India’s COVID-19 death toll could be 10X the official count, research suggests

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India’s excess deaths during the pandemic could be a staggering 10 times the official COVID-19 toll, likely making it modern India’s worst human tragedy, according to the most comprehensive research yet on the ravages of the virus in the South Asian country.

Most experts believe India’s official toll of more than 414,000 dead is a vast undercount, but the government has dismissed those concerns as exaggerated and misleading.

The report released Tuesday estimated excess deaths — the gap between those recorded and those that would have been expected — to be 3 million to 4.7 million between January 2020 and June 2021. It said an accurate figure may “prove elusive” but the true death toll “is likely to be an order of magnitude greater than the official count.”

The report was published by Arvind Subramanian, the Indian government’s former chief economic adviser, and two other researchers at the Center for Global Development, a nonprofit think tank based in Washington, and Harvard University. 

It said the count could have missed deaths that occurred in overwhelmed hospitals or while health care was disrupted, particularly during the devastating virus surge earlier this year.

Worst tragedy since Partition of India

“True deaths are likely to be in the several millions not hundreds of thousands, making this arguably India’s worst human tragedy since Partition and independence,” the report said.

The Partition of the British-ruled Indian subcontinent into independent India and Pakistan in 1947 led to the killing of up to 1 million people as gangs of Hindus and Muslims slaughtered each other.

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One Canadian expert said the report’s overall conclusions are likely right, but its methodology is problematic. 

“They did the best they can,” Prabhat Jha, a doctor and epidemiologist at St. Michael’s Hospital in Toronto, said in an interview with CBC News. “They end up with a big number, well over 3 million deaths, but they end up with [the] somewhat implausible idea that the first viral wave, which was in September of last year, was bigger than the current viral wave, which was in April to May or April to June.”

He said that the researchers included data from unreliable sources, which will lead to pushback from the Indian government about their findings. 

Dr. Prabhat Jha is the director of the Centre for Global Health Research at St. Michael’s Hospital, and professor of epidemiology at University of Toronto’s Dalla Lana School of Public Health. (Unity Health Toronto)

Still, Jha said he agreed that India’s death toll is much greater than 400,000, which he said would mean the country had a death rate about one-eighth of the death rate in the United States.

“No one really seriously believes that the Indian death rates from the infection are so low.”

The report on India’s virus toll used three calculation methods: data from the civil registration system that records births and deaths across seven states, blood tests showing the prevalence of the virus in India alongside global COVID-19 fatality rates, and an economic survey of nearly 900,000 people done thrice a year.

Researchers did caution that each method had weaknesses, such as the economic survey omitting the causes of death. 

So the researchers also looked at deaths from all causes and compared that data to mortality in previous years.

Researchers also cautioned that virus prevalence and COVID-19 deaths in the seven states they studied may not translate to all of India, since the virus could have spread more in urban versus rural states and since health care quality varies greatly around India. 

This image taken by a drone shows grounds being prepared for a mass cremation of COVID-19 victims in New Delhi on April 28, 2021. (Danish Siddiqui/Reuters)

Other nations are also believed to have undercounted deaths in the pandemic. But India is thought to have a greater gap due to having the world’s second highest population of 1.4 billion and because not all deaths were recorded even before the pandemic. 

The health ministry did not immediately respond to an Associated Press request for comment on the report. 

Dr. Jacob John, who studies viruses at the Christian Medical College at Vellore in southern India and was not part of the research, reviewed the report for the AP and said it underscores the devastating impact COVID-19 had on the country’s underprepared health system. 

“This analysis reiterates the observations of other fearless investigative journalists that have highlighted the massive undercounting of deaths,” Jacob said.

‘Collective complacency’

The report also estimated that nearly 2 million Indians died during the first surge in infections last year and said not “grasping the scale of the tragedy in real time” may have “bred collective complacency that led to the horrors” of the surge earlier this year.

Over the last few months, some Indian states have increased their COVID-19 death toll after finding thousands of previously unreported cases, raising concerns that many more fatalities were not officially recorded.

Several Indian journalists have also published higher numbers from some states using government data. Scientists say this new information is helping them better understand how COVID-19 spread in India.

Health-care workers attend to a patient at the Nesco Jumbo COVID-19 center in Mumbai on July 5, 2021. (Rafiq Maqbool/The Associated Press)

Murad Banaji, who studies mathematics at Middlesex University and has been looking at India’s COVID-19 mortality figures, said the recent data has confirmed some of the suspicions about undercounting. Banaji said the new data also shows the virus wasn’t restricted to urban centres, as contemporary reports had indicated, and that India’s villages were also badly impacted.

“A question we should ask is if some of those deaths were avoidable,” he said.



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