Bihar missed out on 3,951 COVID victims, what is behind underreporting of deaths

The revision of deaths by Bihar meant that India reported the highest single-day rise in deaths with 6,148 deaths on June 10.

Bihar missed out on 3,951 COVID victims, what is behind underreporting of deaths
Bodies of the deceased buried on the banks of Ganga river, allegedly due to shortage of wood for cremation, during the second Covid wave, at Shringverpur Ghat in Prayagraj, UP, on May 15, 2021. (Photo credit: PTI)

New Delhi: Deaths caused due to COVID-19 in India have once again been mired in doubts with Bihar adding 3,951 uncounted deaths to its toll on June 9.

The revision of deaths by Bihar meant that India reported the highest single-day rise in deaths with 6,148 deaths, taking the country’s overall death toll to 3,59,676.

Though close to 4,000 deaths were added to the national tally, it did not affect the overall case fatality rate (CFR) of the country significantly.

The national CFR rose from 1.22 percent to 1.23 percent after Bihar’s figures were included.

However, the eastern state’s death toll increased by as much as 73 percent. Its CFR saw a jump of more than half a percentage point, from 0.76 percent to 1.32 percent.

Bihar death toll

June 8: 5,424

June 9: 5,458

June 10: 9,429

June 11: 9,452

(Source: MoHFW)

It is unclear when these deaths were reported in the state but the revision in death toll follows the Patna High Court pointing out the discrepancies in the reporting of deaths in Buxar district on May 17.

Additional secretary (health) Pratyaya Amrit said the additional were unaccounted for and included deaths at private hospitals, under home isolation, and post-Covid complications.

Maharashtra too keeps updating its Covid casualty numbers every month. Its daily death count also includes deaths from the previous two to three weeks.

Leader of the opposition in the Tamil Nadu Assembly Edappadi Palaniswami on June 8 claimed deaths were being ‘wrongly’ certified in the state.

The Madras High Court on Friday said that in Tamil Nadu, there were reports that unless a COVID-19 positive test report was issued for a patient, the subsequent death would not be recorded as a COVID-19 death.

Why under-reporting of fatalities

So, what could be the reasons behind lag or underreporting of deaths by states?

In a scenario when the patient’s test result is awaited or inconclusive and the person dies with suspected COVID-19, the death due to the pandemic may not be confirmed.

People may not come forward to report a death if the person died at home with reasons ranging from stigma to lack of awareness about reporting the death.

Many times, hospitals do not mention that a person died of COVID because of comorbidities, this is in violation of Indian Council of Medical Research (ICMR) guidelines.

Also, relatives of victims prefer to take the body home and insist that the person not be declared as a COVID victim.

What could be the missed numbers?

A public health expert and professor who did not wish to be named told TV9 News that the unaccounted deaths could be two to three times more at least in some states.

“Prior to COVID-19, on a normal day at a crematorium about 20-30 percent spaces are full and the rest are vacant. In May, when we saw crematoriums overflow at many places, it means the increase is two to three times during the day.

At night too crematoriums were full, which means six times more if we take the 30 percent capacity utilisation benchmark,” the professor explained.

A newspaper in Gujarat brought to light the missing COVID victims in the state by reporting that between 1 March 2021 and 10 May 2021, the state recorded 4,218 deaths due to COVID.

But during this period 33 districts and eight corporations issued 1,23,871 death certificates.

Deaths may also be missed if a COVId victim’s last rites are performed in a city of which the person is not a resident.

Compared to 2020 two times more deaths were recorded during the same period in 2021, the paper reported.

Fatalities data essential to contain virus

Accurate reporting of deaths is pivotal to know the actual situation of the pandemic and avoiding future casualties.

“…it’s an important tool for epidemiologists? Not only that. To deal with a problem we must first understand how bad it is..,” Dr Varun C, Consultant Cardiologist, tweeted earlier.

To accurately predict the course of the contagion data on deaths and cases is a must for mathematical modelling.

“The government should first report how many individuals died due to causes other than Covid. The last five years’ average should be compared with the number of cremations being held each day.

Suppose the average is 250 per day and now cremations are 500 per day that means 250 additional deaths have happened, so, that has to be explained,” says the public health expert.

Questions have been raised about the under-reporting of cases and deaths of COVID-19 pandemic by India with a report in a top American publication citing 600,000 deaths on the conservative scale.

The report claims it used data from the three nationwide serosurveys that tested antibodies.

The findings of the third survey suggest that one in five individuals in the country have contracted the disease until January 8, 2021.

The government of India has called the report by the American publication “baseless and absolutely false as it is not supported by evidence.

“The country has a robust system of registering and reporting deaths,” Lav Aggarwal, Joint Secretary, MoHFW said on May 27.

In February, an Indian newspaper reported that Bihar fudged records of COVID-19 testing with fake names and dodgy details leading to underreporting of cases.