India Ranks High In Cumulative Excess Covid-Deaths: Lancet Report

A Global Report Looking At Excess Deaths During The Pandemic Period Put India In A Harsh Light

India recorded the highest estimated number of cumulative excess Covid-19 deaths beating the USA, Russia, Mexico, Brazil, Indonesia and Pakistan, reported a Lancet report on March 10, 2022. The paper that looked at deaths due to Covid-19 between January 1, 2020, and December 31, 2021 also estimated that nearly 18.2 million people died globally as opposed to the official figure of 5.94 million.

With a goal to estimate excess mortality during the pandemic period, the Lancet published a paper wherein researchers searched various government websites, the World Mortality Database compendia, the Human Mortality Database, etc. and identified 74 countries and an additional 266 subnational locations where either weekly or monthly all-cause mortality data were reported for the required period. Further the paper used empirical assessments of excess mortality for 12 states of India.

The study found that the number of excess Covid-related deaths was largest in regions of South Asia, North Africa, the Middle East and Eastern Europe. However, in all this, India estimated the highest cumulative excess deaths at 4.07 million deaths, way ahead of the US, where the estimate stood at 1.13 million deaths. In Russia, estimates stood at 1.07 million deaths, Mexico suffered around 7,98,000 deaths. An estimated 7,92,000 deaths took place in Brazil while the estimated figure for Indonesia was 7,36,000 deaths and for Pakistan it was  6,64,000 deaths.

It may be noted that of these countries, Russia had the highest excess mortality rate at 374.6 deaths per 1,00,000 followed by Mexico (325.1 deaths per 1,00,000), Brazil (186.9 deaths per 1,00,000) and the USA (179.3 deaths per 1,00,000). The global all-age rate of excess mortality due to the Covid-19 pandemic was 120·3 deaths per 1,00,000 of the population. It exceeded 300 deaths per 1,00,000 of the population in 21 countries.

Estimated deaths much higher than reported in India

As per the report, excess mortality rates due to Covid-19 in some Indian states were similar to those of some high-income countries in the northern hemisphere. The report also computed the ratio of excess mortality rate to reported Covid-19 mortality rate to measure the undercounting of the true mortality impact of the pandemic. Accordingly, it found that the national-level ratios in south Asia ranged from 8·33 in India to 36·06 in Bhutan. The most extreme ratios in the region were found in the states and provinces of India and Pakistan, ranging from 0·96 in Goa, India to 49·64 in Balochistan, Pakistan.

Using data from the civil registration system data for 12 states, and the mean reported deaths during the relevant periods in 2018 and 2019, the report obtained excess mortality estimates for select periods during the first and second waves. It also calculated a country-level residual using the residual from the 12 states.

Specifically, the report found that at the national level, India had an estimated 152·5 excess deaths (95 percent UI 138·6–163·3) per 1,00,000 of the population. This number is much higher than the data that was reported during the two Covid-waves. Covid-19 mortality rate was 18·3 deaths per 1,00,000 over the same period.

Further, heterogeneity in excess mortality among the 30 states of India was extremely high. From January 1, 2020, to December 31, 2021, as many as 8 Indian states had excess mortality rates higher than 200 per 1,00,000 population, a level only exceeded by 50 other countries in the world. These states were: Uttarakhand, Manipur, Maharashtra, Chhattisgarh, Haryana, Himachal Pradesh, Punjab, and Karnataka.

Meanwhile, Arunachal Pradesh, Telangana, Sikkim, Rajasthan, Gujarat, Uttar Pradesh, Jharkhand, West Bengal, and Goa had excess mortality rates that were lower than the global average of 120.6 deaths per 1,00,000 population (although 95% UIs overlap). Similarly, sub-national heterogeneity was evident in the excess death counts. Seven states had excess deaths higher than 2,00,000 as of December 31, 2021, namely: West Bengal (2,20,000 deaths), Madhya Pradesh (2,23,000 deaths), Tamil Nadu (2,60,000 deaths), Karnataka (2,84,000 deaths) Bihar (3,23,000 deaths), Uttar Pradesh (5,17,000 deaths) and Maharashtra (6,16,000 deaths).

“Although the excess mortality rates due to the Covid-19 pandemic among Indian states are not the highest in the world, because of India’s large population, the country accounted for 22.3 percent of global excess deaths as of December 31, 2021. Bihar, Uttar Pradesh, and Maharashtra had excess deaths higher than South Africa (3,02,000 deaths), with South Africa ranking tenth among all countries,” said the Lancet report.

States with ambiguous mortality data

Earlier, Citizens for Justice and Peace (CJP) and The Wire published data about Varanasi, Uttar Pradesh that showed huge data discrepancies in death-related data during the Covid-19 pandemic. As per the 2019 Sample Registration System (SRS) bulletin, the actual crude death rate (CDR) for the state as a whole was to be 6.5 percent. Based on the rural-urban make-up of the surveyed population, the study expected the CDR in the surveyed areas to be around 6.7. However by 2019, the recorded CDR of 6.4 percent in this population was close to state-level expectations. There was not much room for further improvement in reporting to push the numbers up.

But in 2020 the CDR rose to 15-20 percent higher than expected either from 2019 data or from the state-wide CDR estimates from the annual SRS. In fact, the death rate during January-August 2021 was, over double the expectation. Even assuming the SRS significantly underestimated pre-pandemic yearly deaths but improved record-keeping to perfection during the pandemic, the deaths during the pandemic period were greatly above expectations.

The surveyed area had 55-60 percent more deaths during the 20 months from January 2020 to August 2021 than expected during that time. Across UP, this surge would amount to around 14 lakh excess deaths.

As per SRS and civil registration data, the state expects around 15 lakh deaths in a normal year. Further 14 lakh people also account for 0.6 percent of the state’s estimated 2021 population of around 23 cr people. Thus, the study claimed that the pandemic excess death toll amounted to almost a full year’s deaths.

Similarly, the report talked about Gujarat as a state with lower excess mortality rate than the global average. Yet, in May 2021, CJP reported data that estimated great under-reporting during the pandemic. On April 27, of the same year local newspaper Sandesh set aside five pages for obituaries in the Rajkot edition alone, while the state’s Covid-19 dashboard recorded only 14 deaths in the previous 24 hours. On the same day, the newspaper stated that 87 bodies were cremated following Covid protocol over the last two days while the government only recorded two Covid deaths.

This showed that despite Lancet report’s efforts to get official data, even the comparatively better surviving states in India were under great duress. Newspaper obituaries made for better indicators of death count in the area rather than official data, said CJP.

The Lancet report concluded that the full magnitude of COVID-19 was much greater in 2020 and 2021 than was indicated by reported deaths. It still called for further research and increased availability of ‘cause of death’ data for distinguishing the proportion of excess mortality directly caused by Covid-19. However, the study, coupled with previous reports of CJP show that there was great discrepancy especially in areas with a considerable Hindutva influence.

To verify this to certainty, the study stresses for ways to strengthen death reporting systems and mitigate political barriers to accurately track and monitor the continuation of the Covid-19 and future pandemics.