As India fights the third wave of COVID-19 and the spread of the new Omicron variant, a study has estimated that nearly three million people died of COVID in India until mid-2021.
The country has logged more than 35 million cases of the coronavirus as of 1 January 2022.
India’s official cumulative COVID-19 death count of 0.48 million shows a death rate of approximately 345/million population. This is nearly one-seventh of the death rate in the US.
The country's COVID deaths are widely believed to be underreported because of the incomplete certification of such deaths and misattribution to chronic diseases. Also, most deaths occur in rural areas, often without medical attention, a survey by CVoter Tracker states.
CVoter Tracker is a nationally representative, random probability-based computer-assisted telephone interview survey carried out everyday to track governance, media, and other socioeconomic indicators.
Of India’s 10 million deaths estimated by the United Nations Population Division (UNPD) in 2020, over 3 million were not registered and over 8 million did not undergo medical certification, the report states.
The World Health Organization (WHO) has recognised such counts as a crude but useful method to track the pandemic, CVoter Tracker survey says.
The survey also suggests that reports by journalists and NGOs using civil registration system (CRS) data have documented a large increase in deaths from all causes, when compared to previous years.
“Unfortunately, the CRS data is reliably available only in states that cover about half of the estimated total deaths in India and may be affected by changes in the level of registration,” it adds.
The COVID Tracker survey covers 0.14 million adults including a sub-study of 57,000 people in 13,500 households with more exact reporting of COVID and non-COVID deaths in immediate family members.
It also studies the government’s administrative data on national facility-based deaths and CRS deaths in 10 states.
India had about 296 million households in 2020 with an average household size of 4.6. Dividing this into the 10.16 million deaths estimated by the UNPD in India in 2020 yields approximately 3.4% of households expected to report a death from any cause in that year (with nearly identical results for 2021), the report calculates.
The majority of COVID deaths India that experienced throughout the pandemic occurred from April 1 to July 1, 2021 (2.7 million), the survey finds.
“India must expand and improve its death registration and medical certification system, with timelier reporting. Uncounted or medically uncertified deaths are not uniform, with larger gaps in the poorest states in central India and larger gaps among women than among men,” it suggests.
India’s significantly higher COVID death rate in 2021 compared to the lower than expected death rate in 2020 requires further research.
The report warns that the spread of infection to rural areas in 2021 is one factor, but there might also be differences in the pathogenicity between the original virus (Wuhan) in 2020 and the mix of alpha and delta variants accounting for most of the 2021 viral wave, or other biological predictors of severe infection which changed between these two waves.
Similarly, tracking death rates will be essential to understand the effects of the Omicron wave currently underway in India, or future viral variants.
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