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

A pre-print from the University of Toronto estimates India’s Covid death rate could be 2,000-2,200/million and not 290/million as reported.

File photo of health workers at a makeshift Covid-19 quarantine facility set up in New Delhi | Photographer: Anindito Mukherjee | Bloomberg

New Delhi: India’s Covid death rate may be about 7-8 times higher than the officially reported figure of 290/million population, a non-peer-reviewed paper from the University of Toronto has concluded.

The official Covid death toll in India currently stands at 4,20,967.

The study led by researchers from the Centre for Global Health Research, Unity Health Toronto and Dalla Lana School of Public Health, University of Toronto quantified all-cause excess mortality in India, comparing deaths during the peak of the first and second waves (Jul-Dec 2020 and April-June 2021 respectively) with month-wise deaths in 2015-19.

The comparison was made using three sources: Civil Registration System (CRS) mortality reports from 15 states or cities with 37 per cent of India’s population; deaths in 0.2 million health facilities; and a representative survey of 0.14 million adults about Covid deaths.

The study that has been put on a pre-print server said: “During the first viral wave, the median excess mortality compared to CRS baseline was 22% and 41%, respectively, in included states and cities, rising to 46% and 85% during the second wave. In settings with 10 or more months of data across the two waves, the median excess mortality was 32% and 37% for states and cities, respectively. Deaths in health facilities showed a 27% excess mortality from July 2020-May 2021, reaching 120% during April-May 2021.”

“The national survey found 3.5% of adults reported a COVID death in their household in April-June 2021, approximately doubling the 3.2% expected overall deaths. The national survey showed 29-32% excess deaths from June 1, 2020 to June 27, 2021, most of which were likely to be COVID. This translates to 3.1-3.4 million COVID deaths (including 2.5-2.8 million during April-June 2021). National extrapolations from health facility and CRS data suggest 2.7-3.3 million deaths during the year,” the study added

This is the latest in a series of estimates on the undercounting of Covid deaths in India.

According to a study published by a US-based think tank and authored by India’s former chief economic adviser Arvind Subramanian, among others, the ‘excess deaths’ caused during the Covid-19 pandemic — from the start of the pandemic to June this year — may be as high as 49 lakh. Meanwhile, the Institute of Health Metrics and Evaluation at the University of Washington estimates that India could be undercounting deaths by a factor of 2.97. The government of India has, however, said there has not been any significant undercounting of Covid deaths in India.

Survey across 8 states, 7 cities

The University of Toronto along with polling agency CVoter covered all states and cities where the proportion of registered deaths before 2020 covered at least 50 per cent of expected deaths. The eight states were Madhya Pradesh, Tamil Nadu, Gujarat, Andhra Pradesh, Odisha, Kerala, Assam, and Haryana. The seven cities were Ahmedabad, Mumbai, Nagpur, Chennai, Bengaluru, Hyderabad, and Kolkata.

During the first wave in 2020, the proportion of excess deaths compared to earlier years of registration ranged from 63 per cent in Andhra Pradesh to 6 per cent in Kerala (total excess 218,000 deaths). The number of excess deaths during the first wave in seven cities ranged from 95 per cent (the authors say this is “improbable”) in Ahmedabad to 21 per cent in Kolkata (total excess 82,000 deaths).

During the second wave this year, the comparable proportions ranged from 198 per cent in Madhya Pradesh to 0 per cent in Kerala (total excess of 495,000 deaths). The comparable proportions for cities was a total excess of 45,000 deaths.

The researchers said that if these estimates are correct then the World Health Organization would need to revise global mortality estimates to account for the Indian deaths. “Even the lowest estimate of 2.7 million deaths and the more credible lower estimate of 3.1 million deaths represent a national Covid death rate per million population ranging from about 2,000 to 2,200, or approximately 6.8 to 7.9 times the reported rate of 290. This would put India’s death rate per million in the range reported in Latin America (around 2,000/million), where registration of deaths is far more complete,” they wrote.

They added: “If our findings are confirmed, this will require substantial upward revision of WHO’s global excess mortality which currently estimates three million deaths (1.2 million more than confirmed COVID deaths) in 2020 just in the Americas and European region. Indeed, our study would double the confirmed COVID deaths worldwide from January 1 to July 10, 2021, which currently stands at two million, of which 0.25 million are in India.”