The actual number of people who have died in India due to Covid-19 in the first two waves of the infection may be over three million, a new analysis of three large databases has shown, adding new evidence that the official toll may be a significant undercount.
Between June 1, 2020, and July 1, 2021, India recorded around 400,000 deaths across the country. This period includes the first wave and the devastating second wave of infections triggered by the Delta variant.
The new report, published by the journal Science early on Friday, estimates the true toll in this period was between 3.1 million and 3.4 million, with roughly 2.7 million of these happening in the April-July period, when the second wave tore through the country.
The analysis was led by researchers from University of Toronto’s Centre for Global Health Research and was based on a national survey as well as data from two government databases – the Health Management Information System of the health ministry to report deaths by states, and the Civil Registration System that records death and birth certifications.
The survey was carried out by CVoter on a nationally representative sample of 0.14million people, while the other two databases gave a picture of all-cause mortality, or deaths due to any reason.
{{/usCountry}}The survey was carried out by CVoter on a nationally representative sample of 0.14million people, while the other two databases gave a picture of all-cause mortality, or deaths due to any reason.
{{/usCountry}}“COVID constituted 29% of deaths from June 2020-July 2021, corresponding to 3.2million deaths, of which 2.7million occurred in April-July 2021 (when Covid doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with Covid and non-Covid deaths peaking similarly,” the authors said in their report.
The HMIS data analysis showed that when compared to pre-pandemic period, all-cause mortality was 27% higher in 200,000 health facilities and the CRS data showed a 26% increase in civil registration of deaths in ten states.
“Both increases occurred mostly in 2021. The analyses find that India’s cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially,” said the report, the lead author of which was Prabhat Jha, the director of the Centre for Global Health Research.
This implies that most of the missed deaths were during the second nationwide wave last year, when the Delta variant ravaged India’s health care infrastructure. Reports and anecdotes by citizens at the time spoke of hospitals full to their capacity, turning away patients in need of critical life-saving attention. The country also reported an acute medical oxygen crisis.
This is not the first report to suggest actual Covid-19 deaths in the country may be manifolds higher.
Bhramar Mukherjee, the chair of biostatistics and professor of epidemiology at University of Michigan’s School of Public Health said the new report was landmark and illustrates what experts in her field have been saying all along: “official numbers simply don’t add up”.
“This distortion affects public perception of the true impact of the disease as well as resource prioritisation. This study is particularly strong because it sheds light on the actual Covid deaths which are a part of the total excess deaths which most studies on India have focused on,” she said.
Mukherjee and her colleagues too estimated the true toll of Covid-19 in India in a study published in November, 2021 in the journal Sage. “Our meta-analysis showed the estimates hovered between 1.8 to 4.9 million and Dr Jha et al (the new report) estimates are right in the middle of that confidence interval,” she added.
“In the US roughly 72% of total excess deaths is attributed to Covid during 2020 whereas in India it was estimated at 29%. This difference points out that the cost of Covid is not just Covid. Much of the excess all-cause mortality is indirectly driven by Covid and the true toll of Covid is of far greater magnitude,” she said.
An analysis of deaths in Tamil Nadu published in the journal Lancet in December, 2021 by UC Berkeley researchers, a second analysis based on CRS data and Consumer Pyramid Household Survey published as a working paper by Center for Global Development in July, 2021 and a pre-print by University of Chicago and University of California-based researchers found similar under-reporting.
Most of these assessments are based on how all deaths have soared, as they did in other countries too, compared to other years – with the difference being almost certainly due to the pandemic. In the latest Science study, this has been corroborated by the CVoter survey.