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COVID-19 might have killed four million people in India – Harvard study

Research published this week by the Center for Global Development in the United States found that COVID-19 has likely killed several million people in India – “catastrophically worse” than the 414,000 officially reported – writes MedicalBrief. The pandemic is thus likely modern India’s worst human tragedy.

Writing in The Guardian on 20 July, Hannal Ellis-Petersen in Delhi said the number of excess deaths in India during the COVID-19 pandemic could be 10 times higher than the official death toll. The study estimates that between three million and 4.7 million more people died than would be expected between January 2020 and June 2021.

Excess deaths are a calculation of how many more people are dying across a defined period of time than usual. While not all excess deaths that occurred during the pandemic would be due to COVID, it is likely that a significant proportion were.

The Center for Global Development (CGD) is a think-tank based at Harvard University. The report was produced by Arvind Subramanian, former chief economic adviser to the Indian government and a distinguished non-resident fellow at the CGD; Abhishek Anand of Harvard University; and Justin Sandefur, a senior fellow at the CGD.

Their study examined three sources of data to piece together a comprehensive picture of the pandemic in India. The CGD report, published on Tuesday 20 July, acknowledges that establishing an accurate COVID-19 death toll may “prove elusive”.

The report says: “India’s official COVID death count as of end-June 2021 is 400,000. The reality is, of course, catastrophically worse…What is tragically clear is that too many people, in the millions rather than hundreds of thousands, may have died.”

India’s second wave rolled in during March, and was the most devastating. The Guardian writes: “People died in the streets and outside hospital gates unable to get a bed or oxygen, and the healthcare system was brought to the brink of collapse.

But from the data gathered, the researchers concluded that the first wave “was also more lethal than is widely believed” and about two million people may have died.

“True deaths are likely to be in the several millions not hundreds of thousands, making this arguably India’s worst human tragedy since Partition and independence,” the report says.

The study

Sheikh Saaliq and Krutika Pathi wrote for AP that the government has dismissed concerns about a vast undercount of COVID deaths as exaggerated and misleading. However, scientists believe that the government count could have missed deaths in overwhelmed hospitals or while health care was disrupted.

The three sources used to calculate the pandemic toll were: data from the civil registration system that records births and deaths across seven states, blood tests showing the prevalence of the virus in India alongside global COVID-19 fatality rates, and an economic survey of nearly 900,000 people done three times a year.

Subramanian emphasised that all three data sources had “merits and shortcomings” but said they all depicted a relatively similar pattern for excess deaths, according to The Guardian. He also emphasised that the data sources only went up to May, so the full impact of the second wave that has continued into June and July would not be reflected.

Researchers cautioned that each method had weaknesses, such as the economic survey omitting the causes of death, said AP. They also cautioned that virus prevalence and COVID-19 deaths in the seven states studied may not translate to all of India.

The crisis in India

Most countries are also believed to have undercounted deaths in the pandemic. But India is thought to have a greater gap due to its huge population of 1.4 billion people, and because not all deaths were recorded even before the pandemic.

State governments and local administrations across India have been accused of purposefully undercounting COVID-19 deaths, according to The Guardian, while stigma attached to the virus prevented many people from getting tested, so many COVID deaths went unrecorded.

Dr Jacob John, who studies viruses at the Christian Medical College at Vellore in southern India and was not part of the research, reviewed the report for AP and said it underscores the devastating impact COVID-19 had on the country’s underprepared health system.

According to The Guardian, report author Arvind Subramanian said: “After the first wave, which was more spread out, there was a sense that India had escaped the worst because there was this undercounting of deaths, and that led to a culture of complacency.

“But in the second wave, with all the horrendous images that we saw, that really galvanised Indian society to get to the bottom of the numbers.

“Much of this is thanks to the heroic efforts of Indian journalists and civil society who tirelessly and furiously recorded deaths and forced state governments to release accurate data and revise their figures.”Over the last few months, some Indian states have increased COVID-19 death tolls after finding thousands of previously unreported cases.

The authors said the undercount of deaths after the first wave of infections last year may also have resulted, in part, from the fact that it was “spread out in time”, as opposed to the sharp curve of the second wave when hundreds of thousands of people died amid shortages of oxygen, beds and vaccines, according to The New York Times.

The study has said that the country’s inability to grasp the “scale of the tragedy in real time” during its first wave from March 2020 to February 2021 may have caused “the collective complacency that led to the horrors of the second wave.”

India is still reporting nearly 40,000 new cases and about 500 deaths a day, according to a New York Times database. Less than 7% of the population is fully vaccinated. Prime Minister Modi has warned of an impending third wave of infections, which government scientists say could strike as early as August, the newspaper says.

“Knowing the true death toll of the pandemic is important for so many reasons,” Subramanian said, The Guardianreported. “How can we have a basic understanding of the impact of COVID without knowing how many people died and where they died? Accurate data is the only way we can prepare a fully-fledged response to the pandemic in the future.”

 

Study details

Three New Estimates of India’s All- Cause Excess Mortality during the COVID-19 Pandemic

Abhishek Anand, Justin Sandefur and Arvind Subramanian

Center for Global Development – Working Paper 589 – published on 20 July 2021

 

Abstract

India lacks an authoritative estimate of the death toll from the COVID-19 pandemic. We report excess mortality estimates from three different data sources from the pandemic’s start through to June 2021.

First, extrapolation of state-level civil registration from seven states suggests 3.4 million excess deaths. Second, applying international estimates of age-specific infection fatality rates (IFR) to Indian seroprevalence data implies a higher toll of around 4 million. Third, our analysis of the Consumer Pyramid Household Survey, a longitudinal panel of over 800,000 individuals across all states, yields an estimate of 4.9 million excess deaths.

Each of these estimates has shortcomings and they also diverge in the pattern of deaths between the two waves of the pandemic.

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.

Understanding and engaging with the data-based estimates is necessary because in this horrific tragedy the counting – and the attendant accountability – will count for now but also the future.

 

The Guardian story – India’s excess deaths during COVID ‘could be 10 times official toll’ (Open access)

 

AP story – India’s pandemic death toll could be in the millions (Open access)

 

The New York Times story – India’s true pandemic death toll is likely to be well over 3 million, a new study finds (Restricted access)

 

Center for Global Development paper – Three New Estimates of India’s All-Cause Excess Mortality during the COVID-19 Pandemic (Open access)

 

See also from the MedicalBrief archives

 

India’s COVID crisis – New cases decline but daily deaths top 4,500

 

Mucormycosis: The deadly ‘black fungus’ afflicting COVID-19 patients in India

 

Politicians, gangsters and the rich jump India's COVID queues

 

India: The mental health emergency that comes after COVID-19

 

 

 

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