centre for Disease Informatics and Research (NCDIR) and found that CM Rupani’s statement is misleading. As per NCDIR director Dr Prashant Mathur these guidelines issued in May 2020. Page 3 states, “Patients may present with other pre-existing comorbid conditions such as chronic obstructive pulmonary disease (COPD) or asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes mellitus. These conditions increase the risk of developing respiratory infections and may lead to complications and severe disease in a COVID-19 positive individual. These conditions are not considered as UCOD (underlying cause of death) as they have directly not caused death due to COVID-19. Also, a patient may have many co-morbid conditions, but only those that have contributed to death should be recorded in Part 2.” Mathur told Alt News, “Death of a COVID-19 patient with comorbidity, such diabetes, and cancer, can happen due to COVID-19 as the contributing or underlying cause.” He also stated, “Irrespective of the cause of death it is important to use COVID-19 related mortality codes on Medical Certificate of Cause of Death (MCCD) forms to understand the impact of the pandemic accurately.” Expert opinion Alt News spoke to Associate Professor Chalapati Rao at Australia National University. Last year, he wrote a WHO editorial titled ‘Medical certification of cause of death for COVID-19′. After reading CM Rupani’s statement to Sandesh News, he said, “In the process of explaining the ICMR guidelines, CM Rupani used the phrases primary and secondary cause of deaths.