5 Lakh Official COVID Deaths in India: What of the Unreported Millions?
India has officially crossed the grim landmark of 5 lakh COVID-19 deaths since the first reported death in March 2020. The figure, however, only makes the large void left by the millions of unreported deaths all the more glaring.
COVID-19 deaths are more than just numbers on a graph, but the numbers have very real human impact.
How do we interpret this data? Is it even possible to do justice to India's COVID death toll and interpret it fairly when such a large chunk of it is missing?
FIT explores the seen and the unseen data of COVID-19 related deaths in India.
India's Official COVID-19 Death Toll
On Friday, 4 February, India's COVID-19 death toll crossed five lakh. Four lakh of these deaths occurred by July 2021— mostly during the devastating second wave.
As far as a global comparison goes, India ranks third behind the US and Brazil in terms of total recorded COVID deaths.
If these numbers are adjusted to the population, in terms of the cumulative COVID-19 deaths per million people, India ranks sixth in the world.
Many experts and analysts, however, are of the opinion that the real numbers are far higher than this, even running into the millions.
"Most studies put excess deaths during the pandemic at between 3 and 5 million - around seven to eleven times official COVID deaths," according to Dr Murad Banaji, a mathematician from Middlesex University in the UK, who has been closely mapping India's COVID-19 data since beginning of the pandemic.
The central Government, however, has vehemently denied these claims, calling their COVID-19 data collection and reporting, 'robust'.
The Ministry of Health and Family Welfare, in fact, went as far as to release an official statement defending their position saying, "media reports claiming under-reporting of COVID-19 deaths are Ill informed, Baseless & Misleading," and that "the Government of India has a very comprehensive definition to classify COVID deaths, based on globally acceptable categorisation."
"Unfortunately, instead of trying to get to the bottom of what went wrong, the government has engaged in amateurish attempts to discredit the research papers and pre-prints estimating India's pandemic mortality."Dr Murad Banaji, mathematician, Middlesex University, UK
Actual COVID-19 Death Toll: Why the Gap in Data?
Despite the reassurance of transparency from the MoHFW, COVID-19 data, particularly the death count, has been difficult to pry out, and has often come only after pressure from the Supreme Court.
"We are not ready to believe that only 12,000 persons died in Bihar," the apex court had said in January in response to data submitted by Bihar in relation to ex gratia compensation to families of the deceased.
"You may misclassify the deaths, you may not ascertain the cause of deaths, but the fact of death is generally difficult to miss," Prof K Srinath Reddy, chairperson, Public Health Foundation of India, told the Quint back when India recorded 1 lakh COVID deaths.
One way that the state authorities can rectify the error and try to close the gap is by conducting mortality surveys covering rural and urban areas, according to Dr Banaji.
There is also no clarity on what exactly constitutes COVID-19 deaths
As per the WHO guidelines, probable deaths or suspected deaths are supposed to be part of death count.
The Supreme Court of India, too, had directed that even suicides within 30 days of testing positive are to be considered COVID deaths, and the family of the deceased would be eligible for ex-gratia compensation of 50,000 rupees.
However, it isn't clear how many of these ambiguous cases actually make it to the official data in India.
In May 2021, a bench preceded by two judges, Justice Ashok Bhushan and MR Shah sought clarity from the centre on the criteria for declaring COVID-19 deaths.
"Death certificates say death due to lung problem and heart issues. Families of victims have to rush from pillar to post. Is there any uniform policy on issuing death certificates to Corona victims? Or are there any guidelines?"The Supreme Court of India, as quoted as saying by NDTV
Speaking to FIT, for a different article, mathematician Dr Murad Banaji said, "We know from serosurvey data that while some states like Kerala and Maharashtra capture a reasonable fraction of their infections, others like UP and Bihar capture only a tiny fraction of all their infections. Moreover, all cause mortality data has told us that death recording is also not very variable."
"We certainly expect fatality rates to be considerably lower during this wave than during the last wave, thanks to the much higher levels of population immunity. But we shouldn't try to infer this from very poor data - instead we should watch those parts of the country with more accurate tracking of infections and deaths, and continue to request civil registration data to get the true picture about mortality."Dr Murad Banaji, mathematician, Middlesex University, UK
Adjustments and Readjustments
Another factor that compromises the quality of the data is the practice of releasing 'reconciled deaths' to make up for unaccounted COVID deaths in the past.
For instance, on Monday, 7 February, Kerala reported 860 deaths. However, only 14 of these deaths were actually in the last 24 hours.
The rest of them were either carried forward from previous days due to delay in documentation or were only declared COVID-19 deaths after reviewing appeals.
The Union Health Ministry sought clarification from the state regarding the constant revision of COVID-19 deaths since October.
The resulting skewered COVID death count, they said, makes it difficult to interpret the daily movement of the graph, and plan policies accordingly.
On the other hand, while Kerala has been consistently publishing reconciled data, many other states have not, leaving gaping holes in their death tolls.
This, in spite of the Union Health Ministry asking states back in November to ensure all backlog data concerning COVID-19 deaths are reconciled at once.
Beyond The Data: People Are More than Statistics
The lack of effort to uncover the actual death toll is disrespectful to the deceased who are denied the dignity of having their lives acknowledged, yes. However, the repercussions of it can run deeper than mere symbolism.
For one, the poor quality of data, as mentioned by Dr Banaji and several other experts, severely compromises any analyses done based on it.
The gap in data and missing numbers also has a very real world impact on the lives of the families of the deceased.
Just last month, the Supreme court pulled up states for low deliverance of ex gratia compensations to families of those who died of COVID-19, and a stark discrepancy between the number of claimants compared to the number of official deaths in several states including Kerala, Andhra Pradesh, and Bihar.
State authorities have also been denying applications for claims to ex-gratia compensation on the ground that the cause of death on the death certificate is not COVID-19.
The top court eventually intervened, reiterating that states cannot reject claims based solely on technical grounds such as this.
"It is crucial to understand why the recording of pandemic deaths in India has been so poor, even compared to some other low and middle income countries," Dr Banaji told FIT.
"We need to understand the role of poverty, of limited testing, of access to hospital care, and of deliberate dishonesty and data manipulation, in leading to this situation."Dr Murad Banaji, mathematician, Middlesex University, UK
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