​A belated admission: on the undercount of India’s COVID-19 pandemic deaths

It has been four years since the delta variant of the SARS-CoV-2 virus hit India. The country bore the brunt of the pandemic’s devastating impact, with harrowing scenes of overwhelmed health-care systems, oxygen-supply shortages and even bodies floating in the Ganga in Uttar Pradesh. Reports based on data sourced from the Civil Registration System through RTIs and other means, by The Hindu in particular, besides independent surveys, showed that the toll was clearly staggering and in millions, much more than the official tally. The government’s response was defensive and dismissive; the attempt was to consistently undermine the findings. After maintaining that the reported number of COVID-19 deaths during this period was accurate, the government, through the Registrar General of India, released a report last week that showed that there were 21.5 lakh excess deaths in 2021 as against 3.32 lakh reported COVID-19 deaths. During a pandemic, the bulk of these excess deaths must have been related to the effects of the disease. Besides, lockdown restrictions had resulted in lower fatalities due to causes such as road accidents. The high number of excess deaths was estimated by The Hindu’s calculations to be nearly 6.5 times more than the reported deaths. The fact that this multiple was even higher for Gujarat (44.2), Madhya Pradesh (19.5),Uttar Pradesh (19.5) and Telangana (18.2) suggests that COVID-19 deaths were under-reported significantly in 2021. These were largely due to the fact that deaths due to comorbidities were perhaps not considered as COVID-19 deaths or because those numbers were suppressed in order to paint a rosier picture of the government’s response to the pandemic.

The nearly four-year delay in releasing this report, alongside the Sample Registration System Report for 2021, reveals the Union government’s reluctance to comprehensively assess the pandemic’s true impact and its casual approach to publishing critical demographic data. This reluctance in publishing timely information coincides with the fact that India’s civil registration system that tracks births and deaths has become more robust over time with most States reporting the bulk of the deaths that occur, either in institutions such as hospitals or at homes. In some States, this reporting happens with a lag when compared to others, but it is encouraging that registration levels are getting better. But medical certification of the causes of the deaths still remains low when compared to other developing countries such as Brazil. A robust maintenance of registration and certification records is important for public health tools. The delay in release of vital data defeats the purpose of the improvements made in civil registration. Data delayed is also data denied.