With images of the Covid pandemic, burning pyres and floaters still fresh in our minds, the current debate about the scale of mortality in 2020 and 2021 seems surreal and unsympathetic. There are two extreme positions. First, the government presents the whole episode as another successful management effort in underreporting the number, and the other, which projects that India will be the largest contributor to the pool of deaths in the world using data fragmented and modeling at the macro level. In terms of deaths per thousand people, India, however, is not among the top 100 countries, although the infection fatality rate of 1.2% places it in seventh position globally.
As it is difficult to obtain accurate statistics on deaths by cause – around 70% of deaths take place at home even in normal times – attempts have been made to estimate Covid deaths by identifying “excess” deaths by relative to what would have been the number otherwise. There are conceptual issues involved since deaths from starvation, the miseries of returning migrants, those related to lockdown, unemployment and other ailments not receiving medical help due to strain on the system, are not not due to Covid, but are part of the excess deaths. Also, the Supreme Court’s decision to consider all deaths within three months of Covid infliction as Covid deaths have led to increased reporting. Likewise, the lives saved due to the confinement and the measures adopted by people to protect themselves from the virus and those who would have died from other causes if there had not been Covid, should be taken on the positive side, increasing the gap between Covid and excess mortality.
Despite this, figures for “excess mortality” beyond what would have been the number without Covid can be calculated without too much hassle in the absence of detailed cause of death data. Naturally, this would be different from the figures reported as Covid deaths by the Civil Registration System (CRS). The differences aren’t just due to concept coverage. Much of it is due to the inadequacy of the registration system, particularly in times of medical and economic emergency. Naturally, independent journalists and health statisticians who had obtained registration data and fragmented information at the field level raised this concern. All this has made experts in the country and relevant global institutions skeptical about the authenticity of statistics from the Ministry of Health and Family Welfare, leading WHO to place India in the category for which Covid death figures are to be generated by modelling. and not based on officially reported figures.
CRS was once a poorly administered data collection system, but coverage has increased significantly, thanks to greater awareness and improved monitoring and follow-ups at the field level. There has been an increase in enrollment starting in 2018. These increases are not uncommon, caused by procedural changes and backlog reports.
Given this, the selection of reference years to use for estimating “normal deaths” becomes extremely important. If one chooses to use, say, the average deaths over the period 2015-2019, one will get a higher estimate of “excess deaths” than using 2018 and 2019 just for the comparison of reference. This appears to have happened in the estimation of excess deaths by independent journalists and researchers who had forced CRS data out of state governments through RTI and other means. This data has also been used by many researchers to arrive at Covid mortality.
The Sample Registration System (SRS) was started in the 1960s as a large-scale continuous population survey to overcome the shortcomings of the SRC. Its most recent bulletin, published in January 2022, provides estimates for 2019, and therefore any increase in SRS Covid death rates would only be available in 2023 or 2024. Obviously a smaller increase in the number of deaths in 2020 compared to 2019, despite a larger population base and Covid, is due to improved registration in 2019. It is still impossible to defend the official claims of 99.9% registration. in 2019-2020 compared to 84.6% in 2018. The WHO figure of 0.83 million Covid deaths in 2020, however, may not be difficult to reconcile if one considers that the total number of deaths reported by CRS is 0.81 million and the fact that there were serious quality and coverage issues in the registration system in 2021. The pandemic and the strategy to combat its spread by the confinement, etc. in 2020 are known to have affected all day-to-day administrative activities of public bodies. The latest National Family Health Survey reveals that only 70% of deaths were recorded by households during the period 2019-21. And yet the ministry has made no attempt to reconsider the CRS estimate of 0.52 million Covid deaths through early May 2022 against the WHO figure.
In an otherwise rare case, the department says that “modelling, more often than not, can lead to an overestimate and, on rare occasions, these estimates can go to the limits of absurdity.” This recalls a statement by the late BS Minhas that international agencies often give income estimates for countries for which they do not have population figures. The limitations of such modeling exercises are well known. For example, the NITI Aayog had predicted that Covid infections would hit zero by July 2020 itself. There are, however, sufficient grounds to question the information disseminated by the CRS. In most states, claims for Covid deaths have been several times higher than officially recorded deaths.
Clearly, there is an urgent need for solid data from local government agencies, scientifically collated and also validated by external mechanisms such as field surveys. Unfortunately, it is not the case. Data analysis is also limited by the fact that most departments present the data in dashboards with the underlying data inaccessible to researchers. Until then, the claims and counterclaims will stand.
This column first appeared in the print edition of May 11, 2022 under the title “The War of Numbers”. Mohanan is Chairman of the Kerala Statistical Commission and Kundu is Senior Researcher at World Resources Institute, New Delhi
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