Maharashtra’s 23,000 ‘backlog’ deaths skew India’s fatality rate, but it isn’t only offender

While Centre says reporting of backlog deaths helps better understand Covid spread, it wants Maharashtra, other states to provide details such as dates & districts to get a more comprehensive picture.

ICMR doctors take blood samples for a study in Dharavi, Mumbai, on 30 May 2021 | ANI Photo

New Delhi: Maharashtra’s Covid death toll rose by 29,920 fatalities in under two months, from 95,958 deaths on 28 May to 1,25,878 by 11 July. 

But, 23,000 of the cases are “backlog” deaths — in that, they occurred much before the days they were reported on. These ‘backlog deaths’ also made up 26 per cent of the total 86,252 deaths reported in the country in the same period. 

The numbers have now left the central government wondering if it has the data to analyse the full spread and impact of the pandemic in the country’s worst-hit state. The Union health ministry is now planning to take the matter up with the Maharashtra government once more. 

Health ministry officials told ThePrint that an earlier communication sent to the state in June, for information on the date and district-wise break up of these deaths, has gone unanswered. 

While officials are appreciative of the state’s commitment to reporting the true impact of the pandemic, they are flummoxed by the fact that over 76 per cent of the state’s deaths are “backlog”. 

Maharashtra Principal Secretary (health) Pradeep Vyas confirmed the numbers but said they are part of a reconciliation exercise. “Yes, more than 23,000 deaths of the prior period have been included in progressive cumulative deaths due to an ongoing reconciliation exercise,” Vyas told ThePrint. “We report daily in our bulletin, the number of prior period deaths with its breakup in different districts.”

Not the only offender

Maharashtra is by no means alone though. 

Health ministry sources said six states whose death numbers are a particular cause for worry, and in serious need of a systemic audit, are West Bengal, Tamil Nadu, Kerala, Karnataka, Bihar and Maharashtra. 

Bihar, the northeastern states and Odisha have over the last few weeks been quietly adding backlog deaths to their daily Covid bulletins, pushing up the casualty figures even as daily cases have plateaued in the 35,000-50,000 per day band. 

But none of the other states’ backlog numbers, say health ministry officials, are as big as Maharashtra.

According to an analysis by the Observer Research Foundation, in the week ending 11 July, about 2,098 backlog cases were added to India’s death numbers. About 1,326 such deaths were added to the numbers for the week before that.  On Tuesday, of the 2,020 deaths, around 1,431 were of Madhya Pradesh’s backlog.

This has also pushed up India’s weekly Case Fatality Rate, which defines the severity of the pandemic and is a measure of total deaths among reported cases. 

India’s cumulative CFR is around 1.35 per cent but the weekly CFR is now above 2 per cent. This is because, between 4 July and 11 July, India’s total caseload went up by 2,89,147 — from 3,05,85,229 to 3,08,74,376. In the same period, the total number of deaths went up by 6,039, from 4,02,728 to 4,08,767.

“The actual daily death number, we are estimating, is about 700-800 but states like Maharashtra, Odisha and the northeastern states have periodically revised their death numbers and that is what is intermittently causing the spike in the casualty figures,” said a senior government official involved very closely with the country’s pandemic response. 

“It is pushing up our CFR,” the official added. “At one point, we were down to 1.09. But we are encouraging it, because the better the reporting is, the better we can manage the pandemic. The truth should come out. As long as the CFR is below 1.5 per cent, we are not worried.” 

The Maharashtra conundrum

Sources in the central government confirmed to ThePrint that there are deep concerns about not just the fact that backlog death numbers are so high in Maharashtra but also because of the way the state is currently reporting casualties. 

“It is complicated because Maharashtra, even when it reports the day’s deaths, actually gives out deaths that happened over a week. Reconciliation like Bihar did, when it added numbers, are easy to understand,” said a second official. 

“We know that Maharashtra is making an effort not to hide numbers but this kind of reporting during a pandemic complicates our understanding of the disease,” the official added. “For example, if all these deaths happened in one place or clusters happened over short periods, those would need examination. With such belated reporting, how do we understand the disease trajectory?”

The official cited some examples. He said that on 11 June, the state reported 383 deaths for the week but 1,532 deaths for the week preceding it. The next day on 12 June, Maharashtra reported 152 deaths for the last week and 2,461 deaths for the week preceding it. On 10 July, the state reported 219 deaths for the week and 519 for the week before it. 

“This reporting pattern means that all its deaths are essentially backlog deaths,” the official said, adding that the Centre is now pushing the state to do better auditing to understand the spread of the pandemic. 

‘Important to identify the location of the deaths’

The central government has also initiated an exercise to analyse excess deaths by looking at the death data from the Civil Registration System. 

The union director general of health services (DGHS), Dr Sunil Kumar, told ThePrint that the Centre has sought the data from states and is currently awaiting their arrival. 

Officials said that while there is no problem about states adding backlog data, it is important that they mention that such an exercise has been done so as to maintain data hygiene. 

It is not enough to merely add numbers to the total, it is also important to know where they have happened and why they have happened, an official said.

“That is why we have written to states asking them to undertake death audits. To Maharashtra and Bihar also, we have said that deaths should be added with details about date and district,” the official added. “This will help us understand the behaviour of the disease better and analyse and plan for the future.”  

(Edited by Arun Prashanth)