World Health Organisation’s latest report on global excess deaths associated with Covid-19 in 2020 and 2021 is leading to heated debates with many criticising India for severely under-reporting fatalities related to the pandemic. According to WHO’s estimates, around 47,40,891 people lost their lives due to Covid in the two pandemic years, 2020 and 2021, but figures released by Government of India show fatalities at just 4.8 lakh for the same period.
Is the WHO right in claiming that Covid-related fatalities were ten times higher in India? There are various reasons why the WHO’s numbers need not be taken too seriously. One, these are just estimates with many uncertainities built in to the model. Two, monthly death numbers are out of sync with the pandemic curve in the country.
Monthly numbers are out of whack
If we look at WHO’s monthly numbers for Covid deaths , they seems to be quite incongruous. For instance in January 2020, it has estimated over 1 lakh Covid-related deaths, but the pandemic had not been declared then, and it was still restricted to China and a few countries. .
Between February 2020 and May 2020, the deaths due to Covid are (–)4.89 lakh. What this means that deaths that would have occurred in normal times was lower by that number.
Between August 2020 to October 2020, the number of deaths are ten times higher than official numbers. While numbers may have been understated in these months, WHO continued to project high death rates in November and December 2020, when cases as well as fatalities abated.
Similarly between October and December 2021, too, WHO is projecting 3.29 lakh deaths, whereas cases and fatalities dropped sharply in this period. The first Omicron case in India was reported on December 2. Even though it spread faster, the number of mortalities and hospitalisations were quite low.
Numbers only estimates based on mathematical model
There are various assumptions that the WHO has used to arrive at the numbers for each month.
“For India, we use a variety of sources for registered number of deaths at the State and Union Territory level. The information was either reported directly by the States through official reports and automatic vital registration, or by journalists who obtained death registration information through Right To Information requests.”
Then the difference between projected deaths without a pandemic, and deaths with pandemic is taken as the deaths caused by the pandemic.
The methodology for generating the estimates adopts a statistical method called a Poisson regression model, according to the report. “The estimates have a range of uncertainty per country, and that level of uncertainty is directly related to a country’s reporting capacity and variable data quality.”
It is quite likely that a large degree of uncertainty is baked in to the model for India, and it would be wrong to take these numbers as correct.
WHO itself has admitted that it will continue its official consultation process with Member States, compile further data and in future can also revise the numbers.
Definition of Covid deaths broader
WHO has broadened the definition of deaths caused by Covid considerably, making it possible that official numbers from the government will be lower.
“Excess mortality includes deaths associated with Covid–19 directly (due to the disease) or indirectly (due to the pandemic’s impact on health systems and society). Deaths linked indirectly to Covid–19 are attributable to other health conditions, for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic,” the latter’s report says.
Since official numbers consider only deaths due to Covid, it is quite possible that the government’s numbers will be lower.
It is, however, quite possible that there is some level of under-reporting in Covid fatality numbers. India’s Civil Registrations Systems data, which was out a few days ago, also hints at possible excess mortality during the pandemic. According to it, 2020 saw around 4.7 lakh more deaths, as compared with 2019 numbers. However, that year, India only reported 1.48 lakh Covid deaths.