COVID mortality in India higher than officially reported, analysis of several data sources suggests

A new analysis finds that by September 2021, India’s cumulative COVID deaths were 6-7 times higher than reported officially. “If our findings are confirmed,” write the authors, “this may require substantial upward revision of the World Health Organization’s estimates of cumulative global COVID mortality, which as of January 1, 2022, stood at 5.4 million.” India’s reported COVID death totals are widely believed to be under-reports because of factors like incomplete certification of COVID deaths and misattribution to chronic diseases. Model-based estimates of cumulative COVID deaths through June 2021 in India range from a few hundred thousand to over four million, with most suggesting a substantial official undercount. In order to better estimate India’s COVID deaths, alternative approaches to model-based estimates are needed. The World Health Organization has recognized counts of recorded increases in all-cause mortality during peak pandemic transmission – which are likely nearly all caused by COVID infection – as a crude but useful method to track the pandemic. To fill the gaps in India’s national level COVID death estimates, Prabhat Jha and colleagues quantified COVID mortality in India using one independent and two government data sources. The authors’ independent nationally representative survey included responses from 137,289 adults in all states and union territories interviewed from March 2020 to July 2021. Jha and team compared COVID deaths reported by people in their survey to a denominator defined as the expected weekly percentage for all-cause deaths. Using their approach, they estimate 3.2 million COVID deaths in India from June 1, 2020 to July 1, 2021, the majority of which occurred from April 1 to July 1, 2021.  The results show consistency between the size of viral waves and COVID deaths. The authors conclude, “our study finds that Indian COVID deaths are substantially greater than estimated from official reports.”