“Poor record-keeping”, “lack of widespread testing” and “India grossly understating the true state of the pandemic” are some of the damning observations on the second wave of the COVID-19 pandemic in India made in a New York Times article.
In the absence of transparency, the NYT spoke to over a dozen experts to analyse the number of cases and deaths to arrive at several estimates for the real extent of devastation on ground zero.
The detailed report also relies on large-scale antibody tests to arrive at estimates. Despite its limitations, the tests provide a fresh way to arrive at more realistic figures. “It gives us a starting point. I think that an exercise like this can put some bounds on the estimates,” Dan Weinberger, an associate professor of epidemiology at the Yale School of Public Health, told the NYT.
The report looks at official data from 24 May to compare with the probable estimates. India’s official COVID report states there have been 2,69,48,800 cases of COVID-19 and 3,07,231 deaths.
The Conservative Estimate
The conservative estimate suggests that the pandemic’s actual toll and infections are, in reality, several times higher than reports suggest. This, the NYT report calls, the best-case scenario.
The report used data from three nationwide antibody tests, called serosurveys. Each survey had about 30,000 people examined for COVID-19 antibodies. They also used a conservative infection-fatality rate in this scenario at 0.15 percent.
These estimates reveal:
- The number of cases is 15 times higher than the official figures. It suggests there are 40.42 crore COVI-19 infections as opposed to the officially reported figure of 2.6 crore cases
- The number of deaths is two times higher than that of the official figures. The estimate points towards 6 lakh deaths against the officially reported 3 lakh fatalities
A More Likely Scenario
The report uses the latest seroprevalence in India, which happened in January 2021, and estimated roughly 26 infections per reported case.
In this “more likely scenario”, the report uses a slightly lower figure (than 26 infections per reported case) to calculate infections and the infection fatality rate at 0.3 percent.
These estimates reveal:
- The number of cases is 20 times higher than the official figures. The estimate suggests there are 53.9 crore COVID infections as opposed to the officially reported 2.6 crore cases
- The number of deaths is over five times higher than the official figures. The estimate points towards 16 lakh deaths against the officially reported 3 lakh fatalities
A Worse Scenario
This scenario uses a slightly higher estimate to account for the current wave of infections per reported case. The infection-fatality rate has also increased to double the previous one at 0.6 per cent.
This scenario takes into account the stress of India’s healthcare system. Over the last few weeks, there has been a severe lack of oxygen, beds, and medicines among other things.
This means that a greater share of those who contracted the virus but are not getting access to medical infrastructure, are dying.
The estimates reveal:
- The number of cases is 26 times higher than the official figures. The estimate suggests there are 70.07 crore COVID infections as opposed to the officially reported 2.6 crore cases
- The number of deaths is almost 14 times higher than the official figures. The estimate suggests 42 lakh deaths have occurred in contrast to the official figure of 3 lakh
How Infection Rates Have Been Calculated
Relying on three national serosurveys, the report states how all three found that the actual number of infections was drastically more than the official figures.
- According to a serosurvey conducted between May and June 2020, the number of actual infections was estimated to be about 28.5 times higher
- According to a serosurvey conducted between August and September 2020, the number of actual infections was estimated to be about 13.5 times higher
- According to a serosurvey conducted between December and January 2021, the number of actual infections was estimated to be over 26 times higher
Even this, doctors said, could be an underestimation.
“Those who had been infected a while ago may have not been captured in this survey. So this is probably an underestimation of the true proportion of the infected population,” said, Dr Shioda, an epidemiologist at Emory University.
How Deaths Have Been Calculated
The report says that infection-fatality rates published were calculated before the second wave in India, meaning that the rate could be much higher.
At the same time, these rates vary greatly by age. A paper that examined infection rates using serosurvey data from three locations in India found huge variations, depending upon the population being sampled.
“We found that age-specific infection-fatality rate among returning lockdown migrants was much higher than in richer countries. In contrast, we found a much lower first-wave infection-fatality rate than richer countries in the southern states of Karnataka and Tamil Nadu,” Dr Paul Novosad, an associate professor at Dartmouth College, said.
While estimates may vary, one thing that can be said “clearly beyond all doubt” is that the pandemic is much larger than official figures portray.