‘India has to count its covid deaths right to steer policy’

India must record covid deaths accurately to frame appropriate public policies and track the severity of Omicron as cases surge across the country, Prabhat Jha, professor of epidemiology, University of Toronto, said in an interview.

Jha, who is the lead author of a study on deaths during the pandemic, said India saw an estimated three million covid deaths, which is about six times the official record of the government at just below 500,000. However, the Indian government has refuted the findings published by Jha and his colleagues.

The paper published in the Science journal estimated that for every death (out of three million) 9-10 households, or 30 million people, were affected by the deaths. The government was not happy with the findings, but it is about fighting the pandemic with the correct tools, Jha said.

For a policymaker, this study is crucial as it opens the possibility of implementing important measures in accounting for the dead so that it can give a better picture of future measures, he said.

As an immediate measure, the government of India should release the facility-level data on deaths from May 2021, Jha said. There are data on around 200,000 facility-level deaths, which the government has access to, that has not been made public. The second measure will be to restart the sample registration system, a statistical sampling done by the government that could give a direct count on the actual tool. Finally, the Centre should add a column to the 2022 census that asks respondents if there was any death in the household (whether covid-related or not) since January 2020.

“India typically has 10 million deaths per year and if the census shows that in 2021 India has a similar number of deaths, it would prove that our numbers were wrong and we will be happy. However, at least it gives direct evidence,” Jha said.

Globally countries are looking to get an accurate count of the severity of the pandemic by measuring death rates. This study shows that even at three million deaths India’s figures are not an exception, but a norm compared with other emerging nations. In Brazil, which has a similar household structure, the death rates are comparable with 2,300 deaths per million population.

However, according to Jha, Brazil has reported all deaths, whereas India still has close to 8 million deaths that were not certified by physicians. The variation between the official figures and the ones in the study differs by state and gender (bias in death registrations of women compared with men).

According to the study, Gujarat and Madhya Pradesh reported the highest excess deaths compared to the officially reported figures.

“In the short term, it is absolutely important to know the toll. You might say why, as death is not useful to anybody. However, it matters for the large number of families that suffered… it is a matter of justice,” Jha said.

On the practical level, Jha said if the Omicron wave is milder it will lead to fewer deaths. “However, if the deaths are not properly accounted for, we won’t know what the overall death total is. So, there is an urgent need to try to improve past accounting,” he said.