Over 90% deaths went unreported? Why WHO data raises questions
WHILE there is little doubt that India’s official Covid-19 death toll is an undercount, as is the case with probably most other countries, the “excess mortality” figures released by the World Health Organisation Thursday raise several questions.
The WHO’s estimate of 47.4 lakh Covid-related deaths in India in 2020 and 2021 flies in the face of overall death data, historical trends in death reporting, and Covid death compensation claims from states.
If, indeed, the WHO numbers are taken at face value, that would imply India missed 90 per cent of all Covid-19 deaths in the first two years of the pandemic – and possibly millions of deaths were not even recorded.
Significantly past data shows that India records over 90 per cent of all its deaths. Several population scientists The Indian Express has spoken to in the last few weeks said missing such a large number of deaths was “extremely unlikely”.
According to WHO, 8.3 lakh Covid-19 deaths happened in 2020 – the official Covid-19 toll for India for that year is 1.49 lakh. The government Thursday said that an estimated 81.2 lakh people died in the country that year due to all causes. This is consistent with past data that shows that, on an average, about 83.5 lakh people die in the country every year in the last decade and a half.
In 2019, India recorded 92 per cent of these deaths. The level of death registrations has seen a sharp rise in the last few years, from 79 per cent in 2017, to 86 per cent in 2018, to 92 per cent in 2019. In its statement, the government also claimed that 99.95 per cent of all deaths were recorded in 2020.
If 8.3 lakh of the 81.2 lakh deaths were caused by Covid-19, as the WHO says, non-Covid deaths in the year 2020 were only around 73 lakh. India’s total death toll for a year has never been below 80 lakh since 2007 till when data is available.
WHO estimates say that 39.1 lakh Covid-19 deaths happened in 2021. This is at least 4 lakh more than what the entire world, put together, reported that year.
India’s official Covid-19 death toll for 2021 is 3.32 lakh. That would mean that India missed almost 92 per cent of the Covid-19 deaths in that year. At a time when government is offering mandatory cash compensation for every Covid-19 death, there is an added incentive for people to get the deaths registered.
In fact, compensation claims offers fresh light on the debate over the actual number of Covid-19 deaths in the country.
Data from 11 states, which together account for 75 per cent of the country’s death burden, shows that the total number of applications made for compensation is less than twice the combined death toll in these states. In Gujarat, the number of applications is over 10 times the death tally but in Kerala the applications are less than the recorded deaths.
The fact that even in Bihar, applications are less than the total deaths shows that compensation claims might not be a foolproof way to assess the actual number of deaths. Apart from the fact that the affluent sections might not be filing these claims to get Rs 50,000 compensation, issues related to accessibility of government agencies and services could also be barriers to people filing these applications. At the same time, however, there is also the possibility of people filing fake applications.
The Supreme Court has already warned people against filing fake claims, and a state like Maharashtra has rejected over 60,000 applications that were found fake.
The bottom-line, however, is that the application numbers are not anywhere near the WHO’s numbers.
The WHO numbers would also imply that the Covid-19 deaths per million population in India is 3,448, instead of 384 according to the official death toll. The global average for deaths per million is about 804. In India, Kerala has the highest deaths per million population right now, barring Goa. About 1,950 people per million population died in Kerala, which is supposed to be one of the best states in keeping records.
Assuming that Kerala has counted 100 per cent of its deaths (which it has not because it is still reporting back-dated deaths almost every day), some experts argue that even if its death per million number is extrapolated to the entire country – as an academic exercise — that would mean about 26.5 lakh Covid-linked deaths, still just over half of WHO’s numbers.
Population scientists say that the actual death count would not be a matter of speculation, or a modelling exercise, once the data from the Sample Registration Survey (SRS) is out. SRS is a survey-based sampling exercise that estimates the number of births and deaths every year. It is through this exercise that we know that about 83.5 lakh people die in the country every year, on an average.
They also say that states will continue to add backdated deaths to the tally after verification. Kerala is doing that on a daily basis, while other states do it periodically. Recently, Assam added over 1,300 deaths to its tally after a data reconciliation exercise. A couple of months ago, Maharashtra added 4,000 deaths to its tally.