India Covid cases top 20 million, figure could be '15 times higher', says expert

Scores died over the weekend in Indian hospitals hit by shortages that have forced clinics in the capital to send urgent appeals for help on social media
Scores died over the weekend in Indian hospitals hit by shortages that have forced clinics in the capital to send urgent appeals for help on social media TAUSEEF MUSTAFA AFP

India has officially recorded more than 20 million coronavirus cases, with 3,446 new deaths on Tuesday taking the toll over 220,000. But experts say the country's unreliable death registration system and underreporting mean the real figures are much higher. 


India has reported more than 300,000 new infections every day for nearly a fortnight.

But scientists and epidemiological modellers say the official numbers do not come even close to reality. 

“There is a mind-boggling number of people who are sick right now in India," according to Bhramar Mukherjee, a professor of biostatistics at the University of Michigan who has been modelling India's Covid-19 outbreak since March 2020.  

“Right now, we estimate that the total number of deaths could be two to five times more, and the total number of infections could be 15 times more.” 

As Covid deaths skyrocket, cremations have been taking place on the street in many cities, with statisticians consulting satellite images of fires lit in order to estimate underreported fatalities. 

“In this second wave, many of the deaths have happened outside health care facilities and hospitals. Many have died in ambulances and bodies burning on pyres outside crematoriums and even on pavements across cities and towns are not factored,” health expert Gautam Menon told RFI. “The cause of such deaths is seldom recorded.”

In the western state of Gujarat, local media tracked 689 bodies that were cremated or buried under Covid-19 protocols in one day in mid-April. The official death toll that day was 78. Such discrepancies have been reported from several states.

Cause of death not assigned               

Scientists say India has always had a poor and delayed infrastructure for reporting of deaths and certifying the case of death in general, particularly in rural areas.

In a 2017 estimate, only one in five deaths was officially reported.

Though many countries have been accused of reportedly underplaying deaths in the ongoing pandemic, in India, death registration itself in many places is incomplete. This is because most deaths are not assigned a cause by a trained medical professional thus making the Case Fatality Ratio (CFR) unreliable.

“Because death registration is poor in India, the government will have little data to respond to the impact of Covid-19 on large sections of the population who live in the rural areas,” Jacob John, a renowned virologist told RFI.

Had these deaths been monitored through a registration system, they could also have influenced the scale and geographic targeting of government relief measures as well as health care system responses.

This time around, the virus is spreading more widely geographically also affecting poor regions such as eastern Uttar Pradesh and remote areas of northern Bihar. Given their high population density and lack of health care makes it hard to quantify the numbers who have succumbed to Covid.

A recent study done by the Indian Medicial Association in 2019 showed critical differences continue to remain between of registration of deaths with poor availability of reporting by age and sex across states.

A case in point on how deaths due to Covid are underreported has been brought out in a study done by volunteers in the southern state of Kerala who meticulously chronicled obituary notices in newspapers last year.

Interestingly, the volunteers led by Dr Arun N Madhavan, a general physician, counted 3,356 deaths from the infection in Kerala for a certain period. But the official death toll from the disease was reported at 1,969.

In the absence of a reliable death registration system, the government’s Integrated Disease Surveillance Program (IDSP) has been collecting data on cases and deaths from Covid-19 from testing laboratories and hospitals.

However, the IDSP’s key drawback is that it has no way of tracking deaths outside hospitals.

“Far better reporting of Covid-19 deaths is needed. Daily or weekly reporting of the total death counts by age and sex by each municipality would help track if there is a spike in presumed Covid-19 deaths,” said Prabhat Jha of the Centre for Global Health Research in Toronto.

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