Lancet study reveals massive under-reporting of Covid-19 deaths

public health budget 2023
Half of the public health budget comes from the National Health Mission that saw a 1.2% increase in allocation compared with the previous year.

There was a sense of disbelief whenever India’s official figure for Covid-19 deaths was cited ever since the first wave of the pandemic hit the country in March 2020. India reported very low fatality figures that sounded unrealistic for a country with poor healthcare infrastructure. Questions were raised on how India contained the epidemic without spending much.

Immediately after the deadly second wave of the pandemic, several international studies started questioning India’s official death figures. Some papers used the data on excess deaths in the country and put the actual death figure between 1.5 times to 8 times what was reported. They veered around a country-specific inflation factor of around 6. But the political leadership shrugged these off as faulty figures produced by enemies of the country. A Lancet study published on Thursday broke the suspense. The paper by Covid-19 excess mortality collaborators puts the number of cumulative Covid-19 deaths in India at 4.1 million, eight times the official figure of 5,15,000.

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Study challenges official death tolls

The study picked up data from 74 countries. The global tally arrived at using the official death tolls is around 6 million, but the Lancet study points to 18.2 million Covid deaths. This means the number of Covid-19 deaths globally was three times the figure compiled from official reports. 21 countries reported excess mortality above 300 per 1,00,000 population. The number of excess deaths due to Covid-19 was largest in four regions — South Asia, North Africa, the Middle East, and eastern Europe.

India’s tally according to Lancet is the highest in the world. The next on the list were the US (1.13 million) and Russia (1.07 million). The US and Russia reported Covid-19 deaths with much more transparency – the official figures were 1 million for the US and 0.35 million for Russia. The ratio between excess mortality rate and reported Covid-19 mortality rate is just 1.37 in the case of the US and 1.64 for Russia. These countries also under-reported deaths, but by a lesser margin.

covid-19 deaths in india

The study also backed the view that Kerala did well in managing the Covid-19 pandemic compared with most Indian states. The mortality rate in Kerala was reasonably low and next to accurate. But sceptics within the state suspected that covering up of Covid deaths was rampant in Kerala. Kerala’s numbers look realistic as it has the best public health infrastructure in the country.

The study finally verified the doubts of various experts. Several large states of North India have poor healthcare infrastructure. The paper analysed the reporting of Covid-19 deaths in Indian states for which they managed to gather data, the results of which were really disturbing.

Under-reporting of Covid-19 deaths

Among Indian states, Goa exhibited the most transparency while reporting deaths. The ratio between excess mortality rate and reported Covid-19 mortality rate is just 0.96, showing that the reporting by the state was transparent. Kerala comes next with a figure of 1.96. Sounds reasonable, given that the media was quoting 1.6 times excess deaths in the state. Kerala reported half of all Covid deaths, says the Lancet study.

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The story from the North Indian states was far more disturbing. Bihar has a ratio of 26.68, the worst in the country. MP stands at 21.2, Rajasthan at 15.07 and UP at 22.58. This means that the worst under-reporting happened in these northern states. Delhi, a state that took a lot of beating, has a figure of 2.44, suggesting that it was more transparent than earlier thought. So is Maharashtra with a ratio of 4.36. The southern states of Tamil Nadu (7.06) and Karnataka (7.41) fared somewhere in the middle. Telangana (13.75) and AP (13.38) had the highest rates of under-reporting in the South.

The real story is always different from the one that is told. It seems Kerala, Goa, Delhi and Maharashtra were a lot more transparent in Covid-19 reporting and were received more flak than they deserved. In the end, it’s all science, sense and sanity.