Several million Covid-19 deaths have most likely not been reported in India, according to a series of new studies suggesting the country’s death toll from the virus is far higher than officially counted by the government.
A team of researchers in Canada, India and the United States estimates that around 3 million Covid deaths during the country’s first and second waves of infections have not yet been accounted for by Indian officials. The results, published Thursday in Science journal, seem to confirm longstanding suspicions among epidemiologists that India’s official record of 483,178 Covid deaths may have significantly underestimated the true devastation of the virus.
“Earlier in the pandemic, we had this ‘Indian paradox’ where there were widespread infections but not many deaths,” said Dr. Prabhat Jha, professor of epidemiology at the University of Toronto in Canada who led the research. “It was a bit of a mystery why this happened, but when we started investigating there were obviously deaths.”
India has confirmed more than 35 million cases of Covid-19 since the pandemic began, according to the country Ministry of Health and Family Welfare.
Jha and his colleagues found that up to 3.4 million Covid deaths were likely under counted from June 2020 to July 2021. Many of these deaths occurred last spring, Jha said, when India was particularly hard hit by the delta variant.
As a result, cumulative deaths in the country could be six or seven times higher than official reports as of September 2021, the scientists concluded.
India’s Ministry of Health and Family Welfare did not immediately respond to requests for comment on the country’s Covid death toll.
Jha, who is also director of the Center for Global Health Research at St. Michael’s Hospital in Toronto, said the discrepancy was mainly due to the uneven reach of India’s death registry systems. It’s a problem that precedes the pandemic, he added.
“If someone dies in North America, they usually die in a hospital or nursing home, or if they die at home, a coroner must issue a death certificate,” Jha said. “In India, especially rural India, deaths occur many times and they simply cremate the body in a field or bury it with no official registration of the death.”
Indian officials usually only counted Covid deaths in cases confirmed by laboratory tests, according to the study. This means that especially during the Delta Wave, when test resources were scarce and healthcare systems were overwhelmed, many suspected Covid deaths likely fell through the cracks.
Jha said that there is an average of around 10 million deaths in India each year, which is a basis for measuring what is known as excess death, or the number of reported deaths that is higher than what would be expected over the same period.
The researchers used a nationwide representative survey by CVoter, an Indian polling institute, to estimate how many Covid deaths were missed by official censuses. 140,000 randomly selected people took part in the survey, who were asked over a period of 15 months whether their household had a Covid death.
“Since almost all Indians have a cell phone, you actually get a good snapshot of the country,” Jha said.
The researchers then compared the results with the number of deaths that would be expected in the country without the influence of Covid.
Jha said the survey found India’s average 3 percent death rate doubled in just three months during the spring Delta Wave.
The researchers calculated that India saw a 29 percent increase in additional deaths during the first two waves of infections. The researchers used two other sources of data – the government’s own numbers of hospital admissions through June 2021 and records from civil registration systems in 10 Indian states – to confirm and refine their estimate.
The results are in line with other research, which also suggests that the Covid death toll in India has been grossly underestimated.
A study published on December 22nd in The Lancet Infectious Diseases found a 41 percent increase in all-cause deaths from March 2020 to June 2021 in the Chennai district of India’s southeast coast. During the Delta Wave, the death rate in this region during that period in the pre-pandemic years was about five times higher than normal death rates, said Joseph Lewnard, assistant professor of epidemiology at the University of California, Berkeley. who directed the research.
“This confirms that a significant proportion of Covid infections are never identified from the outset, so that no cause of death can then be assigned,” he said.
Lewnard added that Chennai has a more resilient health system compared to many other parts of India, meaning the difference between actual Covid deaths and what has been officially reported could be even more pronounced elsewhere in the country.
A separate one Study published in July 2021 Researchers at the Center for Global Development found that from the start of the pandemic to June 2021, India may have had 3.4 to nearly 5 million additional deaths.
Lewnard said it was important for India and other countries to have an accurate list of Covid deaths in order to understand the real cost of the pandemic.
“We make our decisions to move forward with Covid-19 as we do with other diseases, in part by understanding the burden they put on our society,” he said.
This will allow accurate Covid death tolls to show where public health resources and interventions have been lacking and how these tools could be better disseminated in the future. This type of information can be especially useful now as cases are increasing in India due to the Omicron variant.
“It’s about making sure the dead get the respect they deserve and aren’t forgotten,” Jha said. “But counting the dead actually helps the living because it gives you a roadmap to whether all of the things we are doing to fight Covid and the trillions of dollars we are spending are actually working.”