Covid death toll in India may be 8 times more: Lancet study

The Indian health ministry on Friday said the new Lancet study, which claimed that India’s estimated excess Covid-19 deaths in the first two years of the pandemic may be around eight times higher than official figures, was “speculative and misinformed”.

The true Covid-19 death toll in the first two years of the pandemic may be at least three times the reported numbers in the world, and, in India, more than eight times the official figures, according to a new analysis published in The Lancet journal.

Thane: People get inoculated against Covid-19 as vaccination continues at a normal pace at TMC's CR Wadia Hospital even as the cases have drastically reduced in Thane on March 10, 2022. (HT Photo/Praful Gangurde)

The calculations are based on excess deaths, the number of additional deaths between January 1, 2020, and December 31, 2021 compared to the average number of deaths recorded in preceding years from all causes.

The number of confirmed Covid-19 deaths in 2020 and 2021 was 5.9 million, but the actual tally could be as high as 18.3 million, the analysis said. In the case of India, where the official death tally showed 489,000 deaths, the actual death toll may have been a little over four million.

The toll in India, the analysis added, is likely to be the highest in the world.

In a statement issued on Friday, the health ministry said that the study provided estimates of all cause excess mortality for a number of countries based on a mathematical modelling exercise.

The ministry further insisted that the reporting of deaths is regularly done in a transparent manner and is daily updated in public domain on the website of Union Ministry of Health.

“It is highlighted that quoting issues as sensitive as death, that too during an ongoing global public health crisis like pandemic Covid-19, should be dealt with facts and with required sensitivity. This type of speculative reporting has potential to create panic in the community, can misguide people and should be avoided,” the ministry said.

The Lancet study provides the first peer-reviewed estimates of excess deaths due to the pandemic globally and for 191 countries and territories (and 252 subnational locations such as states and provinces).

“In the time of an epidemic when excess deaths are reported with no explanation, it can be attributable to the disease that has caused the outbreak. It is an assumption, nonetheless, since there is not an adequate system in place that can give the real picture. What is required in our public health system is the need to set-up a proper system to determine exact death numbers with a definitive cause; and adequate investment in that control. It is doable,” said Dr Dileep Mavlankar, director, Indian Institute of Public Health-Gandhinagar.

Several similar analyses have pegged India’s true Covid-19 death toll to be at least 6-7 times the official tally, based on deaths recorded across a multitude of databases, such as the Civil Registration System that is used for recordkeeping when people apply for death certificates.

According to the paper, weekly or monthly data on deaths from all causes in 2021, 2020, and up to 11 prior years was obtained for 74 countries and 266 states and provinces from government websites, World Mortality Database, Human Mortality Database, and European Statistical Office.

The data were used in models to estimate excess mortality due to the pandemic, including for locations with no weekly or monthly reporting of death data.

“The excess death rate is estimated to be 120 deaths per 100,000 population globally, and 21 countries were estimated to have rates of more than 300 excess deaths per 100,000 population. Rates of excess deaths are estimated to have varied dramatically by country and region,” said the paper.

The highest estimated excess death rates were in Andean Latin America (512 deaths per 100,000 population), Eastern Europe (345 deaths per 100,000), Central Europe (316 deaths per 100,000), Southern sub-Saharan Africa (309 deaths per 100,000), and Central Latin America (274 deaths per 100,000).

Several places outside these regions are estimated to have had high rates, including Lebanon, Armenia, Tunisia, Libya, several regions in Italy, and several states in the southern USA.

In stark contrast, some countries were estimated to have had fewer deaths in 2020 and 2021 based on mortality trends in prior years, including Iceland (48 fewer deaths per 100,000), Australia (38 fewer deaths per 100,000), and Singapore (16 fewer deaths per 100,000).

With 5.3 million excess deaths, South Asia had the highest number of estimated excess deaths, followed by North Africa and the Middle East (1.7 million) and Eastern Europe (1.4 million).

At the country level, the highest number of estimated excess deaths occurred in India (4.1 million), the USA (1.1 million), Russia (1.1 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000), and Pakistan (664,000).

Among these countries, excess deaths as aproportion of thepopulation were highest in Russia (375 deaths per 100,000) and Mexico (325 deaths per 100,000), and were similar in Brazil (187 deaths per 100,000) and the US (179 deaths per 100,000).

As per the analysis, the large differences between excess deaths and official records may be a result of under-diagnosis due to a lack of testing and issues with reporting death data.

Distinguishing between deaths caused directly by Covid-19 and those that occurred as an indirect result of the pandemic is crucial, the authors say.

However, deaths may also have occurred indirectly from causes such as suicide or drug use due to behavioural changes or lack of access to healthcare and other essential services.

“To date, only 36 countries have released cause of death data for 2020. As data from more countries becomes available, it will be possible to better determine how many excess deaths were due directly to Covid-19 and how many occurred as an indirect result of the pandemic or responses to it,” said the authors.

Dr Haidong Wang, of the Institute for Health Metrics and Evaluation, US, the lead author, said in a statement: “Understanding the true death toll from the pandemic is vital for effective public health decision-making. Further research will help to reveal how many deaths were caused directly by Covid-19, and how many occurred as an indirect result of the pandemic.”