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At worst case, India’s COVID deaths are 14 times higher than govt count

Officially, India has reported 26.9 million (2.69 crore) Covid-19 cases and 307,231 (3.07 lakh) deaths as of 24 May 2021, but an analysis by The New York Times says the actual figures are likely to be much higher — 700.7 million (70.07 crore) cases and 4.2 million (42 lakh) deaths in a worst-case scenario.

Published on 25 May, the report titled ‘Just How Big Could India’s True Covid Toll Be?‘, NYT says it arrived at this estimate after studying the case and death counts, the results of three national serosurveys conducted and consulting with more than a dozen experts.

The experts consulted included Kayoko Shioda, an epidemiologist at Emory University, Dan Weinberger, an associate professor of epidemiology at the Yale School of Public Health, Dr Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy and Dr Paul Novosad, an associate professor of economics at Dartmouth College.

Citing poor record keeping and lack of widespread testing, the report said getting a clear picture of the total number of infections in the country was hard. Further, it said the undercount was “more pronounced, for technical, cultural and logistical reasons”.

“Because hospitals are overwhelmed, many Covid deaths occur at home, especially in rural areas, and are omitted from the official count. Laboratories that could confirm the cause of death are equally swamped,” Kayoko Shioda, an epidemiologist at Emory University, is quoted as saying.

“Additionally, other researchers have found, there are few Covid tests available; often families are unwilling to say that their loved ones have died of Covid; and the system for keeping vital records in India is shaky at best,” he further said.

The NYT report also noted that even in a normal year, about four out of five deaths in India were not medically investigated.

What is the actual count of India’s Covid cases
By extrapolating data from three nationwide serosurveys — about 30,000 out of 1.4 billion (140 crore) Indians were examined for Covid antibodies in each survey — the NYT analysis presented three possible figures to produce the “true scale of devastation in the country”.

Despite admitting how wide-scale serosurvey has its limitations, Dan Weinberger at the Yale School of Public Health, is quoted saying: “The surveys provide a fresh way to calculate more realistic death figures … It gives us a starting point … I think that an exercise like this can put some bounds on the estimates.”

A conservative estimate: NYT says the real number of infections is likely to be 15 times higher, i.e., 404.2 million (40.42 crore), and the infection fatality rate (IFR) 0.15 per cent. This puts the death toll at 600,000 (6 lakh), which is double the official figure reported by India.

A more likely scenario: Using data from the latest national seroprevalence study, conducted between December 2020 and January 2021 and which estimated nearly 26 infections per reported case, NYT estimated the infection fatality rate to be 0.3 per cent. It also predicted there were more than 1.6 million (16 lakh) deaths, more than five times the official count as of 24 May 2021.

A worse-case scenario: For this, NYT used a “slightly higher estimate of true infections per known case to account for the current wave”, and pegged the real number of infections to be 26 times higher than the official count — 700.7 million (70.07 crore) against 26.9 million. The IFR is estimated to be 0.60 per cent, putting the death count at 4.2 million, which is 13.7 times the current total.

Each serosurvey conducted at various points in the pandemic revealed that the Covid spread in India is 13.5, 28.5, and 26.1 times higher, respectively, than the official tally since data revealed more number of people had developed antibodies than the total number of infection figures shared by the government.

The report further suggested that “almost half of India’s population may have had the virus”.

Serosurvey data
The first serosurvey conducted between 11 May and 4 June last year showed 64.60 lakh people had developed antibodies when the confirmed cases at the time was 2.26 lakh (28.5 times higher). Similarly, in the second serosurvey conducted between 18 August and 20 September, the official case tally was 54.90 lakh while the serosurvey found 7.43 crore (13.5 times higher) had antibodies. The third survey conducted between 18 December and 6 January found 27.10 crore people with antibodies, which was 26.1 times higher than the official tally of 1.04 crore.

On their approach to calculate the death rates, the NYT report notes that since most of the infection fatality rate estimates published were calculated before the second Covid wave in India, the overall rate will likely be higher. ThePrint