New Delhi: 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, according to a study published by a US-based think tank and authored by India’s former chief economic adviser Arvind Subramanian, among others.
India’s official Covid death count as of end-June 2021 was around 4 lakh.
The study published by the Center for Global Development (CGD) has been co-authored by Abhishek Anand of Harvard University and Justin Sandefur of CGD, besides Subramanian, who is now with Brown University in the US.
‘Excess deaths’ mean additional fatalities recorded during the pandemic, as compared to a corresponding period in pre-pandemic years. Excess deaths amid the pandemic could be a potential indicator of undercounting in India’s Covid toll.
However, it is not a measure of unrecorded Covid fatalities alone, but also additional deaths with an indirect Covid link — for example, patients with non-coronavirus afflictions who died for want of medical attention as much of the healthcare infrastructure shifted towards catering to the pandemic.
The paper adds to multiple reports that point to the fact that India’s official Covid fatality tally may be an underestimate. Earlier this month, the WHO said the global death tally at the time — around 40 lakh — may be an underestimate as well.
The study also suggests that the first wave may have been more lethal than popularly believed. Not grasping its scale, it adds, may have “bred the collective complacency that led to the horrors of the second wave”.
The study employs three data sources to offer as many estimates about excess deaths during the pandemic. These include media reports and research derived from civil registration of deaths (CRS) data maintained by states, seroprevalence studies in India in conjunction with data from around the world on infection fatality rates (IFRs), and a periodic survey conducted across lakhs of households by the Mumbai-based think tank Center for the Monitoring of the Indian Economy (CMIE).
All three methods, the authors note, have their limitations.
“Estimating Covid-deaths with statistical confidence may prove elusive. But all estimates suggest that the death toll from the pandemic is likely to be an order of magnitude greater than the official count of 400,000,” the team said.
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The three estimates
According to the researchers, the first estimate, based on CRS data from seven states — extrapolated for a country-wide estimate — suggests 34 lakh excess deaths.
The second, applying international IFR estimates to Indian seroprevalence data, implies a higher toll — around 40 lakh.
The analysis of the Consumer Pyramid Household Survey (CPHS) — which covers over 800,000 individuals across all states — yields an estimate of 49 lakh excess deaths, the researchers add.
Questioning India’s official death toll, the researchers note that its death rate is much lower than other countries like Brazil, Italy, US, and the UK even though these nations have lower infection rates.
Unlike other countries, they add, India still does not have estimates of excess deaths during the Covid pandemic. The only all-India numbers available are based on models, some of which have been derived from “hypothetical infection and infection fatality rates that were not linked to India data per se”, they say.
With this paper, the researchers add, they seek to “use these three sources to provide three new estimates of all-cause excess mortality for India, during the Covid pandemic for both the first and second waves”.
“Given all the difficulties, getting at the true estimate will be difficult and only by piecing together data from different sources will we improve our understanding of the reality of the pandemic,” they add.
Listing the limitations of each approach, the researchers note that “CRS-based numbers are still not available for all the states” and “they are known to under-count deaths”. The CRS numbers also stop for most states in May 2021, they add.
For the second estimate, the researchers say it “is only partly based on Indian data (on infection rates) and assumes IFRs based on other countries whose validity for India is open to question”.
The researchers say the focus “of the CPHS has been employment, income and consumption”, but describe its data on mortality as “a collateral benefit”. However, potential measurement errors are cited as a limitation.
Despite the caveats, they note that “true deaths are likely to be in the several millions not hundreds of thousands, making this arguably India’s worst human tragedy since Partition and Independence”.
The purpose of the paper “has been to report — without in any way endorsing — different data-based estimates”, they add.
“A collective understanding of and engagement with them and indeed with estimates from other data sources, warts and all, is now necessary,” the authors note.
(Edited by Sunanda Ranjan)
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