India’s missing Covid-19 death data: Explained in 6 points


There has been a major debate about India’s reported missing Covid-19 death. As per several reports, the Centre is underreporting the Covid-19 death and thus presenting a low fatality rate picture in the public domain. As we write this piece, India stands at 40,96,695 total Covid-19 cases with 70,558 deaths. The total number of recovered patients stands at 31,65,104. Now if we calculate the percentage, the mortality rate is 1.72%, while the cover hover around 77.22%.
However, experts have questioned shortcomings and lack of clarity in vital registration, testing practices, and classification of Covid-19 deaths. They have expressed their concern of underreporting of Covid-19 deaths in a latest report by The Lancet. In this article, we shall discuss whether India us actually missing its real Covid-19 death figures and if so, how.

India Covid-19 death
Photo: Twitter

Here’s the matter of India’s reported missing Covid-19 deaths explained in 6 points

1. What are the fault lines? Where do they lie?

According to a report by BBC, it is unclear how suspected or probable Covid-19-attributable deaths are being included in mortality estimates. The Indian Council of Medical Research (ICMR) guidelines stipulate that deaths of people with suspected or probable Covid-19 should be included in mortality data, based on WHO ICD-10 codes for Covid-19-related deaths. Interestingly, information about whether state data on deaths include suspected and probable cases is not in the public domain.

“For Covid-19, we have to throw the net more widely to capture all the deaths (confirmed and suspected) in order to understand the disease better and for its management,” said Prashant Mathur, director of the National Centre for Disease Informatics and Research (NCDIR), an ICMR body in a report. “It is important to correctly record the cause of deaths. But it is up to individual states to follow these guidelines. As per the existing law, NCDIR is not required to get data about suspected or probable deaths from states so I can’t say whether deaths are being certified.”

2. How is the process of underreporting of deaths working?

As a report explains, a handful of states are heavily attributing Covid-19 deaths to patients’ underlying conditions or co-morbidities. Also, different Indian states are using different COVID-19 diagnostic tests.Two states, Gujarat and Telangana, appear to have under-counted heavily, as an investigation shows. In Vadodara, Gujarat, the number of deaths grew by just 49% in the last two months, even as the caseload leapt by a whopping 329%. Also,  there have been reported discrepancies between the official toll from the virus and counts from crematoria and burial grounds in some cities.

These are the reason, experts are saying that India missing a lot of deaths, considering only a small fraction of the population has been tested – around 1.72% – and many deaths are not being medically reported? Also, only one in four deaths in India is certified for a cause. “Of course there is under-counting as we have weak health surveillance systems,” says Oommen C Kurian of the Observer Research Foundation, a Delhi-based think tank, said to BBC. “But the question is about the scale of under-counting.”

3. Is India’s low fatality rate entirely a vague representation?

No, absolutely not. The low death rate is NOT entirely a misreporting or miscalculation. Many epidemiologists attribute this relatively low fatality rate to a young population – the elderly are typically more vulnerable. But it is not clear whether other factors, such as immunity deriving from previous infections from other coronaviruses, are also responsible. Also, they point to a pattern of low mortality in South Asian countries that share a similar demographic of a younger population: reported Covid-19 deaths per million are 22 in Bangladesh and 28 in Pakistan. Clearly, given the population size, India is doing far better than Europe and the United States. But Kaushik Basu, a former chief economist of the World Bank, told in a BBC report: “It is irresponsible to treat this as consolation. There are limits to the value of geographical comparisons. As soon as you do that, you realise India is doing very poorly. In China, Covid-19 deaths per million population is 3. In India it is 34. Within South Asia, the only country doing worse than India is Afghanistan and going by the trends, India will overtake Afghanistan.”

4. Case count could be missing women

The popular belief is that women are far less likely to be affected by covid-19. But mounting evidence points to the hidden toll that covid-19 could be taking on women in India.

According to a report, when the results of the second round of Delhi’s SARS-CoV2 sero-prevalence survey were released last week, one finding stood out: the prevalence of infections was higher among women than among men. This is not the first sero-survey to have found this. The Mumbai and Ahmedabad sero-surveys had similar findings, the magnitude of the gap being higher in Mumbai. The Pune sero-survey did not find such a gap. The report says the reason this finding is unusual is because in terms of officially counted cases – persons confirmed as covid-positive after an RT-PCR or antigen test – women trail men significantly.

5. What steps have been taken to prevent underreporting of deaths?

According to a report, more than 230 Indians, including doctors, researchers and students, have petitioned authorities to release information on deaths for at least the last three years to calculate “excess deaths”. They want road fatalities – more than 150,000 people die in road accidents in India every year – to be identified separately so that a more reliable picture is available of deaths due to diseases.
Under-counting is not peculiar to India. In July, a review of the mortality data in 28 countries found at least 161,000 more people have died during the coronavirus pandemic than the official Covid-19 death counts report. India was not among the countries surveyed.

Some experts have suggested that telecoms companies should release call record data from March to find out where millions of Indians moved to from their workplaces in the cities in the wake of the lockdown. Using the telecoms data, the government could send teams to the hotspot areas to record hidden adult deaths. As we all know that when the pandemic ends, the toll from Covid-19 will be the only indicator by which countries’ performance in containing the infection will be judged.

6. Are the experts’ suggestions being followed?

As The Lancet report highlights, public pressure and media reports about alleged undercounting have begun to push many states to review their Covid-19 mortality data. “In several states, many of the ‘missing’ deaths were added later on to the tally after audits. For example, Tamil Nadu has added backlogs of 400-plus deaths. So did Maharashtra. West Bengal used to exclude all deaths due to comorbidities from Covid-19 deaths, but they stopped such practices”, John said in the report.
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