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The true death toll of COVID-19

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At the time of writing, COVID-19 officially has claimed more than 400,000 lives in India. Some believe the true death toll of COVID-19 to be considerably higher.

In an interview with The Wire, data journalist Rukmini S. posits the actual number of fatalities to be 2.5 million including 1.5 million fatalities during the second wave. In the thirty-minute interaction with Karan Thapur, Rukmini argues for a mortality survey to ascertain the true death toll of COVID-19, arguing that it is “fast, easy to do, cheap and can be very well done.” She points to a similar survey which Jharkhand conducted in just ten days. 

As The Wire summarises, “Rukmini explains in detail the system she has used to calculate the true figure of COVID-19 deaths. This first calls for a calculation of excess deaths, and she explains how that’s done. From this figure of excess deaths, the official COVID-19 death toll is subtracted. What you are left with can be loosely called missing COVID-19 deaths. They are not all COVID-19 deaths, but the vast majority are likely to be.” 

In an analysis for IndiaSpend published by Rukmini, “a spate of deaths from “fever” and “unknown causes” tore through rural India in April and May this year, coinciding with India’s second COVID-19 wave, new official data show. While deaths from clinically diagnosed respiratory infections surged too, the spurt of undiagnosed deaths points to the scale of potential undercounting of COVID-19 deaths in India. 

“The latest data are from the National Health Mission’s (NHM) Health Management Information System (HMIS), and show nearly 300,000 more deaths in May 2021 compared to May 2019, which is more than 2.5 times India’s official Covid-19 death count for the same period.” 

Concerns similar to Rukmini’s over the true death toll of COVID-19 in India have been expressed previously – as recently as last month. The Wall Street Journal reported towards the end of June that “India has officially recorded more than 390,000 coronavirus deaths [at that time], but families who have lost loved ones, health experts and statisticians say that vastly undercounts the true toll. Families…have been left struggling to get compensation that some states have set up for Covid-19 victims. India’s undercount has also left a huge gap in the world’s understanding of the impact of the Delta variant, which health experts believe helped drive one of the world’s worst Covid-19 surges in April and May. India was the first to detect the highly infectious variant, which has hopscotched around the world. It is fueling a surge in the U.K., and is expected to become the dominant variant in the U.S..” 

At that time, The Economic Times noted that “the University of Washington’s Institute for Health Metrics and Evaluation believes the true death toll in India may exceed 1.1 million, almost three times the reported number.” 

To understand the true death toll of COVID-19 is imperative in grappling with the pandemic. It has real impacts on families who are bereft of compensation, presents issues with epidemiological modelling, and understanding where we are in handling this crisis. With a third wave imminent, such issues must be resolved on the basis of practicality and of ethics. As Rukmni notes, summarised by The Wire, “a proper inquiry into COVID-19 deaths, including how death statistics were presented and used by the government to suit the case it wants to make, is something we owe to the dead. 

“She said honesty and transparency about the total deaths should be our way of paying respect to the “millions” who have died and also the best response to the catastrophe India has suffered over the last fifteen to sixteen months.” 

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