On July 21, 2021, India reported close to 4,000 fresh COVID-19 deaths, taking the official toll to 4,18,480. But this number is a gross underestimate of the true COVID deaths in the country, a new study says.
The report was published by Arvind Subramanian, former chief economic adviser to the Government of INdia, and two other researchers at the Center for Global Development, a non-profit think tank based in Washington, and Harvard University.
What did the study find?
“Excess deaths” in India are likely close to 10 times what is currently being reported officially. The study pegged excess deaths (number of people who died beyond what is being recorded officially) between 3.4 million and 4.7 million from January 2020 to June 2021.
Researchers also said that as many as two million deaths occurred before the surge in April and May. “The fatalities were spread over a longer stretch of time, which muted the apparent severity. Failing to understand the scale of death, the report said, may have bred the collective complacency that led to the horrors of the second wave,” the study noted.
The estimated numbers likely make COVID-19 India’s worst humanitarian disaster since independence.
As per official numbers, India’s death toll is the world’s third highest after the US and Brazil. With an increase in deaths, India’s case fatality rate (CFR) has gone up to 1.34 percent. Case fatality rate is the proportion of COVID-19 infected people who have died.
On July 21, India’s total cases (incl. cured, active, deaths) stood at 3,12,16,337, out of which 4,18,480 have died, which is 1.34 percent (CFR).
It increased from July 20, when India’s total cases were 3,11,74,322 and the death toll was 4,14,482, which is 1.33 percent (CFR).
In fact, the CFR has been at 1.33 since July 13, 2021 and it was at 1.32 on July 12, 2021.
What did the study base its estimates on?
The study was based on three data sources:
1. Deaths from several states logged into the country’s civil registration system
2. Blood tests that show antibodies for the virus in India along with fatality rates in other countries
3. Nationwide household economic survey of nearly 900,000 people that is conducted thrice a year
Limitations of the study
1. The researchers admitted that pinpointing the number of deaths due to COVID-19 with confidence may be elusive. They, however, found that all estimates put the true toll of the pandemic at many times higher than the official death count.
2. They also cautioned that some of the methods used to come up with the estimates had weaknesses, like the economic survey omitting the causes of death.
3. The researchers also cautioned that virus prevalence and COVID-19 deaths in the seven states they studied may not translate to all of India, as the virus could have spread more in urban versus rural states and since health care quality varies greatly around India.
4. “Excess deaths” takes into account various factors surrounding death due to reasons like heart disease or diabetes because people were afraid to seek treatment during lockdowns, those who lost their lives due to pandemic stress etc, apart from those who died because of the virus directly.
What have other studies said about India’s COVID numbers?
SBI study: As per a research carried out by SBI, a large number of COVID deaths escaped counting all over the country due to lack of diagnosis in medical causes of deaths in nearly 35 percent of cases, as per trends of recent years. The study claims that owing to this lack of medical intervention, there has always existed a gap between registered deaths and estimated deaths.
The Economist: As per The Economist, India’s true COVID-19 death toll could be 5 to 7 times more than the official figures. A recent paper by Christopher Leffler of Virginia Commonwealth University in America, cited by The Economist, estimates that between 1.8 million and 2.4 million people have died from COVID-19 since the start of the pandemic.
University of Chicago and Duke University: Another study carried out by professors at the University of Chicago and Duke University, found that COVID-19 cases in the southern state of Karnataka are nearly 95 times more than reported. The researchers collected data from a representative sample of households in 20 districts in the state. The study claims, Karnataka alone had approximately 31.5 million cases of COVID-19 by the end of August, 2020, relative to 8 million reported nationally in India until February, 2021.
University of Washington study: As per a new study by the University of Washington’s Institute for Health Metrics and Evaluation, the actual number of COVID-19 deaths in India by May 5, 2021 could have been as high as 6,54,395. This is when the official number was pegged at 2,21,181, which is roughly a third of what the Institute for Health Metrics and Evaluation claims.
Union of Michigan and the Indian Statistical Institute: Almost 7 lakh people died during the current surge till May 15, 2021 as opposed to nearly 1.16 lakh deaths reported, as per a mathematical model proposed by a team of researchers from Union of Michigan and the Indian Statistical Institute. Their modelling studies suggested that India would have underreported cases by nearly 26.73 times and deaths by 5.77 times during the latest surge which commenced in March, 2021. In comparison, the underreporting of cases and mortality during the first wave was estimated to be 11.11 times and 3.56 times.
How ICMR data points to higher case load?
An estimated two-thirds of people in India have COVID-19 antibodies, as per a new ICMR serosurvey of 28,975 people. The study found that 67.6 percent were found to have antibodies, indicating past exposure to the virus. For the first time, minors in the age group of 6 to 17 years were also included in the serosurvey, with antibodies interestingly discovered in nearly half of them.
As much as 67.6 percent of the Indian population is 94,24,77,835 who may have antibodies in them (have tested positive) as per ICMR’s serosurvey, and this number is 30 times more than the total number of reported cases as of July 21, 2021, which is 3,12,16,337.
Underreporting of both infections and deaths is an issue that not just India, but every other country in the world faces. Even countries with widespread testing are not spared.
In May, 2021, the World Health Organization said that the actual COVID-19 death toll in the world could be double or triple the official number.
Implications of underreporting
A more accurate estimate of cases and deaths would give us a more accurate understanding of the virulence of new variants, like the Delta variant, which was first found in India last year. Health experts believe it is the Delta variant that amplified the surge in cases.
As of now, Delta is the cause of a spike in cases in the UK, and the variant has become the dominant one in the US.
Underreporting may have also led to collective complacency. Scientists have been warning about the potential for another wave, as many people have already dropped social distancing and the wearing of masks in recent weeks.
Will we ever know the true COVID death toll?
Collection of additional data is key here. India’s household surveys which collect information on family deaths, will likely fill in some of the death tally gaps. Also, census data should reflect the people who just vanished during the pandemic.
How will it help us?
The researchers say a more accurate picture of death counts will help us understand what went wrong from a public health and policy perspective during the pandemic. It will also help us figure out what could have ideally been done to restrict the death toll. It will give us the true scale and scope of the tragedy.
A realistic COVID death count will also throw light on the impact of vaccine inequality, wherein doses are not provided in a timely fashion to low-resource countries.
The researchers say it will also help us understand the ripple effects of mortality – such as erosion of confidence in the health system and state.
Also, “accurate accounting of death is also one of the simplest dignities. Knowing how and why your family member died is fundamental to grieving but also to knowing that they were valued by society — and their loss might help mitigate future harm,” one of the researchers said.