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AFP
More than 50,000 people have died from Covid-19 in India
India has registered more than 50,000 dead Covid-19, which is taking the UK to become the fourth-least-hit country for dead.
But the death toll per million people stands at 34 – much lower than what has been reported in Europe or North America.
The death toll from the case as CFR, which measures deaths among Covid-19 patients, is just about 2%. Even in bad hits like Maharashtra, the death toll only doubles in about 40 days. “Death rates have kept low all the time, even as cases have increased,” said K Srinath Reddy, chair of the think tank, Public Health Foundation of India.
Many epidemiologists report this relatively low death rate to a young population – the elderly are typically more vulnerable to infection. It is not clear whether other factors such as immunity derived from previous infections of other coronaviruses are also responsible. They also point to a pattern of low mortality in South Asian countries that share a similar demographic of a younger population: reported deaths of Covid-19 per million are 22 in Bangladesh and 28 in Pakistan.
Clearly, corrected for population size, India is doing much better than Europe and America. Yet, as Kaushik Basu, a former World Bank chief economist, says, “It is irresponsible to treat this as comfort.”
Prof Basu told me that there are limits to the value of geographical comparison.
“Once you do that, you realize that India is doing very badly. In China, Covid-19 deaths per million people are 3. In India it is 34. Within South Asia, the only country that is doing less than India is Afghanistan. and going through the trends India will take over Afghanistan. “
Prof Basu says India is one of the few countries where the floor of the curve has not been. “From the end of March until now, the cases and deaths not only increase but do so at an increasing rate,” he says.
Also, experts say, India’s relatively low death toll does not tell the whole story, and some are of the opinion that there is substantial undercounting in several states.
For one, many states, contrary to WHO guidelines, do not include suspected cases in the final count.
Second, a handful of states give Covid-19 deaths severe to the underlying conditions as co-morbidities of patients. Two states, Gujarat and Telangana, seem to have a lot going for them, according to a study by journalist Priyanka Pulla. In Gujarat’s Vadjarara, for example, the death toll has risen by just 49% in the last two months, even as caseloads jumped by a whopping 329%.
Third, differences have been reported between the official toll of the virus and counts of crematoria and cemeteries in some cities.
That India misses a lot of deaths, considering that only a small fraction of the population has been diagnosed – less than 1% – and many deaths are not medically reported? “Obviously there is undercounting because we have weak health care system,” said Uncle C Kurian of Observer Research Foundation, a Delhi-based think tank.
Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, says it is “difficult to measure how much underreporting goes without historical data and calculation of excessive deaths during this period”.
“Excessive deaths” are the majority of deaths above normal levels, some of which may have been caused by Covid-19.
More than 230 Indians, including doctors, researchers and students, have asked authorities to provide information on deaths for at least the last three years to calculate “excessive deaths”. They want road deaths – more than 150,000 people die in traffic accidents in India each year to be identified separately so that a more reliable picture of deaths due to diseases can be obtained.
Underpayment is not unique to India. In July, a review of mortality data in 28 countries found at least 161,000 more people died during the coronavirus pandemic than the official Covid-19 death toll report. India was not among the countries surveyed.
Prabhat Jha of the University of Toronto, who led India’s ambitious Million Death Study, one of the largest studies of premature mortality in the world, tells me that even in high-income countries with good medical certification, “analyze” undercounts by 30-60% of daily death count “.
Dr Jha says telecom companies should release call record data from March to find out where millions of Indians moved to their workplaces in the cities in the wake of the unlock. (While jobs dried up in the closing cities, these workers went and took trains to their homes and spread the infection.)
With the help of the telecom data, the government was able to send teams to the hotspot areas to record hidden deaths for adults. He also suggests that municipalities should release total deaths for all causes compared to previous years to get an idea of “excessive death”.
“How can India flatten the Covid-19 death curve if it does not measure death properly?” since Dr Jha.
When the infection ends, the toll of the coronavirus will be the only indicator on which the performance of countries in controlling the infection will be assessed.
Charts by Shadab Nazmi
