Tag: covid 19 deaths

Disbursal of Claims Under PMJJBY Rose by 438% In FY22, Reflecting Higher COVID Deaths in Second Wave

In 2020-21, when India was hit by the first wave of the COVID-19 pandemic, disbursal of claims under the scheme increased 49.2% to 63,181. In the following year, however, disbursal of claims shot up by 438%.

New Delhi: Disbursal of claims under the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY), a life insurance scheme, shot up by 438% in the financial year 2021-22 to 340,192, Business Standard reported, citing government data.

The scheme offers death coverage due to any reason. Persons in the age group of 18-50 years having an individual bank or post office account are entitled to enrol under the scheme. The social security scheme launched in May 2015.

In 2020-21, when India was hit by the first wave of the COVID-19 pandemic, disbursal of claims under the scheme increased 49.2% to 63,181, data released by the finance ministry on May 9 showed, the newspaper reported.

In the following year, however, disbursal of claims shot up by 438%, as earlier mentioned. This reflects the higher number of deaths during the second wave of the COVID-19 pandemic, and also raises questions on the government’s handling of the pandemic situation.

Enrollments under the scheme fell in FY22 by 20.6% to 25.4 million after rising by 191% to 32 million in the financial year 2020-21.

In FY23, annual enrollment under the scheme grew 30%, reaching its highest level at 33 million, the financial daily reported.

People who join the scheme before completing 50 years can continue to have the risk of life covered up to 55 years upon payment of the regular premium annually. This is for the policy years that run from June 1 to May 31.

Under the scheme, life cover of Rs 2 lakh is provided in case of death against a premium of Rs 436 per annum.

India was estimated to have had the highest number of COVID-19 deaths until December 2021 at 4.7 million, according to a World Health Organization report. It had added that India’s COVID-19 death toll was almost 10 times its official tall.

Of its 4.7 million deaths, 0.83 million (17.65%) occurred in 2020, according to the data; the rest were in 2021, as a result of India’s devastating second wave driven by the delta variant.

If Vaccines Averted 4.2 Million COVID Deaths, Govt Must Also Accept Excess Death Estimates

While the Union government vehemently opposed excess death estimates, it has so far not rejected claims made in a study published in the Lancet about deaths prevented by the vaccination programme.

New Delhi: On June 23, the Lancet Infectious Diseases published a study which said that about 20 million COVID-19 deaths were averted worldwide due to the vaccination programme. The same study estimated that in India, 4.2 million such deaths were prevented in 2021. This figure made headlines in several publications across the country. 

However, the researchers from Imperial College London, who wrote this paper, arrived at this number on the basis of excess death numbers for India and other countries – the same excess mortality data that the Union government rejected, no matter which agency it arrived from, be it the World Health Organisation, the Institute of Health Metrics and Evaluation (published in The Lancet) or any other independent group of researchers.

In fact, at the World Health Assembly held in the last week of May, India’s health minister Mansukh Mandaviya made no secret of his government’s displeasure with the WHO’s estimates, which said India witnessed 4.7 million deaths due to COVID-19 in 2020 and 2021 – a number almost 10 times higher than India’s official count. 

Excess mortality is the difference between registered deaths due to all causes in a pandemic year and the number of deaths that one expects to occur in that year if there hadn’t been a pandemic, estimated based on previous years’ data.

Interestingly, India has not rejected the figures on the number of deaths prevented even after about 14 days of publication of the June 23 paper. While the government issued almost immediate rebuttals to any excess death estimates that exceeded its own, no government functionary has said anything about the present paper.

Also read: Why India’s Response to WHO on Excess COVID-19 Deaths Doesn’t Hold Water

So, can the government accept the present findings and reject the others, even though the sources for both would be linked? The Wire asked two experts the same question. Both Aashish Gupta, a demographer and currently a David E. Bell Fellow at the Harvard Center for Population and Development Studies; and T. Sundararaman, former head of the Union Ministry of Health and Family Welfare’s National Health Systems Resource Centre, said no. 

Either the government has to reject the fact that 4.2 million deaths were averted due to its COVID-19 vaccination programme in the country from December 2020-21, or it has to accept the excess mortality figures, they said. 

For context, the researchers estimated the number of deaths prevented due to COVID-19 vaccination both on the basis of deaths officially reported by countries and the excess mortality estimates that various agencies came up with. For the latter, the researchers used the data from The Economist.

The researchers explained why they decided to take excess mortality as a denominator, too. “Because of the heterogeneity in death registration and certification worldwide, we also fit the model to all-cause excess mortality. For countries and time periods for which excess mortality had not been reported, we used model based estimates of all-cause excess mortality, first produced by The Economist,” they said in the paper. 

Bodies buried in the sand on the banks of Ganga river, as coronavirus cases surge, in Unnao district, Thursday, May 13, 2021. Photo: PTI

Difference in number of deaths averted

The researchers estimated that if only those deaths that were officially reported are taken as the denominator for the calculations, the total deaths averted globally would stand at 14.4 million; 5.6 million fewer than if excess mortality estimates are taken as the denominator in the calculations.

Similarly, for India, if only officially reported deaths were to be taken as the baseline, then the number of deaths prevented due to the country’s vaccination programme – which the Narendra Modi government emphatically mentions on all international platforms – would be 3.4 million; 700,000 fewer than the 4.2 million figure that made the headlines. 

This difference, between the number of deaths prevented by vaccines when calculating with the two different denominators, exists for virtually every country considered, as presented in the supplementary material of the paper. However, an analysis by The Wire reveals that this difference is the highest in the case of India. 

COUNTRY DEATHS PREVENTED BASED ON OFFICIALLY REPORTED DEATHS (A) DEATHS PREVENTED BASED ON EXCESS MORTALITY ESTIMATES (B) DIFFERENCE (B MINUS A)
India 3,422,000 4,210,000 0.7 million
Russia 465,000 811,400 0.34 million
Thailand 124,600 382,600 0.26 million
Pakistan 27,370 271,800 0.25 million
Spain 244,800 456,200 0.21 million
Bangladesh 21,630 177,700 0.16 million
Brazil 884,800 1,043,000 0.15 million
United States 1,763,000 1,902,000 0.13 million

Source: The Lancet Infectious Diseases

The Wire’s analysis was in line with what the authors generally observed in the paper. “The discrepancy between vaccine impact estimates based on excess mortality and COVID-19 (registered) deaths was concentrated in settings with lower death registration and certification,” the paper said.

As of now, the Indian government has not said which denominator it prefers for understanding the impact of its vaccination programme. Nor does the paper give a clear judgement as to which figure – the officially reported deaths or the excess mortality estimates – should be considered the ‘correct’ denominator.

However, the authors of this paper do say, “The strong temporal correlation observed globally between reported COVID-19 mortality and excess mortality provides evidence that excess mortality is an informative indicator of pandemic-related mortality.”

In fact, on June 29, WHO director-general Tedros Adhanom Ghebreyesus, referring to the advantage of the vaccination programme in a press conference, said 20 million people’s lives were saved – the number that relied on excess mortality estimates. 

Sundararaman said if the Indian government has to assess the achievements of its vaccination programme, the excess mortality estimates have to be accepted. “It is important to know what we achieved due to the country’s vaccination drive. Such an assessment would figure into future pandemic preparedness for every country; and therefore, for India also,” he said. 

But Gupta and Sundararaman both suggested that the Indian government move on from the controversy and accept the single biggest lesson; to improve the death registration system of the country by making it effective and timely. 

This sentiment is also echoed in the authors’ observations in the paper: “This substantial discrepancy (in the estimates of number of deaths prevented due to two different denominators) underpins the crucial need for continued investment in civil registration and vital statistics to prevent biases in mortality reporting (thus) further minimising the perceived impact and necessity of vaccination in settings with lower reporting of deaths.”

Sundararaman said if the government takes credit for the fact that a major tragedy during the third wave was avoided due to its vaccination programme, then it has to say what the baseline was.

“This Lancet paper hints precisely at that,” he added, and opined that accepting this paper’s findings will only put the spotlight on the success of the world’s biggest adult vaccination drive ever undertaken, though also highlighting the grim reality of excess deaths.

Why India’s Response to WHO on Excess COVID-19 Deaths Doesn’t Hold Water

The Indian government’s objections to WHO’s estimates have stalled the publication of a report containing them, delaying a crucial effort to understand the pandemic’s impact.

This article was originally published on The Wire Science, our website dedicated to science, health and environment reportage and analysis. Follow, read and share.

The WHO has reportedly estimated that India could have had four million excess deaths during the COVID-19 pandemic. This would make India the country with the highest number of pandemic deaths in the world by far – with around a quarter of the global total.

The Indian government has objected to the WHO’s estimates. According to the New York Times, the Indian government’s objections have stalled the publication of  the estimates, potentially delaying an important effort to understand the worldwide impact of the pandemic.

Let’s be clear that this is not a new controversy. The WHO’s estimate is in line with previous work, and the Indian government’s objections also follow a familiar pattern. Several preprint as well as peer-reviewed papers on pandemic mortality in India have elicited rebuttals from the health ministry in the form of statements entitled “COVID-19: Myth v. Facts”. These rebuttals have labelled the academic work variously as “ill informed”, “speculative”, “fallacious” and “completely inaccurate”. The work has also been accused of “creating panic in the community” and “misguiding people”.

The numbers in context

A mass cremation of people who died COVID-19 at a crematorium in New Delhi, April 22, 2021. Photo: Reuters/Danish Siddiqui

Until the WHO report is available, it is hard to say much about the details of their approach to estimating excess mortality – but there are some things we can say with confidence.

First, the WHO estimate is consistent with estimates in a number of published studies, technical papers and preprint papers. These come from several independent research groups, and use data from the civil registration system (CRS), a few different surveys and other government systems.

Most of this work has estimated excess deaths due to the pandemic to be between 3 and 5 million, with the lowest central estimate being 2.7 million and the highest being 6.3 million. Nowhere do we see estimates close to the official figure of around 0.5 million COVID-19 deaths.

Second, the WHO’s estimate is in keeping with the epidemiology of COVID-19. The numbers are consistent with India’s large but relatively young population, and the wide spread of disease, largely occurring before vaccination could have a major impact. Four million pandemic deaths is tragic but very plausible – unless we believe that Indians are somehow less vulnerable to the severe effects of COVID-19 than others.

Third, the WHO’s estimate implies that India has spectacularly failed to count its pandemic deaths, with around eight-times as many excess deaths as official deaths from the disease. This ratio is high, but believable if we read ground-level reports from journalists, which have shown how easy it is for official figures to miss the majority of deaths when disease sweeps  through marginalised populations.

For context, India is not alone in failing to track pandemic deaths: the ratio of excess deaths to official COVID-19 deaths is similar or higher in several countries, mostly in Asia and Africa. But it seems important to understand why some countries, such as Iran and South Africa, have done better, with much lower ratios of excess deaths to recorded deaths.

Estimating excess mortality

A woman and her son walk past a graffiti on a street in Mumbai, December 1, 2021. Photo: Reuters/Hemanshi Kamani/File Photo

The WHO estimate is neither surprising nor implausible – but this does not place it above criticism. Before we can assess the Indian government’s objections, we need to understand what the literature actually attempts to estimate.

The number of pandemic excess deaths is the difference between two quantities: expected deaths during the pandemic and actual deaths in this period.

Estimating expected deaths means asking, “If the pandemic had not occurred, how many people would have died during the pandemic?” This is an example of a counterfactual – a question about a scenario that didn’t actually occur. To answer it, you necessarily need some modelling, even if there is good historical data.

Estimating actual deaths should be more straightforward. In countries with good vital registration, we simply use death registration data. In India, however, there is missing data, plus uncertainties around levels of registration. Thus, we need some modelling and/or extrapolation to fill the gaps.

All of this means putting a number on pandemic excess deaths in India is not straightforward, and that there is space for valid disagreements. So let’s examine the Indian government’s objections to see if they can be classified as “valid scientific debate”.

Government objections

Parliament House. Credit: Reuters

One objection is that many of the studies use “unofficial” CRS data – obtained, for example, by journalists through Right to Information requests. The Union government could, of course, accelerate the release of “official” data and bypass this problem. But in any case, it is unclear what data is in fact unofficial and why this should affect the results.

Andhra Pradesh, for example, has freely available CRS data on an online portal, and this shows a huge surge of 2.5-3 lakh excess death registrations during the pandemic – compared to just 15,000 official COVID-19 deaths in the state. Is data on this portal “official” or “unofficial”? Are we to believe that most of these excess registrations are a consequence of errors?

A related objection is that the size and diversity of India makes filling the data gaps risky. There is some truth in this – but the objection is overstated. CRS data of reasonable quality is available for more than half of the national population, with more limited data covering much of the remainder. Moreover, there is no evidence that extrapolation leads to national estimates which are too high. In fact, some states such as Uttar Pradesh and Gujarat which are often left out of analyses for lack of good data, have quite possibly seen higher mortality than the national average.

Ultimately, data gaps are a problem, but:

  • We can quantify and mitigate this problem in various well-known ways. For example, the authors of the WHO analysis stress that they carried out “extensive sensitivity… and cross-validation analyses” to address the uncertainties.
  • Issues of data availability and quality can push estimates in either direction. The government has never demonstrated that they systematically push excess mortality estimates upwards.

In response to government criticisms about data and methodology we have to ask two questions: has the government demonstrated that the scale of the uncertainty is enough to make a critical difference to the results? And have they demonstrated evidence of systematic bias?

To both questions, the answer is a clear ‘no’.

Incoherent objections

ICMR director-general Balram Bhargava. Source: YouTube

While the objections about data quality and availability begin with a grain of truth, some others are contradictory or incoherent. For example, one statement dated July 27, 2021, claims that “all the births and deaths in the country get registered”. This is, of course, false, as government data plainly shows. But it also begs the question: if CRS data is so reliable, why does the government insist that the big surges in deaths in CRS data are a mirage?

Then there are logical absurdities, such as this from March 11, 2022 (emphasis in the original):

“For states where Civil Registration System was available, reported deaths during the pandemic has been compared with average reported deaths for the same period in the year 2018 and 2019 which doesn’t take into account multiple pandemic management efforts including lockdown, containment zones, testing and contact tracing, wider dissemination and implementation of clinical management protocols and world’s largest vaccination drive, which form the foundation of pandemic management in the country.“

The health ministry appears to be arguing, “We tried to manage the epidemic; so it is unfair to find high mortality in CRS data. You have not given us marks for effort.”

This appears to be a category error. We expect mitigation and vaccination to reduce mortality; but they do not change how we measure it!

The list of errors and flawed arguments goes on. Here are a few more examples.

The health ministry repeatedly reminds us of Indian Council of Medical Research (ICMR) guidance on death recording, in order to claim that “the likelihood of underreporting is less” – but there is no discussion of whether ICMR guidance was implemented. (It often was not.)

Monetary compensation for families of victims is mentioned, again to claim that underreporting is unlikely. This is problematic because many, many victims died without being tested. And in any case, compensation was only approved in October 2021, after most of the deaths had occurred.

Test positivity is brought in: “But, this variation in COVID-19 positivity rate within India was not considered for modeling purposes.” But test positivity has no clear relationship to mortality.

Conclusions

Representative image of last rites of a COVID-19 victim. Photo: PTI

When all is said and done, it appears that the objections raised by the Indian government to estimates of COVID-19 mortality do not hold water. The objections appear to fall into two categories:

  • Arguments which begin with a valid but general observation – gaps in the data, risks in extrapolation, etc. – but fail to demonstrate how these invalidate the conclusions or lead to systematic bias.
  • Distractions, red herrings and logical errors.

Each published estimate has uncertainties and there are valid criticisms to be made of all the studies. But the bottom line is this: mortality data is now available from many different sources, and it has been analysed by many different groups. And even the most optimistic readings of this data point to India’s pandemic toll being many times the official COVID-19 toll.

It is almost a year since convincing data started to emerge showing that the great majority of pandemic deaths were going uncounted in India. Since then, there has been plenty of time for the Indian government to strengthen mortality surveillance. Even now, many uncertainties could be resolved by (i) accelerating the release of official CRS data for the pandemic period, and (ii) conducting a large-scale mortality survey to fill in gaps left by incomplete death registration.

Instead, government efforts seem focussed on rebutting scientific work. These rebuttals are weakly argued and show little awareness of the data or methodologies. They also seem to be in bad faith, always implying that published estimates of mortality are too high, but never trying to quantify the uncertainties or acknowledging that the estimates could be too low.

It is a sign of the times that a fair amount of coverage of the most recent dispute has framed the story as “India” standing up to a global body in an act of defiance. “No, we did not die in large numbers”, the government and supportive media appear to proclaim on behalf of Indians. COVID-19 brought tragedy into the lives of many millions of families in India, and it is an absurd version of patriotism that denies this.

Murad Banaji is a mathematician with an interest in disease modelling.

WHO Is Disputing India’s COVID Death Numbers, So Govt Wants to Bury Global Report

Soon to be released WHO data has estimated that at least four-times as many people died during the COVID-19 pandemic as India has officially recorded.

This article was originally published on The Wire Science, our website dedicated to science, health and environment reportage and analysis, on April 3. Follow, read and share.

New Delhi: Even as the Indian government has, at every turn, dismissed researchers and research institutions that have said the country’s excess deaths during the COVID-19 pandemic far surpass the official record, it has come up against a challenger it may find is not so easy to ignore: the World Health Organisation.

Ahead of releasing data about the world’s ‘official’ number of excess deaths due to the COVID-19 pandemic, the WHO has set the cat among the pigeons of Indian government officials by recording that India’s toll was at least four-times higher than what government records show – and has also recorded the Indian government’s request that the WHO numbers be delayed by “10 years”, according to a news report.

Two members of a technical advisory group (TAG) that prepared the forthcoming report have confirmed to The Wire Science that its findings are at odds with the Indian government’s claims about the number of people who died due to COVID-19 in the country since early 2020 – and in line with independent researchers estimated.

This conclusion is likely to seriously challenge India’s insistence of the integrity of its data collection system. The WHO has effectively stamped its authority on all those studies that disputed the official figures, especially those whose estimates are closer to the WHO’s own. The WHO itself carries some heft by virtue of being an agency of the United Nations, of which India is one member state.

The Narendra Modi government has often restricted access to some of the relevant data, including withholding important numbers, and disputed expert advice and assessment at many turns to vex discussions on the subject. Nonetheless, many researchers have been able to piece together estimates of excess deaths using what is available in the public domain, as well as through surveys, hospital records, compensation claims, etc.

At the same time government officials have also consistently denied the findings of these studies, at times casting doubts on their robustness and at others simply standing by its own death surveillance system. According to these studies (see here, here and here for example), the excess ranges from 5.8x to 10x of the official death toll. India’s official COVID-19 toll is 0.52 million so far.

Both members of the TAG didn’t specify what the WHO’s own estimate of India’s COVID-19 death toll was. But Prabhat Jha, an epidemiologist at the University of Toronto, said he understands the “WHO’s estimates [to be] consistent with all other scientific studies.” He is also a member of the same TAG but said he was commenting independently.

However, according to an unnamed WHO technical advisory group member quoted by Amruta Byatnal for Devex on March 30, the WHO has estimated India’s excess death count to be at least 4x above its official number. This, the report added, has riled the government – so much so that it asked that the WHO hold off releasing its report for an astounding 10 years.

Also read: India Had Most ‘Excess’ Deaths During the Pandemic, Analysis Says

It is the WHO’s policy to share international data it has compiled with its member states – and this is how the Indian government came to learn of the WHO’s findings. However, it appears the WHO has decided to place its obligation to share this data over India’s request to delay its publication by a decade. The body confirmed to The Wire Science that it will release the numbers in early April.

“We are confident that, in cooperation with the TAG with whom we have been working, WHO has constructed a sound model that is producing robust estimates, that will be published shortly, noting India’s reservation,” it wrote.

Most recently, a prominent study published on March 11, 2022, estimated that India had the most excess deaths among the world’s countries, as a sum of recorded and unrecorded fatalities. In terms of recorded deaths alone, India has reported the third-highest number of deaths due to COVID-19, after the US and Brazil.

“Given the infection fatality rate of this virus and the level of infection which India experienced in 2020 and 2021, the death toll just doesn’t match with the two factors,” Bhramar Mukherjee, a professor of epidemiology at the University of Michigan’s School of Public Health, told The Wire Science. “It was very simple” even without these studies. “But now we have observed data on excess mortality.”

Mukherjee also serves on the WHO group for COVID-19 deaths; her comments here were however offered in her independent capacity.

Prabhat Jha, an epidemiologist at the University of Toronto, said many other countries  haven’t been honest about their excess death numbers. As the WHO’s forthcoming report itself is expected to acknowledge, the world has had 6 million more deaths since early 2020 than it has recorded. But he also said there was a key difference between their and India’s responses: other countries have tended to dispute the number of excess deaths whereas India has denied that such deaths exist at all. “India’s position is far more extreme,” according to Jha.

“The extent of infection, testing capacity, the capacity of the healthcare system prior to the pandemic, the burden of comorbidities like cardiovascular diseases and diabetes, and prevalence of smoking are some factors … that feed into modelling for COVID-19 deaths,” Mukherjee said. For India, according to her, it was a challenge to get proper figures even about these factors because of the poor quality and availability of data.

Both Jha and Mukherjee said the Indian government’s denial of expert findings on excess deaths could have better legs to stand on if it could produce a better study of its own. For Mukherjee, this means the government releasing Civil Registration System data for all states every month, instead of the 10-12 states for which this data is available on an annual basis. Jha, on the other hand, suggested revising upcoming Census forms.

“Add a simple question: ‘has there been any death in your household starting January 1, 2020?’ If yes, record age, sex and date,” he explained. “If that’s available, you have a direct counting of excess deaths. That’s the simplest way.”

Lancet Study Says India Had the Highest Mortality of Any Country During Pandemic

According to the analysis, eight states had mortality rates exceeding 200 deaths per 100,000 people – which is higher than that of 141 countries.

This article was originally published on The Wire Science, our website dedicated to science, health and environment reportage and analysis. Follow, read and share.

New Delhi: As many as 4.07 million people in India are estimated to have died during the COVID-19 pandemic in 2020 and 2021, according to a new analysis. This is eight times more than the number of COVID-19 deaths India has officially registered. Even now, the official toll is only 0.5 million.

This analysis attempted, for the first time, to estimate excess deaths during the COVID-19 pandemic worldwide, and was published in The Lancet on Thursday. It has determined that 18.2 million people in 191 countries have died since March 2020 – versus 5.94 million officially recorded deaths.

Overall, it suggests that India had the highest mortality of any country during the pandemic.

The analysis was conducted by a team of experts at the Institute for Health Metrics and Evaluation (IHME). The IHME is an independent research organisation in the US. It has been issuing various epidemiological forecasts since the pandemic began.

The second-worst-hit country is reportedly the US, with 1.13 million deaths in 24 months – 1.14-times more than its officially recorded deaths. Five more countries had excess deaths exceeding 0.5 million in this period: Russia, Mexico, Brazil, Indonesia and Pakistan.

These seven countries together account for more than half of all excess deaths due to COVID-19 in the 191 countries.

Note here that the estimated excess deaths are overall deaths during the pandemic – and not necessarily due to COVID-19.

“The magnitude of disease burden might have changed for many causes of death during the pandemic period due to both direct effects of lockdowns and the resulting economic turmoil,” the analysis paper read.

The research team computed excess COVID-19 deaths data with the help of ‘all-cause mortality’ figures – deaths due to all causes in a country – that countries release every year.

Some countries also share ‘cause-specific mortality’ data – but this was limited to 36 countries in the last two years, according to the paper. Murad Banaji, a mathematician and disease modeller, said it is nearly impossible to attempt such an exercise in India at least.

“I can say with complete certainty about India that it is going to be an absolute nightmare to try to separate out how many excess deaths are due to COVID-19 itself,” he told The Wire Science. Banaji was not involved in the IHME analysis.

According to his own estimates published last year, India could have had 3 million excess deaths in 2020 and 2021 together.

Bodies of the deceased buried in the sand near the banks of the Ganga, allegedly due to shortage of wood for cremation, Shringverpur Ghat, Prayagraj, May 15, 2021. Photo: PTI

All-cause mortality

For India, the analysis team at IHME started with the civil registration system (CRS) to estimate excess deaths. To calculate excess deaths in a given year, the researchers will have needed two sets of data: one to estimate the baseline and the other to estimate the excess over that baseline.

The baseline figures came from CRS numbers for 2018 and 2019. Then they calculated the excess in 2020 and 2021. When they compared the numbers to the actual number of deaths registered in the same years, they found that the difference was a stunning 4.07 million.

This exercise is only deceptively simple, as Banaji said earlier. In India, death registration trends haven’t been consistent over the years in the first place. A state might register only half the deaths in a given year compared to the last, for example. This renders the baseline itself to be unreliable.

To sidestep this possibility, the research team also used data from another source: the well-known Global Burden of Disease Study for 2019.

Second, the CRS was also available only for 12 states. How did the team calculate excess deaths data for the other 16? The paper only said:

“For locations without weekly or monthly reported all-cause mortality data, we developed a statistical model that captured the relationship between the key COVID-19-related covariates, such as seroprevalence, infection-detection ratio, and other population-level burden of disease metrics, and excess mortality rate.”

In fact, the authors used this information in place of national registration data wherever the latter wasn’t available. The Wire Science also wrote to Haidong Wang, an associate professor of health metric sciences and the analysis’s lead author, for more information on this front. His response will be included as and when it is received.

State-wise scenarios

According to the analysis, eight states in India had mortality rates exceeding 200 deaths per 100,000 people. Only 50 other countries in the world, of the 191, had worse mortality during the pandemic. These states were Uttarakhand, Manipur, Maharashtra, Chhattisgarh, Haryana, Himachal Pradesh, Punjab and Karnataka (in descending order).

On the other hand, Arunachal Pradesh, Andhra Pradesh, Telangana, Sikkim, Rajasthan, Gujarat, Uttar Pradesh, Jharkhand, West Bengal and Goa had excess mortality rates lower than the global average – of 120.6 per 100,000 people.

In terms of the absolute number of estimated deaths, Maharashtra topped the chart in India with 0.6 million. Bihar came second with 0.3 million.

This IHME analysis is not the first to report potentially undercounted deaths during the pandemic in India. There have been a plethora of estimates (see here, here, here, here and here, for example), ranging from 2.9 million to 5 million. In terms of India’s official toll, they imply an excess ratio of 5.8x to 10x.

On January 6, 2022, an analysis led by Prabhat Jha, an epidemiologist at the University of Toronto, reported 3.2 million excess deaths in India in 2020 and 2021 – and as many as  2.7 million during the second COVID-19 outbreak alone.

Every time an estimate like this has come along, the Union government has responded with complete denial. It has also issued at least four statements: on June 12, 2021, July 22, 2021; July 27, 2021 and January 14, 2022. On all occasions, it trumpeted how “robust” the CRS was and rejected the possibility of fatality undercounting.

The noted demographer P. Arokiasamy, formerly with the International Institute of Population Science, Mumbai, told The Wire Science in January 2022 that only a nationwide survey could settle the question of India’s ‘missing’ deaths once and for all.

An ongoing Supreme Court case has also been testimony to fatality undercounting during the pandemic. Many state governments have admitted, tacitly or otherwise, that they have sanctioned compensation claims for more victims than their respective registration systems have recorded.

Banaji said the Union government must look into this and other such studies instead of rejecting them. “If that many people had died and one thought it was not due to COVID, then one had to say what other reasons could be,” he told The Wire Science.

“Whatever be the cause, it shows a huge mishandling of the pandemic. The death of 4 million people [represents] a massive mortality impact.”

Why Kerala Reported More COVID-19 Deaths Than Any Province in the World in Last 28 Days

Many of the deaths that Kerala is reporting are part of a revision of its official death toll. If states like Gujarat were to follow its lead, the situation in Kerala may not appear so grim.

This article was originally published on The Wire Science, our website dedicated to science, health and environment reportage and analysis. Follow, read and share.

New Delhi: In the past 28 days, Kerala has reported the most COVID-19 deaths among any province in the world. According to the Johns Hopkins University’s coronavirus tracker, the South Indian state has reported 5,421 deaths in this period. At a distant second is the US state of New York, which has recorded just over 4,200 deaths. In the same period, Kerala has reported more than 364,000 COVID-19 cases – while New York’s figure is more than 2.3 million. On the face of it, the situation in Kerala is very concerning.

But a closer look reveals there is more to the story. Many of the deaths that Kerala is reporting are part of a revision of its official death toll.

Since October 21 last year, Kerala has added 16,958 ‘backlog’ deaths, based on the claims of compensation it has received from families of people who have died of COVID-19. The updated claims account for nearly a third of Kerala’s total death toll, which as of January 23 stands at 51,816.

The revision exercise was undertaken by the state in compliance with a Supreme Court order. The top court, hearing petitions to provide ex-gratia to families of those who died because of COVID-19, had directed the Union government in October 2021 to provide simplified guidelines. Under the new guidelines issued by the Centre, people who die within 30 days of testing positive for COVID-19 are eligible for compensation.

The Kerala government subsequently issued a government order, which said the new guidelines have added “few more criteria for declaring death due to COVID and death due to Covid complications as COVID death”. The guidelines also provide family members with an opportunity to correct the cause of death on official documents issued by the authorities, the order said.

From the beginning of the pandemic, experts around the globe have said that the official death tolls do not truly reflect the scale of the health crisis. This was especially true between April-June 2021, when India was swept by a disastrous second wave of COVID-19. Subsequent media reports, studies and estimations have shown that many states have massively undercounted deaths due to COVID-19.

Under the new guidelines, several states have accepted more compensation claims than their official death tolls – an implicit acknowledgement that the latter is an undercount of the actual COVID-19 death toll.

The updated death toll may have sullied Kerala’s reputation for managing the pandemic well. “Kerala’s mortality from Covid-19 has more than doubled in the 2nd wave compared to the first due to the addition of backlog deaths. The merit of its claims of being a state with the lowest mortality from Covid-19 has significantly diminished,” Rijo M. John, health economist and adjunct professor at Kerala’s Rajagiri College of Social Sciences, told The Print.

Also Read: COVID-19: What We Do and Don’t Know About India’s ‘Missing’ COVID Deaths

However, Kerala is among the handful of states which have updated their official death tolls. If states like Gujarat – which has handed out seven-times more compensation claims than its official death toll – were to follow the state’s lead, the situation in Kerala may not appear so grim. Indeed, even as the updated toll means that Kerala has the second-highest number of deaths among states in the country, its case fatality rate is better than most others.

John also acknowledged that Kerala is still performing better than the national average. “The overall Covid-19 mortality of 0.92% in Kerala based on reported deaths, however, continues to be lower than that of the national average at 1.38%,” he said, also adding other states should also update their official toll.

Representative image of a cremation in progress at Ahmedabad, amidst a surge in COVID-19 cases. Photo: PTI

Such a possibility seems remote. For example, Gujarat’s health minister Rushikesh Patel said the state government does not plan to update the state’s official death figures.

“What has been declared by the state is the official Covid-19 death figures. There are some who died due to some other diseases and some others who died in private hospitals or at home. There were also some patients who recovered from the hospital but later died at home. That doesn’t mean they died of Covid. The Supreme Court has said that anyone diagnosed with Covid and regardless of where they died, have to be paid compensation… we are doing that,” Patel told Indian Express.

His statement flies in the face of the WHO’s definition of a COVID-19 death. The UN body defines a death due to COVID-19 “as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g. trauma)”. A death due to COVID-19 should not be attributed to another disease (like cancer) and should be counted independently of preexisting conditions or comorbidities.

While Kerala has updated its death toll, there is still room for improvement, according to experts. The toll should have details about the date of deaths, age, gender, comorbidities and vaccination status, experts told Down to Earth.

Bhramar Mukherjee, epidemiologist and professor at the University of Michigan’s School of Public Health, told The Print that states should “check and verify the actual date of death and incorporate the number for that exact date”. The “blips in excess mortality estimates” caused by adding backlog deaths are causing confusion, she said.

“As modelers we have been distributing these ‘catch up’ numbers over a time window to smooth our fatality rate estimates. The time lag from infection to death is a key parameter and these anomalies affect our estimates,” Mukherjee added.

Gujarat’s Official COVID Toll Is 10k – But it Received 90k Claims for Compensation

One report suggests that Tamil Nadu, Telangana and Uttar Pradesh are also underreporting deaths due to COVID-19.

Bengaluru: In a strange turn of events, the Gujarat state government informed the Supreme Court on January 16 that it has approved 68,370 claims for ex gratia for COVID-19 victims – while the state’s official cumulative death toll was only 10,094 until then.

According to Times of India, the state wrote in its compliance report for the apex court that it had received 89,633 applications in all. The state offers a sum of Rs 50,000 to the family of every individual who succumbed to the disease.

On January 19, a Twitter account called @BollyNumbers wrote that Gujarat wasn’t alone. Based on similar data, it reported that Tamil Nadu, Telangana and Uttar Pradesh had also differences disbursed amounts for more claims than what their official COVID-19 tolls indicated.

The account also wrote that four other states had received more claims (as opposed to the number of approved claims) than the official number of COVID-19 deaths, until January 16, 2022: Maharashtra, Andhra Pradesh, Chhattisgarh and Delhi.

The newspaper quoted unnamed officials in the Gujarat health department saying the state followed the Indian Council of Medical Research (ICMR) guidelines: that the deaths of patients with existing comorbidities and/or age-related complications wouldn’t be classified as ‘COVID-19 deaths’ even if they had the disease at the time of death.

As The Wire Science has reported, it is very difficult to attribute a death to a comorbidity if a patient also has COVID-19. One reason is that COVID-19 itself could complicate the outcomes of existing conditions – like most infectious disease can. Yet this criterion alone has left many COVID-19 deaths out of the country’s official tally.

This said, the ICMR guidelines also stipulate that for a family to claim the ex gratia emolument, it only has to produce a ‘positive’ PCR test of the victim taken within 30 days of their death. This could be a reason for the discrepancy: that nearly nine-times more people have died with COVID-19 in Gujarat than the number of people who have died in a way that fits the ICMR’s definition of a ‘COVID-19 death’.

Recently, epidemiologist Prabhat Jha told The Wire that the WHO doesn’t trust India’s COVID-19 death data because India undercounts more than other countries. Jha led a study published on January 6, 2022, that estimated India’s true death toll due to COVID-19 could be six-times higher than the official tally.

There have been concerns about widespread fatality underreporting in India since 2020 itself. In August that year, an investigative report by The Wire Science revealed the true scale and mechanics of the problem. As the report wrote:

There is evidence that at least two cities in Gujarat, Vadodara and Surat, and all districts of Telangana are flouting the ICMR guidelines. All of them are naming comorbidities as the underlying cause in a large number of confirmed deaths, and aren’t counting such deaths in their official tallies.

According to Times of India, Ahmedabad and Surat currently account for more than half of all official deaths in Gujarat.

In the last two years, some states, including Maharashtra, Tamil Nadu and Delhi, have also performed ‘reconciliation exercises’ – in which they have updated their deaths data weeks or months after a particular date, causing the tally to remain low in that period before suddenly jumping up.

In June 2020, mathematician and disease-modeller Murad Banaji found that even after its reconciliation exercise, Maharashtra may have been continuing to underreport the number of COVID-19 deaths, based on simulations of the “typical delay between when cases are recorded and when deaths are recorded, both on average”.

A year later, in June 2021, an NGO in Tamil Nadu said its analysis of the number of death certificates had found that the state could be underreporting COVID-19 deaths by a factor of six.

Gujarat’s habit of underreporting COVID-19 deaths also became evident when, last year, many publications found that Gandhinagar had reported no COVID-19 deaths in April – yet there were bodies of people who had died of COVID-19 being transported to crematoria. They subsequently reported that the death count was being suppressed in cities throughout the state.

An editor of the leading Gujarati daily Sandesh, Rajesh Pathak, told BBC at the time that the Gujarat government neither confirmed nor denied their reports of fatality underreporting. The government’s approval of more than 68,000 claims for ex gratia today may be this confirmation.

Note: This article was updated at 2:12 pm to include discrepancy in the COVID-19 deaths data for Tamil Nadu, Telangana and Uttar Pradesh as well.

Delhi: Of 97 Who Died Due to COVID Between January 9-12, 70 Unvaccinated, 19 Took Only One Jab

“More than 75% of the people who died due to coronavirus had not even taken a single dose of the vaccine,” said health minister Satyendra Jain.

New Delhi: More than 75% of those who succumbed to the novel coronavirus infection in the current wave in Delhi were unvaccinated, health minister Satyendra Jain said on Friday.

He also said that the city is expected to record less than 25,000 coronavirus cases on Friday.

Delhi had on Thursday reported 28,867 COVID-19 cases, the sharpest single-day spike since the pandemic began, and 31 deaths, while the positivity rate surged to 29.21%, according to the health department data.

Delhi’s previous biggest daily jump of 28,395 cases was recorded on April 20 last year.

According to official data, of the 97 people who died due to COVID, between January 9 to January 12, 70 people were unvaccinated, while 19 had taken the first jab and eight were fully vaccinated. Besides seven were minors.

“More than 75% of the people who died due to coronavirus had not even taken a single dose of the vaccine. 90% of the people had severe comorbidities like cancer and kidney ailments. Even the seven patients below 18 years had chronic issues,” Jain noted.

He said one of the persons who died had allegedly attempted suicide and was hospitalised for it.

“He tested positive and died three days later,” said the minister.

The minister added that more than 13,000 hospital beds are available in the city.

“The hospitalisation rate has become stagnant and the daily admissions have reduced. It is a matter of great relief,” he said.

Out of 15,433 COVID beds in hospitals, 2,424 were occupied on Thursday, according to official data.

(PTI)

Mahtab Alam, Priyanka Pulla Win RedInk Awards for Articles Published in The Wire

Their wins come close on the heels of Dheeraj Mishra and Seemi Pasha winning a Ramnath Goenka Award each for an article and video published in The Wire.

New Delhi: Journalists Priyanka Pulla and Mahtab Alam have won the Mumbai Press Club’s RedInk Awards 2021 for articles that were published by The Wire. While Pulla won in the category ‘Health & Wellness (Print)’ for a story titled ‘India Is Undercounting Its COVID-19 Deaths. This Is How.’, Alam was declared a joint-winner in the ‘Arts’ category for his tribute to actor Tom Alter titled ‘The ‘Angrez’ Who Wrote His Memoir in Urdu’.

The RedInk Awards for Excellence in Journalism, organised by the Mumbai Press Club, are in their 10th year now. They are the only set of awards that extend peer recognition, backed by stakeholders, sponsors and participants.

Pulla’s report, published in The Wire Science in August 2020, revealed that several cities and states in India were undercounting deaths due to COVID-19 through two methods: counting only those deaths of patients who tested positive for the virus in their official toll; and not reporting all confirmed deaths either.

Read the award-winning story here: India Is Undercounting Its COVID-19 Deaths. This Is How.

Alam wrote about actor Tom Alter, the son of White American immigrants who was born in Mussorie, and his penchant for Hindi and Urdu. While writing about the actor’s ability to speak, read and write in Urdu, Alam also describes Alter’s quick wit. The article recounts an instance when a journalist asked the actor, ‘Aap itni achchi Hindi kaise bol lete hain? (How do you speak Hindi so fluently?)’, pat came Alter’s reply, “Muhn se (With my mouth).”

Read the award-winng story here: Tom Alter: The ‘Angrez’ Who Wrote His Memoir in Urdu

On December 24, the Mumbai Press Club announced that the ‘Journalist of the Year – 2020’ award will be given posthumously to Reuters photojournalist Danish Siddiqui for “his spectrum of the investigative and impactful body of news photography ranging from the Rohingya and anti-CAA protests to Covid-19 and the Afghanistan Civil War.” Siddiqui was tragically killed by the Taliban in Afghanistan on July 15 this year while on duty.

The RedInk lifetime achievement award was awarded to senior journalist Prem Shankar Jha. The Press Club in a statement noted that the 83-year-old Jha, a regular contributor to The Wire, was chosen to receive the award for his “long and distinguished career of incisive and analytical writing”.

On Tuesday night, The Wire‘s Dheeraj Mishra and contributor Seemi Pasha won the Ramnath Goenka Award in the Government and Politics category in the ‘digital media’ and ‘broadcast media’ divisions respectively.

SC Slams States For Lack of Wide Publicity to Portal on Ex-Gratia for COVID Deaths

A bench of Justices M.R. Shah and B.V. Nagarathna said unless wide publicity is given, people will not be able to know the portal address on which they can make an online application.

New Delhi:  The Supreme Court on Monday slammed states for not giving wide publicity about a portal developed for disbursal of ex-gratia compensation for COVID-19 deaths.

A bench of justices M R Shah and B V Nagarathna said unless wide publicity is given, people will not be able to know the portal address on which they can make an online application.

The top court noted that some states have not given any wide publicity by giving full details of the portal in advertisements in newspapers, more particularly in vernacular language papers, and local channels.

It also noted that the particulars of the Grievance Redressal Committee constituted have also not been furnished.

“Unless publicity is given to a common man he will not be able to know the portal address on which they can make an application online. Counsel appearing for Gujarat have stated at the Bar that before the next date of hearing advertisement shall be given in all newspapers, in particular the local newspapers,” the bench said.

Also read: NDMA For Rs 50,000 as Compensation to Families of COVID-19 Victims: Centre to SC

The counsel for the Maharashtra government stated that it has received approximately 84,000 applications, out of which, as of today, 8,000 applicants have been paid ex-gratia compensation.

“It is very unfortunate that only 8,000 payments have been made. Counsel has submitted that the remaining will be paid ex-gratia compensation at the earliest. We direct them to make the payment after considering the application within a week from today. Put up on Wednesday,” the bench said.

The apex court had earlier expressed concern over the low number of claims for ex-gratia compensation for COVID-19 deaths and directed state governments to inform if wide publicity has been given concerning the scheme for compensation.

The top court was hearing a batch of pleas by advocate Gaurav Kumar Bansal and intervenors represented by advocate Sumeer Sodhi seeking ex-gratia assistance to family members of COVID-19 victims.

The apex court had earlier asked the Centre to gather information from states on the progress made on disbursal of ex-gratia compensation of Rs 50,000 to the kin of COVID-19 victims and pulled up the Gujarat government for issuing notification constituting a scrutiny committee contrary to its directions.

On November 18, the top court had pulled up the Gujarat government for issuing a notification which was “just contrary” to the directions given regarding ex-gratia to the next of kin of those who died due to COVID-19 and said an attempt has been made to “overreach” the directions issued by the apex court.

The top court had on October 4 said that no state shall deny ex-gratia compensation of Rs 50,000 to the next of kin of the deceased due to COVID-19 solely on the ground that the death certificate does not mention the virus as the cause of death.

The court had also said that the ex-gratia is to be disbursed within 30 days from the date of applying to the district disaster management authority or the district administration concerned along with the proof of the death of the deceased due to coronavirus and the cause of death being certified as died due to COVID-19.

The top court had said that its directions for payment of compensation to the family members of the persons, who died due to COVID-19, are very clear and there was no requirement at all of constituting the scrutiny committee to award compensation.

It had said it was very much made clear that even in a case, wherein the death certificate the cause is not shown as death due to COVID-19 but if found that deceased was declared positive for coronavirus and has died within 30 days, automatically his or her family members are entitled to the compensation without any further conditions.

(PTI)