Explained: India’s low COVID-19 death rate, undercounting and govt’s desperation to portray ‘success’

In its fifth month of battling COVID-19, there have been more than 11 lakh cases and 27,503 deaths in India. The country ranks third globally in the number of confirmed COVID-19 cases. Correspondingly, in the United states, which tops the list, there have been 35.5 lakh confirmed COVID-19 cases and 1.37 lakh deaths. Brazil, which is second on the list, has had 20.46 lakh cases and 77,851 recoded deaths.

At a glance, it would seem that India is doing much better with fewer number of deaths. But that would be a myopic observation as India is not recording all COVID-19 deaths. In some states, deaths are not even being recorded, while in others, COVID-19 deaths were being recorded as death by any of the co-morbidities such as chronic hypertension, diabetes, or cancer. All of these make people more vulnerable to the virus.

Then there are several people with COVID-19 symptoms who died before they were tested, or their tests showed negative. These are not recorded either. Studies from Wuhan University in China and Northwell COVID-19 Research Consortium in the US have shown that asymptomatic people can also suffer lung and kidney damage.

But all of this goes against what even Indian Council for Medical Research (ICMR) guidelines state. The research body states that all deaths, including those with comorbidities, and suspected deaths must be recorded as ‘died due to COVID-19. This is relevant because testing is limited in a country like India, with just 8.55 tests per thousand people. It must also be mentioned that all the tests (RT-PCR, TRUNAT, CBNAAT and rapid antigen) could give false negatives. Even the RT-PCR tests, which is considered the gold standard of testing COVID-19, has only 70% sensitivity.

In several villages in the country there are no testing facilities, so then will nobody ever get COVID-19? These are questions that many epidemiologists have been attempting to teach the government. The insistence on tests to prove COVID-19 is also worrying.

“Are tests the only way to find COVID-19 cases? What is the clinical diagnosis? We have strict clinical criteria for COVID-19, so if you fulfil it, you don’t even need a test. If a person has fever and loses sense of smell, it is COVID-19. No more proof is required. Similarly, there are about eleven criteria and if a few of them are fulfilled, it is COVID-19. So, even if we do not test, we know that the person has COVID-19. And even if they test negative, they have COVID-19. Tests can be falsely negative in half of the tests,” said Dr T Jacob John, virologist and former professor at Vellore-based Christian Medical College.

This also means that an equally large number of deaths in many parts of the country will go unrecorded. According to a report in the British Medical Journal, the family of a 38-year-old man in Madhya Pradesh struggled to get him treatment for COVID-19 even though they were located in the state’s capital Bhopal. Eventually, when they reached a hospital, the person died. The family was informed that he was suspected to have died due to COVID-19.

A few days later, after the cremation, the family found out that the city had not even recorded the 38-year-old’s death as from COVID-19.

When the administration was questioned, the principal secretary of Madhya Pradesh’s Directorate of Health Service, Faiz Ahmed Kidwai said that since it was unclear whether the deaths was from COVID-19, it wasn’t recorded by the state.

This is not an isolated case. The governments of multiple states, including Delhi, Telangana, Maharashtra, Madhya Pradesh, West Bengal, Gujarat and Uttar Pradesh have been accused of hiding COVID-19 deaths. This undercounting is deliberate and fuelled by the political need for state governments to portray success in containing the spread of the virus.

Moreover, the central government has been using these fewer death number to claim victory over the virus. In fact, Prime Minister Narendra Modi claimed, “Despite our large population, we minimised the deaths and our recovery rate is 50%. That has become a point of discussion across the world.”

Two weeks ago, Union Home Minister Amit Shah again claimed that India’s statistics were far better than anywhere else in the world. “India under Modi is better placed to fight COVID-19. Some people predicted mass deaths in India, but that hasn’t happened,” contended Shah.

However, the outbreak in India shows no sign of slowing. “It has pushed some states and cities to reimpose the lockdowns lifted weeks ago. Both the number of daily cases and daily deaths are rising and setting fresh records,” said Prabhat Jha, an epidemiologist at the University of Toronto. He was speaking to The Washington Post. He underscored that more and better data would be required from India to understand the scope of infections in the country.

According to the report, the newspaper had contacted officials in four of India’s largest cities — Mumbai, Delhi, Chennai and Kolkata — to obtain data for total deaths in each month from March to June for 2019 and 2020. Only Mumbai provided full and up-to-date figures and Kolkata did not even respond.

In Delhi, the death data mismatch continues. It came to light in the first week of May, when an analysis of the COVID-19 data put out by the Delhi government revealed that the state has been hiding the number of deaths due to coronavirus. Between May 2 and May 8, the Delhi government had insisted that the number of deaths remained at 65. But in reality, 20 more persons had died of COVID-19 at Lok Nayak Hospital and Rajiv Gandhi Super Specialty Hospital together. If the death data from other hospitals had been included, the number would be multiplied in May itself.

Even now, a look at the COVID-19 burials and cremations point towards a continuation of the policy of hiding death numbers. The three Delhi municipal corporations recorded 4,155 COVID-19 deaths until July 17, according to a report on the website ThePrint. However, the Delhi government stated that as of July 17, the death toll stood at 3,571.

In Vadodara, the official figures, according to the report in The Washington Post, showed that the total number of coronavirus cases has increased by more than 2,000 since the start of June. But the number of deaths rose by just three from 57 to 60, indicating official cover-up.

A group of health activists called ‘Doctors for Seva’ in Hyderabad have accused the state of hiding deaths by not testing enough people, and not counting deaths even among COVID-19 confirmed patients.

“The gaps in India’s data mean the true number of COVID-19 deaths is higher than the official figure, but no one knows by exactly how much in the absence of further research,”pointed out K Srinath Reddy, president of Public Health Foundation of India.

Most states, including Delhi, have appointed “death audit committees,” which are panels of doctors who evaluate COVID-19 related death. But, that has not stopped the fudging of data.