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COVID-19 Deaths Are Being Underreported In India

by Aakash Sharma

COVID-19 Deaths Are Being Underreported In India

December 28, 2020

The death toll due to COVID-19 stands at more than 148,000 in India. India has 10.2 million COVID-19 cases, second highest in the world

With a population of more than 1.3 billion people, India currently has the world’s second-highest number of coronavirus cases at 10.2 million, second only to the United States. According to government data, the death toll due to COVID-19 stands at more than 148,000 deaths, with the DPM rate being 1.4% (DPM rate- deaths per million rate), one of the lowest in world. In comparison, the United States, the most infected country, has a death rate of 1.7%. India’s number of deaths per 100,000 people is 8.16, compared with 72.9 in the United States.

The low death rate in India, one of the worst-hit countries in the world by the pandemic, has baffled health experts. Government’s Department of Science and Technology (DST) set up a COVID -19 Indian National Supermodel back in May to monitor the transmission of the infection, deaths inflicted by it and other significant research for aiding decisions involving health system readiness and mitigation measures.

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Health workers and family members in personal protective suits move the body of a man who died of Covid 19 for cremation. (File Photo | Parveen Negi, EPS)

The reasons outlined by government officials and health executives for the low death rate under the supermodel mainly focus on:

  • country’s younger population,
  • late arrival of the virus,
  • strict lockdown, and
  • possible immunity given by other endemic viral diseases.

Contrary to the government’s claims, experts argue that one of the key reasons for the low death rate is the underestimation and undercounting of total deaths. An investigation by The Wire Science found that COVID-19 deaths are being underreported across India, misleading the numbers that are shown in the public domain and effectively hampering the public safety. Experts believe that the relatively low fatality rate doesn’t tell the whole story and allege substantial undercounting in several states.

The investigation by The Wire Science found serious lags in the recording of deaths in various cities across India. Hospitals in these cities counted only those deaths of patients who tested positive for the virus – i.e., ‘confirmed COVID-19 deaths’ – in official tolls. When patients who had symptoms of COVID-19 but weren’t tested, tested negative or had an inconclusive test result die, their deaths weren’t included.

Epidemiologists refer to such deaths variously as ‘suspected COVID-19 deaths’, ‘probable COVID-19 deaths’ and ‘clinically diagnosed COVID-19 deaths’, which are, in essence, clubbed under the category of ‘suspected deaths’. These suspected deaths are not counted under deaths due to COVID-19.  Suspected deaths make up a major blind spot for India because all nucleic acid tests used to confirm COVID-19, like CBNAAT and RT-PCR, sometimes give results as false negatives. Which means even a patient who is infected with the virus can test negative. More than 30% of RT-PCR results can be falsely negative depending on when the patient’s sample was collected.

Another problem with not reporting suspicious deaths is that many states still run very few RT-PCR tests, therefore, many infections are never be confirmed. When some of these people die, not counting them among COVID-19 victims deflates the number of deaths due to the disease.

For these reasons, a clinical diagnosis along with X-rays or CT scans and blood-oxygen-level examination is a more dependable way to identify COVID-19 patients according to Sher-i-Kashmir Institute of Medical Sciences’ virologist Dr T. Jacob John (The Wire Science).

“For all diseases, clinical diagnosis is fundamental, more so in an epidemic. Lab testing is additional evidence,” remarked Dr John in his interview to The Wire Science. According to him, “Between clinical criteria and a lab test, the former is more reliable, unless both tallies”.

Given these facts, many countries have realized that the calculation of suspected deaths is important for properly charting the effects of COVID-19. In April, for example, the U.S. Center for Disease Control (CDC) asked states to start reporting “probable deaths” along with confirmed deaths.

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Taking a COIVD patient for proper secured treatment.

While not reporting suspected deaths is a common trend among all states, it’s not the only kind of undercounting happening in India. Some states are also not counting many confirmed deaths. Instead, they have been attributing a fraction of such confirmed deaths to co-morbidities – pre-existing conditions the patient may have had, like diabetes, cancer or AIDS, that worsen the effects of COVID-19. These “deaths due to co-morbidities” are then excluded from these states’ death tolls.

For Uttar Pradesh, India’s most populous state with a population of over 200 million, The Print analysed government data between 1 September and 20 October to find that active cases had decreased by almost half — to 30,416 on 20 October from 55,538 on 1 September. However, in the same period, the number of deaths almost doubled to 6,714 from 3,542. This trend indicates that infections are not being caught early enough and that testing data needs to be more robust and detailed.

In West Bengal, reports have come out disclosing the stealth with which private hospitals in the state are “hiding” Covid-19 deaths, fearing that patients would avoid those establishments if the actual death numbers fatalities are put out. The state government is allegedly underreporting deaths caused due to Covid-19 as there is no proper mechanism in the rural areas to ascertain whether a person has died of coronavirus infection or some other disease.

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Health workers wearing personal protective equipment carry the body of a COVID-19 victim for cremation in Gauhati, India, Thursday, Sept. 10, 2020.

Even Kerala, the most developed Indian state which claims to be the champion in data transparency and has an exhaustive official Covid-19 dashboard, has been reportedly undercounting deaths due to COVID-19. Patients who tested negative “just before they died” and did not belong to the state were not counted in final death tallies.

Nearly all countries have undercounted initial Covid-19 deaths by 30 to 50%, according to a BBC report on COVID-19 deaths. But for dealing with the unprecedented situation that the coronavirus pandemic has pushed us into, the Indian government must put in some serious groundwork. Municipalities must calculate and release total deaths by week with comparison to earlier years to find out the number of excess deaths during this period. Excess deaths are the deaths above normal levels, some of which may have been caused by Covid-19. This way the disease control centres can map out accurate results and effective strategies to deal with the pandemic and ensure public safety.

How do you think can common people contribute like us contribute towards collating accurate data regarding COVID-19 cases and deaths? Tell us in the comments below.

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