The Covid care centre at the Government Homoeopathic Medical College in Iranimuttom, Thiruvananthapuram | Photo: Praveen Jain | ThePrint
The Covid care centre at the Government Homoeopathic Medical College in Iranimuttom, Thiruvananthapuram | Photo: Praveen Jain | ThePrint
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New Delhi: The Union Health Ministry will send yet another central team to Kerala Friday for effective Covid management as the state continues to report a spike in daily cases. This is the second such team to visit the state in July.

For two straight days, Kerala, once a globally celebrated Covid-19 “model”, has recorded more than 22,000 new cases and over 50 per cent of India’s daily tally. However, it appears that among all states, Kerala is underreporting Covid cases the least.

Health economist Rijo John calculated the undercounting factor based on the fourth sero survey conducted by the Indian Council of Medical Research (ICMR). Government officials confirmed to ThePrint that the undercounting factor is in line with government estimates.

The findings of this latest sero survey showed that the top two states which are underreporting cases are Bihar and Uttar Pradesh.

While Bihar undercounted Covid cases by a factor of 134, Uttar Pradesh undercounted cases by a factor of 100. Kerala, meanwhile, undercounted cases by a factor of six. This means that for every case detected in Kerala, the system missed six others.

In Bihar, for every detected case, 134 infections were missed and in Uttar Pradesh, for every detected case, 100 infections were missed. This means that by 31 May, Bihar actually had nearly 947 lakh infections against its detected caseload of seven lakh while UP had nearly 1,689 lakh infections against its detected case load of 17 lakh.

The other worst-hit state, Maharashtra, is underreporting cases by a factor of 12. This means the state had 714 lakh cases when it had officially counted just 57 lakh.

India as a whole underreported Covid cases by a factor of 33, the analysis found. This means that 9,265 lakh Indians were infected with coronavirus by 31 May but only 282 lakh cases were diagnosed. The study is based on the 4th ICMR sero survey conducted in June-July and case count in the states on 31 May.

A government official noted: “The sample also includes those who were vaccinated. The percentage of population with full vaccination was less than 5 per cent in most states at the time of survey still, not accounting for it might lead to over estimation of the undercounting factor.”

The results of the fourth sero survey announced last week showed that by the first week of June this year, 67.6 per cent Indians had antibodies against the SARS-CoV-2 virus. The state-wise breakup found that Madhya Pradesh, with a sero prevalence of 79 per cent, had the highest proportion of its population exposed to the SARS-COV2 virus, while Kerala had the least — 44 per cent.

Interestingly, the Government of India has said in the past that undercounting has happened only in cases and not in deaths, even though the director general of health services has been asked to seek death registration data from states. This was done after a series of reports highlighted an unusual increase in death registrations under the Civil Registration System (CRS).

Also read: India’s Covid death rate likely to be 7-8 times higher than reported, study finds

All states undercounted Covid cases

The data shows that all states undercounted Covid cases, but only Uttar Pradesh and Bihar did it by a factor of 100 or above.

Illustration: Soham Sen | ThePrint

Madhya Pradesh undercounted cases by a factor of 86, Jharkhand by 70, Rajasthan by 66, Gujarat by 59, and West Bengal by 44. This means that when the official count in MP was eight lakh, the state actually had 674 lakh infections. In Jharkhand, when the official count was three lakh, the state had 236 lakh infections. When the official count in Rajasthan was nine lakh, 617 lakh people in the state were infected. Gujarat had 481 lakh infections when it had detected just eight lakh cases, and West Bengal had 607 lakh infections against its official figure of 14 lakh cases.

“Nowhere in the world have all Covid-19 infections been detected. That is a function partly of the nature of the virus. A majority of cases are asymptomatic and do not get detected. Even the people themselves are unaware that they got it. That is the case in even the most advances health systems too,” a senior health ministry official said.

This report has been updated to reflect that the analysis on the Covid cases undercounting factor was calculated by health economist Rijo John, based on ICMR’s fourth sero survey.

Also read: Why ‘model state’ Kerala is accounting for more than half of India’s daily Covid cases


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