The health ministry said that it has been advising all states and Union territories to follow guidelines while recording deaths.(PTI Photo)
The health ministry said that it has been advising all states and Union territories to follow guidelines while recording deaths.(PTI Photo)

Missing out on deaths is unlikely: Govt on reports of excess Covid fatalities

The health ministry also informed that the reporting of daily new cases and deaths in India follows a bottom-up approach, where districts report the number of cases and deaths to the state governments and to the ministry constantly.
By Rhythma Kaul, Hindustan Times, New Delhi
UPDATED ON JUL 23, 2021 12:29 AM IST

New Delhi: The Centre on Thursday refuted reports that claimed India’s actual Covid-19 death toll could be in millions, far higher than the official toll of 419,043.

In their study published this week, researchers from Center for Global Development, Washington DC, and Harvard University scientifically analysed data and concluded that an estimated 4.9 million people in India may have died from Covid-19. The report was based on estimating “excess mortality”, the number of extra people who died compared with pre-crisis figures.

But the government argued its case using the case fatality rate. A statement released by the ministry of health and family welfare said the case fatality rate, as on December 31, 2020, stood at 1.45%. “...even after an unexpected surge observed in the second wave in April-May 2021, the case fatality rate today stands at 1.34%,” the statement read.

The government conceded that some cases could go undetected, but given the “robust and statute-based” death registration system in India, “missing out on deaths is unlikely”.

The health ministry also informed that the reporting of daily new cases and deaths in India follows a bottom-up approach, where districts report the number of cases and deaths to the state governments and to the ministry constantly.

“As early as May 2020, to avoid inconsistency or confusion in the number of deaths being reported, Indian Council of Medical Research (ICMR) issued ‘Guidance for appropriate recording of Covid-19 related deaths in India’ for correct recording of all deaths by States/UTs as per ICD-10 codes recommended by WHO for mortality coding,” the statement from the ministry further read.

As regards the reports of massive under-reporting of deaths due to Covid-19, the ministry clarified that these were quoting findings from recent studies and using age-specific infection fatality rates of the US and European countries to calculate excess deaths in India based on sero-positivity.

“The extrapolation of deaths has been done on an audacious assumption that the likelihood of any given infected person dying is the same across countries, dismissing the interplay between various direct and indirect factors such as race, ethnicity, genomic constitution of a population, previous exposure levels to other diseases and the associated immunity developed in that population. Furthermore, the sero-prevalence studies are not only used to guide strategy and measures to further prevent the spread of infection to the vulnerable population but are also used as another basis to extrapolate deaths,” the ministry said, adding that the studies also have another potential concern that the antibody titers may diminish over time, leading to underestimation of true prevalence and corresponding overestimation of the infection fatality rate.

“The reports also assume that all the excess mortality figures are Covid deaths, which is not based on facts and totally fallacious. Excess mortality is a term used to describe an all-cause mortality figure and attributing these deaths to Covid-19 is completely misleading,” the statement read.

The health ministry said that it has been advising all states and Union territories to follow guidelines while recording deaths. It has also emphasised the need for a robust reporting mechanism to monitor deaths down to the district level, the ministry said, adding that it has advised the states to conduct thorough audits in hospitals and report deaths that may have been missed.

“During the peak of the second wave, the entire health system was focused on effective clinical management of cases requiring medical help, and correct reporting and recording could have been compromised which is also evident in a few states such as Maharashtra, Bihar and Madhya Pradesh reconciling their number of deaths recently,” the statement read.

In addition to this reporting, the government said, the robustness of statute-based civil registration system ensures that all births and deaths in the country are registered. This is a time-consuming process and the numbers are usually published the following year, but it ensures that no deaths are missed, the government said.

In his speech in Parliament on Tuesday, Union health minister Mansukh Mandaviya said, “The Centre compiles and publishes the data that is sent to it by the state governments. Our job is to publish that data and nothing else.” He also said that the government didn’t instruct anyone to disclose fewer deaths and positive cases.

Frontline health workers said they saw more lives being lost to the second wave of Covid-19 than the first one.

“One of the main reasons for that could be that people were reporting late to a hospital, leading to Covid-19 related complications that became difficult to treat. Not all cases are fit to undergo home quarantine, and if there are danger signs visible such as dip in oxygen saturation levels, high persistent fever, breathing difficulty, etc., then the patient needs to be rushed to a hospital as fast as possible,” said a senior doctor at a Covid-19 designated hospital on condition of anonymity.

He, however, said, the overall mortality rate doesn’t seem to have seen a massive jump.

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