12 states, UTs undercounted Covid deaths in 2022: Report

The surplus over the number of deaths that would have happened at the death rate seen in 2019, were higher than the Covid-19 tally issued by states in 2022

New Delhi: India registered 8.6 million deaths in 2022, the least deadly year of the Covid-19 pandemic. This represents a 15% decline from 2021, the deadliest pandemic year, with the death rate likely returning to pre-pandemic levels. This suggests mortality was normalising as Covid-19 infections became less severe and vaccines were deployed.

The CRS report shows India registered 8.6 million deaths in 2022 compared to 10.2 million in 2021. (Representational image)

However, signs of health system stress persisted due to the virus. Excess deaths, or the surplus over the number of deaths that would have happened at the death rate seen in 2019, were higher than the Covid-19 tally issued by states in 2022. This suggests that states undercounted deaths related to Covid-19. Data suggests at least 12 states and union territories evidently did so. Moreover, the proportion of deaths without medical attention remained elevated compared to pre-pandemic levels.

These findings come from two reports published on Thursday by the Office of the Registrar General of India (ORGI), under the ministry of home affairs: Vital Statistics of India Based on the Civil Registration System (CRS) 2022, and the report on the Medical Certification of Cause of Death (MCCD) 2022. CRS records all registered births and deaths in the country and is the most important source of statistics related to them. The MCCD captures a fraction of the CRS deaths where deaths are medically certified.

To be sure, mortality rates are typically assessed after adjusting for population. For instance, the Sample Registration System (SRS) reports use sample surveys to estimate the crude death rate (CDR) per thousand population. CDR shot up to 7.5 in 2021 from 6.0 in 2020 and 6.2 in both 2018 and 2019. The lower CDR in 2020 was likely because accidental deaths decreased in the year, as HT explained on May 8.

Since ORGI hasn’t published the 2022 SRS report, no survey-based CDR estimate is available. However, using registered deaths and National Commission on Population projections, CDR in 2022 was 6.3—close to 2018-2019 levels.

The SRS may arrive at a higher 2022 CDR estimate since not all deaths are registered in the CRS. Historically, SRS estimates exceeded CRS-based calculations by 1.0 and 0.5 per thousand population in 2018 and 2019, though this gap disappeared in 2020 and 2021.

While the estimated death rate suggests the health system was normalising, other indicators show incomplete recovery. At the 2019 death rate of 6.2, deaths in 2022 would number 8,554,450. This is 95,480 deaths more than the 8,649,930 deaths registered in the 2022 CRS. Pandemic bulletins issued by states in the year only counted 50,435 deaths from Covid-19.

At least 12 states and UTs undercounted Covid-19 deaths, according to the MCCD report. These jurisdictions reported 6,076 Covid-19 deaths in 2022, while the MCCD attributed 12,818 deaths directly to or related to Covid-19 in these jurisdictions.

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To be sure, the MCCD data doesn’t show national-level undercounting for 2022. Nationally, only 25,393 deaths were attributed to Covid-19 in MCCD data, compared to 50,435 in pandemic bulletins. This likely reflects that MCCD captures just over 20% of registered deaths, with coverage varying by state. Despite this limitation, MCCD found 413,580 Covid-19 deaths nationally in 2021 compared to 332,510 in pandemic bulletins.

The partial recovery in 2022 is also seen in another set of numbers from the CRS. Some 50.7% of registered deaths occurred without medical attention, compared to 47.3% in 2021, 45% in 2020, and 34.5% in 2019.