Identifying Covid deaths is the challenge but hard to hide large numbers: experts

That will take some time. For, experts point out, it will be a “humongous and impractical task” in the middle of a pandemic to do a national door-to-door survey assisted by medical experts to find the post-mortem cause of the deaths.

THAT THERE is a surge in the number of all-cause deaths in the months of April and May is established. To find out how much of the surge — beyond the 1.69-lakh official count — is because of Covid is a task cut out for state governments and the Centre.

“To go back and identify who amongst those who died during the pandemic period was due to Covid if not already tested or officially counted as Covid death by the state is, in practical terms, impossible,” Pronab Sen, Chairman, Standing Committee on Economic Statistics, and ex-Chief Statistician of India, told The Indian Express. “What we can, however, do is modelling based on pilot studies, study of symptoms, and surveys of next of kin to get an estimate.”

That will take some time. For, experts point out, it will be a “humongous and impractical task” in the middle of a pandemic to do a national door-to-door survey assisted by medical experts to find the post-mortem cause of the deaths.

But given how India counts its dead and, is getting better at it with each year, experts said, there is a consensus that the extra deaths will not go uncounted; although it may go unidentified as Covid.

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“I don’t think deaths can be hidden like that. Certainly not a large number of deaths,” said Partha P Majumder, one of India’s foremost statisticians who currently heads the Indian Academy of Sciences. “You cannot hide this number, but what will be a big problem is identifying those who died of Covid.”

“Normally, few registered deaths are medically certified. For instance, in 2019, only 20.17% of registered deaths were medically certified,” said a statistician in the Registrar General’s office, who did not want to be named.

There are broadly two ways in which official India counts its dead: CRS (Civil Registration System) and SRS (Sample Registration System). The CRS gives the number of registered deaths in a year, which states provide to the Registrar General of India usually with a six-month lag. The latest available CRS is for 2019, released with a lag of 18 months in June 2021.

The SRS is a nationwide survey of urban and rural units undertaken jointly by the Registrar General and the states to estimate the number of dead in a year. So the SRS usually counts more deaths than CRS, since it is a statistical model used to estimate death. The latest available SRS data is for 2018, released with a lag of 18 months in June 2020.

In 2019 — the latest year for which CRS data is available — the number of registered deaths at 76.41 lakh was 92 per cent of the estimated deaths at 83.01 lakhs (SRS).

The uptick in deaths this year also needs to be read with the context that under CRS, registration of deaths has significantly improved in the recent past.

The number of registered deaths under CRS as a percentage of estimated deaths arrived at under SRS has jumped by 12 percentage points between 2017 and 2019 to 92 per cent. This increase in efficiency is expected to continue in 2021 as well.

Besides this, there is an average increase in the number of estimated deaths year-on-year.

In 2018, the number of estimated deaths increased by 4.86 lakh and in 2019 by 6.9 lakh. The Registrar General, in association with states, is currently undertaking the SRS for 2020 — the first wave of Covid-19, the peak being August-November.

Simultaneously, what also needs to be accounted for is the possibly lower deaths due to road accidents, since many parts of the country were in lockdown mode during March-June. Accidents claimed more than 1.54 lakh lives in 2019, and accounted for 2% of all registered deaths in the year.

Several demographers, population scientists and other experts working on Covid-19 deaths told The Indian Express that the current death toll due to the pandemic in India was almost certain to be an undercount but ruled out estimates of it being 10-14 times higher as estimated in a widely shared piece in The New York Times that suggested a multiple of over 13.

Two analytical columns in The Indian Express by experts over the last month suggest different multiples for undercounting.

Dr Tushar Gore, a pharmaceuticals expert, and Viral Acharya, the former RBI Deputy Governor, used hospital-bed estimates to estimate an undercount range of 3x-9x. Arvind Subramanian, the former Chief Economic Advisor, Justin Sandefur, who is with the Center for Global Development and Kennedy School’s Abhishek Anand, estimated deaths in the second wave in the 1.4 million (approx 6x) to 2.4 million (10x) range.

Demographers also discount fears that many deaths were simply not getting recorded. “As of now, there is plenty of evidence to suggest that the reported number of Covid-19 deaths is an undercount. But eventually, we will have a fairly good estimate for the total number of deaths caused due to Covid-19,” said Majumder.

“We are already seeing some attempts being made to include deaths that were previously not counted. So, at least some of the deaths that were missing from the records earlier would get included. The difference in reported deaths and actual deaths might never become zero, but the gap would progressively become smaller,” said Majumder who is also the founding director of Kalyani-based National Institute of Biomedical Genomics.

He was referring to the ongoing data reconciliation exercise in several states that have resulted in inclusion of large numbers of previously uncounted deaths. States like Maharashtra and Karnataka do this on a continuous basis, while others carry out this exercise periodically.

After April 1, for example, Maharashtra has reported almost 70,000 Covid-19 deaths, more than half of its total death toll of nearly 1.25 lakh. Most of these, around 50,000, were reported weeks, sometimes even months, after the deaths took place.

In states like Karnataka also, a large proportion of deaths that are included in the daily bulletin happen to be those that occurred several days or weeks earlier.

Last week, Madhya Pradesh added nearly 1,500 previously uncounted deaths to its tally. Bihar did a similar thing last month when it included close to 4,000 previously uncounted deaths in a single day.

Professor P M Kulkarni, a former professor of Jawaharlal Nehru University who is one of India’s topmost population scientists, said more such “corrections” would happen in the future.

“The problem is that we are trying to get death statistics in real time. That is a difficult ask. Because there will always be uncertainties. But India has very robust methods of counting its dead. Even where there are weaknesses, we are very well aware of those weaknesses, and therefore can apply suitable corrections. I have absolutely no doubt that, eventually, a very good estimate of the actual number of those who died because of Covid-19 would become evident,” Kulkarni said.

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