Explained: Mystery of millions of Covid deaths as Govt rubbishes ex-CEA's claims

The government today rubbished a report prepared by three experts, including former chief economic advisor Arvind Subramanian, that suggested India’s Covid death toll was heavily undercounted and the actual Covid death toll could be in the range of 3.4 million to 4.9 million, 8-10 times more than the official figure of over 4,00,000 deaths in the country, writes Krishnanand Tripathi, Deputy News Editor, ETV Bharat.

New Delhi:The government today rubbished a report prepared by three experts, including former chief economic advisor Arvind Subramanian, that suggested India’s Covid death toll was heavily undercounted and the actual Covid death toll could be in the range of 3.4 million to 4.9 million, 8-10 times more than the official figure of over 4,00,000 deaths in the country.

The report was prepared by three researchers, former CEA Subramanian; Abhishek Anand of Harvard University; and Justin Sandefur of Centre for Global Development. The authors used three different data sources, the data of deaths collected by seven states representing half of India’s population; extrapolating the death rate by applying the infection fatality rate to presence of Covid antibodies in population; and by using the data captured by a household survey of over 8,00,000 individuals done by a private firm Centre for Monitoring Indian Economy (CMIE).

In their report, the authors admitted that two of the three sources used by them capture all-cause mortality and not the specific deaths caused due to Covid infection. The authors also suggested that concealing the real death toll in the first wave led to complacency that caused a ferocious second Covid wave this year.

The ministry of health and family welfare Thursday questioned the use of findings of some recent studies conducted in the US and EU countries using age-specific infection fatality rates to calculate excess deaths in India based on the sero-positivity.

“The extrapolation of deaths has been done on an audacious assumption that the likelihood of any given infected person dying is the same across countries, dismissing the interplay between various direct and indirect factors such as race, ethnicity, genomic constitution of a population, previous exposure levels to other diseases and the associated immunity developed in that population,” said the ministry.

The government also questioned the two other data sources, Civil Registration of Deaths (CRS) data collected by states and Consumer Pyramid Household Survey (CPHS) data captured by a private firm the Centre for Monitoring Indian Economy (CMIE) deal with all-cause excess mortality and not the specific cause of death.

“The reports assume that all the excess mortality figures are COVID deaths, which is not based on facts and totally fallacious,” said the government explaining that excess mortality is a term used to describe an all-cause mortality figure and attributing these deaths to COVID-19 would be completely misleading.

The health ministry said India has a robust system that follows ICMR guidelines based on the WHO’s ICD-10 codes for correct recording of all Covid-19 deaths and it has always advised states to conduct death audits and report any cases or deaths that could have been missed.

Controversy over India’s Covid death toll

After the mighty second Covid wave in March-April-May killed over 2,50,000 people in the country this year, there is a huge controversy within and outside India about the correct death toll as several experts have questioned infection and casualty figures collected and reported by States.

A new research conducted by three experts, including India’s former Chief Economic Advisor Arvind Subramanian, suggests that the real number of Covid deaths in the country could be ten times the official number of over 4,00,000 deaths in the country.

Using three different data sources, researchers estimated that the total all-cause excess deaths during the two Covid waves in India could be in the range of 3.4 million deaths to 4.9 million deaths.

Actual death toll higher than official figure: Report

“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; they also suggest that the first wave was more lethal than is believed,” said the authors.

First estimate of 3.4 million deaths

In the first method, the authors used state-level civil registration of deaths (CRS) data collected by seven states to extrapolate all India figures of excess deaths to be 3.4 million. These seven states - Andhra Pradesh, Bihar, Chhattisgarh, Karnataka, Kerala, Madhya Pradesh, Tamil Nadu and Uttar Pradesh represent half of the country’s population but they also admitted that this method of applying the data of seven states to arrive at an all India figure has its limitation as states vary in terms of health facilities and spread of the virus. They also highlight that use of the CRS data only covers deaths reported till May this year as it is not available for the month of June.

As per their analysis using the CRS data, there could be 2 million Covid deaths in the country during the 13-month long first wave and 1.4 million Covid deaths during the three-and-a-half month-long wave this year. However, the official Covid death toll for the two waves are 1,60,000 and 2,40,000 people respectively.

Sero-prevalence suggests 4 million deaths

In the second method, the authors used sero-prevalence data, which captured the presence of Covid-19 antibodies in population of a country and applied international estimates of age-specific infection fatality rates (IFR) which tells the proportion of deaths in relation to total number of Covid infections in a country.

According to the second method, the Covid death toll in India could be even higher at around 4 million, ten times the official numbers reported by States. Their estimation suggests that there could be 1.5 and 2.4 million deaths in the first and second waves respectively, taking the total number to 3.9 million deaths.

“Strictly speaking, our second estimate is a Covid-caused one because it is based on Covid infections and Covid-related IFRs,” the authors said in the report.

Household survey suggests 4.9 million deaths

The Consumer Pyramid Household Survey (CPHS) conducted by the CMIE thrice a year covers over 8,00,000 individuals across all states. The CMIE CPHS data, which covers the period of the previous four months of the year in which the survey was conducted, reported a total excess death of 4.9 million as surveyors ask for any death in the family in the last four months but they did not ask and recorded the cause of death.

According to their study using CPHS data, the authors said there could be 3.4 million deaths in the first wave and 1.5 million deaths during the second wave taking the total death to 4.9 million people, the highest death toll for any of the three methods.

“Each of these estimates has shortcomings and they also diverge in the pattern of deaths between the two waves of the pandemic,” said the authors while underscoring the limits of each of three data sources used and analysed by them.

First wave a silent killer

The most important diversion among the three data sources is that the states’ civil registration data (CRS) and CMIE’s the Consumer Pyramid Household Survey (CPHS) data project the Covid death toll to be higher in the first wave, 2 million and 3.4 million respectively and lower death count in the second wave at 1.4 million and 1.5 million.

Whereas the authors’ analysis using international infection fatality rate (IFR) applied to India’s demography and sero-prevalence rate suggested Covid death toll to be lower at 1.5 million in the first wave and higher at 2.4 million in the second wave.

India’s official Covid death toll also conforms to the pattern, but according to the authors, grossly under-estimates the overall Covid toll in the country.

Hiding death toll in first wave led to second wave

In the report, the authors asserted that hiding the real Covid death numbers in the first wave led to the complacency that caused the second wave.

“The first wave seems to have been more lethal than is popularly believed. Because it was spread out in time and space, unlike the sudden and concentrated surge of the second wave, mortality in the first wave appeared moderate,” said the authors.

“But even the CRS data suggest that up to 2 million might have died in that period. In fact, not grasping the scale of the tragedy in real-time in the first wave may have bred the collective complacency that led to the horrors of the second wave,” noted the authors while underscoring the need to correctly capture and report the Covid death toll to avoid a possible third wave.

While acknowledging the limits of each data source, the authors said that understanding and engaging with the data-based estimates was necessary because, in this horrific tragedy, the counting and the attendant accountability will count for now and future as well.

The authors acknowledged that as per the three data sources used by them, the excess Covid death toll could be in the range of 1 million to 6 million overall, with central estimates varying between 3.4 to 4.9 million.

“Regardless of source and estimate, actual deaths during the Covid pandemic are likely to have been an order of magnitude greater than the official count. True deaths are likely to be in the several million not hundreds of thousands, making this arguably India’s worst human tragedy since partition and independence,” they said.