"We may be under reporting deaths but by what fraction? 100, 500? Overall I don't think we are dying at the same rate as Italy or other European countries," says Dr K Srinath Reddy.
US President Donald Trump recently accused India of 'playing dirty' with its COVID-19 death data. As India crosses the sobering statistic of one lakh deaths caused by the ongoing pandemic, how do we interpret this data? Do we look at the 100,000 number – which is staggering, or we examine deaths per million – where India, by virtue of its population, fares much better. Prof K Srinath Reddy, chairperson, Public Health Foundation of India and a leading epidemiologist talks to The Quint, to decipher the data.
1 Lakh Deaths vs Case Fatality Rate
On the question of whether we need to look at 100,000 deaths as a figure to judge India's response or examine the deaths per million population, which is at 70, Dr Reddy says both are important factors. Domestically, 100,000 deaths are a huge number in terms of losses, but when we look at international comparisons, when we are told we are second in ranking in terms of total cases, and we are moving up in terms of deaths, absolute numbers do not matter in terms of international comparisons.
"Just as in the economy, it is not enough to compare countries in terms of GDP but you have to look at per capita GDP, similarly you have to adjust the numbers to population size," Dr Reddy adds. Compared to India, deaths per million in some countries in Europe are 10 times higher. He adds though that there is no place for complacency.
Is India Steading the Coronavirus Curve?
"Deaths usually follow cases by 14-15 days," explains Dr Reddy. Dr Reddy says you can't keep a track of cases and deaths at the same time-frame, but case counts are also very variable. It depends upon the type of tests you are conducting, the criteria you are applying, and a number of other factors. Looking at case count and test positivity rate is not very helpful.
“Deaths on the other hand, even with under counting, are more likely to give better trends.”
Even if there is undercounting, it will not vary too much over time, says Dr Reddy, so the 'signal to count ratio' will remain fairly constant. We have to keep deaths and the moving average in mind over a period of time and only then we can say if the virus is under control.
On Undercounting of Deaths
"You may misclassify the deaths, you may not ascertain the cause of deaths, but the fact of death is generally difficult to miss," says Dr Reddy. He points to similarly low data from neighbouring countries in South Asia. He says focus should be on overall trends which are more important.
COVID vs Comorbidities
As per the WHO guidelines probable deaths or suspected deaths are supposed to be part of death count, but there is no clarity on how states do it in India. Dr Reddy says there has to be more uniform reporting and comorbidities have to be counted as COVID deaths.
COVID-19 Pandemic vs Syndemic
A recent Lancet editorial called the on going pandemic a 'syndemic' of our failed health systems and increasing burden of non communicable diseases. Dr Reddy agrees that the virus cannot be seen in isolation. It is more than an infectious disease, but it is attacking people more who have underlying diabetes, hypertension etc. He warns about India's NCD burden and says the current pandemic is a warning to our health systems that you cannot deal with the virus in an isolated and segmented manner, while ignoring non communicable diseases. "We have to look at the totality of the human being, and totality of the society, rather than trying to chase one virus at a time."
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