Conversations around India’s recording of COVID-related fatalities have been reignited by recent international reports that have suggested that India’s actual COVID body count might be ten times as much as what the official figures reveal. Last week, in the backdrop of Chennai recording a surge in COVID-related deaths, it was reported that crematoriums and burial grounds in the city were being overburdened. Subsequently, Chief Minister MK Stalin had also instructed his officers to present a true picture of COVID fatalities and not resort to fudging any data.
Even under normal circumstances, experts have suggested that owing to the nation’s heavily underfunded public healthcare infrastructure, just about 86 per cent of nationwide deaths make it to the official registration in government systems. And the number of fatalities that are offered an official cause of death, which are essentially cleared by a doctor, amount to just about 22 per cent. In the backdrop of such statistics, when a pandemic-like situation emerges, it might be anyone’s guess as to how many fatalities go under the radar.
According to Ramanan Laxminarayan, the Director of the Centre for Disease Dynamics, Economics and Policy, in 2020, it was estimated that just one in 30 infections were being detected by testing, which in turn proved that the reported cases are a serious underestimation of true infections. Disparities were reflected in Gujarat’s reported fatalities as well. In the middle of April, fatalities on a single day as reported by the State health bulletin, were 78. However, data from seven cities in the state confirmed that as many as 689 bodies were either cremated or buried as per COVID protocols on that day. A similar situation was reported in Uttar Pradesh. Health officials last month said they had recorded 68 deaths across the entire state in one day – and a newspaper report about Lucknow the very same day, quoted on an official who recorded 98 COVID funerals in Lucknow alone. In the case of Bhopal, in Madhya Pradesh, over a period of 13 days last month, the city officials reported 41 COVID related deaths. However, cremation and burial grounds during the same period have witnessed as many as 1,000 interments.
As per stakeholders in the healthcare policy space, the phenomenon of underreporting is not endemic to India. Even in the US, during the early days of the pandemic, New York was called out for under-reporting its nursing home deaths by a few thousand. These numbers were finally added to the tally in February 2021, which pushed up the deaths of nursing home residents from 8,500 to 15,000. Here in India, there is an acute need for a reliable death registration system. As a fallback, the government has introduced an Integrated Disease Surveillance Program (IDSP) that collects data on COVID cases and deaths from testing laboratories and hospitals pan India. The flip side is that there is no way of tracking deaths outside hospitals, a problem amplified during the second wave when many are succumbing to the disease at homes or en route to hospitals.
Though one may argue that actual numbers are being suppressed to prevent panic, a troubling consequence of missing deaths is that one can no longer reliably use fatality data to estimate total infections. Without good data, accurate projections are impossible, making it difficult to gauge the true state of the pandemic, a situation that will leave the government unprepared and ill-equipped to continue its battle against COVID in the long run.