Is India undercounting its COVID-19 deaths?

In 2020, deaths due to COVID-19 increased exponentially from the 12th week due to the COVID-19 pandemic in 24 countries in Europe

India’s COVID-19 case fatality rate (CFR, deaths/cases) has always remained low. But data from some European and Asian countries show that since the 10th week of 2020, “excess deaths” have surged. In countries with relatively poorer income levels such as Indonesia and Ecuador, a very small % of those excess deaths have been attributed to COVID-19. With historically poor registration of deaths and medically-certified death rate, is India too undercounting its dead?

Fatality rate

India’s CFR of 3.1% (in red) as of May 18 is among the lowest in countries with more than 1 lakh cases and much below the world average of 6.6%. The chart plots cumulative cases against the CFR as of May 18.

Case fatality rate of India and other countries

Among nations with over 1 lakh cases, only Turkey and Russia have a lower case fatality rate than India.

Excess deaths

The chart shows the weekly excess deaths (deviation in mortality from the expected level) in 24 countries in Europe from January 1, 2016 to May 15, 2020. In 2020, deaths increased exponentially from the 12th week due to the COVID-19 pandemic. The spike recorded in the first 10-12 weeks of 2017, 2018 and 2019 can be attributed to the flu season which was unusually lethal. In 2020 the flu season was relatively less deadly.

COVID-19 deaths among excess

The graph plots the % share of COVID-19-related deaths among the excess deaths for nations which had such data. In high-income countries (represented in blue), the share of COVID-19 deaths are higher among the excess deaths. In upper middle income countries (represented in red) such as Russia, Turkey and Ecuador and lower middle income countries such as Indonesia (represented in orange) the share of COVID-19 deaths among the excess deaths was much lower. This suggests that the relatively poorer countries may not be testing the dead for COVID-19 or they maybe undercounting them due to comorbidities.

As it can be seen from the chart most countries which have shared data on excess deaths are from the high income groups while many countries in the lower income group don’t maintain this data.

India is one among such countries which do not maintain real time data on all deaths.

Last word

On April 30, West Bengal announced that 105 COVID-19 positive patients had died, but did not count 72 of them as they died due to comorbidities. On May 18, the Delhi government asked its hospitals not to take samples of dead people to test for COVID-19. Also, while the Delhi government’s official COVID-19 death toll was 68 until May 8, the number of such deaths in just two hospitals in the city that The Hindu accessed was 107. These COVID-19-specific stories along with the fact that India medically certifies only 22% of deaths (as of 2017) suggest that India may be undercounting its dead.

Source: The Economist, EuroMOMO, Johns Hopkins University’s coronavirus tracker

With inputs from The Hindu