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India accounted for over 31% of all ‘excess deaths’ globally in the two covid-19 years of 2020 and 2021, estimates released by the World Health Organization on Thursday show. The numbers mark a sobering reality check of the upheaval caused by the pandemic to Indian households in the last two years, and is a reminder of the gross undercount in official data. Around 14.9 million excess deaths were recorded globally in the two years, of which a staggering 4.74 million were from India—the highest in the world, the WHO data shows. India classifies only around 481,000 deaths between January 2020 and December 2021 as “covid deaths".

1. Highest toll

“Excess deaths" refers to the difference between deaths registered in a given period and the deaths registered in a similar period in a normal year. The difference can give a sense of the toll of a pandemic like covid-19—both direct due to the disease, and indirect, such as due to non-covid patients missing out on timely care as resources were diverted to tackling covid.

With 1.1 million excess deaths, Russia is a distant second to India. While India had the highest toll, when adjusted for population, it was not vastly different (3,419 excess deaths per million population) from the numbers registered in high-income countries such as Poland and the US, despite their better healthcare systems. Peru had the worst death rate (8,734 excess deaths per million population).

 

Even before its release, the data from the UN health body had generated intense criticism from the Indian government, which reportedly tried to delay its publication. New Delhi has questioned the WHO’s methodology, and on Thursday, “strongly objected" to the release, saying that WHO “chose to ignore" the available data submitted by India and did not address the country’s concerns.

2. Gross undercount

India’s excess deaths in the two years, as estimated by WHO, were at least 6.9 times the toll officially attributed to covid-19. Among countries with over 20,000 covid deaths, this was the worst scale of likely under-reporting after Egypt. Pakistan and Bangladesh fared better, with excess deaths that were 1.5 and 1.8 times their official covid death numbers.

Governments naturally miss deaths during a pandemic like covid-19: not everyone is able to get a test and defining a covid death is complicated. However, countries with far better healthcare systems were able to minimize the scale of under-reporting.

 

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“The data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises," Tedros Adhanom Ghebreyesus, WHO Director-General said.

Tellingly, 20 countries (including India), which represent approximately half of the global population, account for over 80% of the estimated global excess mortality, WHO data shows.

3. Age and gender

The WHO estimates confirm the findings by researchers throughout the pandemic that the elderly are the most vulnerable group due to covid-19. Almost one in four excess deaths in India were in the 80-plus age group in 2020 and 2021. This accounted for 8.7% of the entire population in this age group. In each age group, men were more vulnerable to death, and the risk came down drastically by age. The likelihood of dying was higher across age groups in 2021, the year of the second wave in India, than in 2020. Globally, men accounted for 57% (8.5 million) of the excess deaths.

All excess deaths should not be linked to covid-19, and should only be used as an indicative measure of the direct and indirect toll of the pandemic. The WHO’s baseline of deaths expected in a normal year was based on the mortality data from 2015-2019.

4. Growing consensus

The WHO’s estimates have placed the Indian government on the defensive over its methodology, but it is somewhat consistent with other research by scientists and media organizations over the past year. At least six such studies compiled byMintshow that the median estimate for excess deaths in India during the pandemic hovers around 4 million.The Economistputs its upper limit at 9.4 million—the highest among these models—with a midpoint estimate of 5.7 million.

 

All studies conclude that the second wave in the summer of 2021 was particularly fatal, and officially recorded deaths are several times lower. Like the WHO, these studies used data from various sources, such as the government’s civil registration system (CRS) that records births and deaths to government hospital data and nationally-representative surveys such as the Consumer Pyramids Household Survey. Some studies also flagged inadequacies in India’s birth and death registries with complete data available for just 12 states.

5. State-wise toll

Even though India has not officially released data on excess deaths at a national level, the signs of the underreporting have been there all along, thanks to individual states’ data analysed by journalists and researchers. The ‘excess deaths’ based on state data were several times higher than the official tolls attributed to covid by authorities.

Data compiled by news outlets and researchers for 12 states during April-May 2021—at the peak of the second wave—show excess deaths were anywhere between 11 to 40 times the official covid toll in some cases. Madhya Pradesh, for instance, recorded 42 times ‘excess deaths’ as the official covid-19 deathsbetween April and May 2021. Even states with more robust health systems, such as Tamil Nadu and Kerala, saw undercounts during this period, indicating the strain on overwhelmed health systems at a time when the country saw grave shortages of medical oxygen, ambulance and hospital beds.

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