CNN reported this week (28 Apr) that India has been under counting COVID-19 cases and deaths.
According to the health ministry, 401,993 new infections were registered over the past 24 hours, taking the total caseload to 19.1 million. There were 3,523 deaths, bringing the toll to 211,853.
Medical experts believe actual COVID-19 numbers in India may be five to 10 times greater than the official tally. Health workers and scientists in India have long warned that COVID-19 infections and related deaths are significantly underreported for several reasons, including poor infrastructure and human error.
“It’s widely known that both the case numbers and the mortality figures are undercounts, they always have been,” said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in New Delhi.
“Last year we estimated that only one in about 30 infections were being caught by testing, so the reported cases are a serious underestimate of true infections,” he said. “This time, the mortality figures are probably serious underestimates, and what we’re seeing on the ground is many more deaths, than what has been officially reported.”
The country’s daily death toll is now projected to continue climbing until mid-May, according to prediction models from the University of Washington’s Institute for Health Metrics and Evaluations. It could peak at more than 13,000 a day — more than four times the current daily death toll, the predictions show.
“I don’t think any family has been spared a Covid death,” said Laxminarayan. “There’s a missing person in every family that I can think of.”
Another example of this is noted in accounts by Reuters, where it documented how Kurukshetra crematorium in Surat, Gujarat’s second largest city and a second crematorium known as Umra cremated more than 100 bodies a day under COVID protocols three weeks ago, far in excess of the city’s official daily COVID death toll of around 25, according to interviews with workers.
Undercounting deaths
Even before the pandemic, India was already undercounting its dead.
India’s underfunded public health infrastructure means that even in normal times, only 86% of deaths nationwide are registered in government systems. The majority of people in India die at home or other places, not in a hospital, so doctors usually are not present to assign a cause of death. Increasingly, COVID-19 patients are now dying at home, in idling ambulances, in waiting rooms and outside overwhelmed clinics in India.
“All countries to some extent have faced this problem of accurately classifying Covid-related deaths, but I think in India the problem is quite acute,” said Dr Bhramar Mukherjee, professor of biostatistics and epidemiology at the University of Michigan.
The director of India’s National Centre for Disease Informatics and Research (NCDIR) acknowledged that it was difficult to ensure individual states follow the guidelines to capture all confirmed and suspected COVID-19 deaths.
“As per the existing law, NCDIR is not required to get data about suspected or probable deaths from states so I can’t say whether deaths are being certified,” the director said. Dr Mukherjee estimates that fatalities could be underreported by a factor of between two and five.
The number of mass funerals, cremations and bodies piling up have indeed cast doubt on the official reported deaths in numerous cities these past few weeks.
Max Rodenbeck, South Asia Bureau Chief for The Economist told CNN, “There is one crematorium in Delhi, which is a big land in the park, and (it is) building 100 new funeral pyres … This, is again, in India’s biggest city with the most attention. What happens beyond Delhi is pretty awful.”
