Data on covid deaths in India may have gaps

India is approaching the grim milestone of 10,000 coronavirus deaths, perhaps as early as the middle of next week, amid a warning by health experts on Friday that the country may be undercounting fatalities as states continue to use widely varying criteria to categorize their dead.

While the central government’s rapid response team for covid-19 last month recommended that all states conduct covid-19 death audits, most continue to follow their own ways of reporting death data, presenting a hazy picture of the disease burden in India.

“First, India has among the lowest per capita rates of testing in the world and many covid-19 deaths may not be reported. Then there are reports that states are under-reporting deaths to present a better picture of their performance,” said Ramanan Laxminarayan, director at Center for Disease Dynamics, Economics and Policy. “States should realize that undercounting deaths presents a problem in identifying communities with greater transmission.”

India has seen a sharp increase in the number of deaths in June as covid-19 cases continue their unrelenting rise despite testing rates being as low as 3,777.6 per million. The country on Friday took the fourth spot among worst-hit countries in terms of caseload, now trailing only the US, Brazil and Russia.

India on Friday surpassed Iran and Germany to take the ninth spot in terms of deaths, as per data from the Johns Hopkins live dashboard of the disease and the count from the health ministry and states. India on Friday reported 397 deaths, the highest single-day casualties so far, taking the total toll to 8,813.

Maharashtra with 3,717 deaths, Gujarat with 1,385 and Delhi with 1,214 have the highest covid-related fatalities. The per-day average of deaths has more than doubled to 288 in June from 136 in the previous month.

The Delhi government set up a three-member panel in April to audit deaths caused by covid-19. The move followed a mismatch between the figures released by the state government and those by Delhi’s municipal corporations, who sourced data from crematoriums and cemeteries.

Since the setting up of the panel, the number of deaths reported in Delhi has seen a sharp rise—alarmingly, the toll doubled in the very week of its formation. Similarly, Tamil Nadu this week ordered a death audit in Chennai after over 200 suspected covid deaths were found to have been left out of the official tally.

One problem health experts face is that states use different criteria for declaring deaths caused by covid-19, which means the actual number of reported deaths may be higher than the current figures.

“The cause of death should be given in the death certificate according to the International Classification of Diseases. Not many states may be following this. Some may be using covid as secondary cause, then the death wouldn’t reach the official toll of the state. Many states may not be testing bodies, and this would further decrease the actual toll,” said Dr Jugal Kishore, head, department of community medicine, Safdarjung Hospital. “Each death should be audited to improve the quality of care.”

Pretika Khanna and Leroy Leo contributed to the story.