Indian statistician and modeler are equal to none in the world. The government can easily set up a panel of experts to arrive at an independent and reliable estimate of the country’s pandemic toll.
Indian statistician and modeler are equal to none in the world. The government can easily set up a panel of experts to arrive at an independent and reliable estimate of the country’s pandemic toll.
The World Health Organization (WHO) has recently released a report Global deaths are estimated from this COVID-19 during 2020-2021. It suggested that approximately Worldwide pandemic can be attributed to 14.9 million deaths During that period, it is estimated that around 4.7 million of these deaths occurred in India alone. for comparison, Official Indian COVID-19 Toll 0.48 million for that period, which is less than a factor of about 10 from the WHO’s numbers.
Several independent news reports have suggested that the Indian government was under pressure from the WHO to suppress their estimates. Indeed, once the report came out, it was immediately criticized by many prominent government representatives. A government press release called the report “statistically unsound and scientifically questionable”.
India’s rejection of the report It is the only country among the 194 member states of the WHO to do so. However, India’s estimates are roughly in line with estimates from several independent groups, all falling in the broad range of 2.2 million to 6 million deaths.
Understanding ‘excess mortality’
At the core of all such estimates, especially in situations where the official numbers may not align with reality, is a quantity known as the “excess mortality”. It compares estimates of the actual death rate with the number of expected deaths in the same year, but without the death rate due to the pandemic, a clear counterfactual. Thus there are two estimates here – the estimate of the actual number of deaths, and the “counterfactual” estimate. The difference between these is the number of more deaths that we must attribute to the pandemic.
For counterfactual estimation, one must exclude the number of deaths from previous pre-pandemic years, but with additional statistical corrections that reflect how the population varies from year to year. To a lesser extent, the indirect effects of the disease must also be taken into account. These should include the fact that there are fewer deaths due to road accidents during the period of lockdown, for example. Accounting for those who died simply because it was difficult to access medical treatment during the pandemic period, even if for non-COVID-19 reasons, is also important.
For actual death tollOne must rely on official figures, if it is to be considered accurate, or estimate numbers by other means, as the WHO did for India.
The government’s issue with the WHO report includes these two different estimates. It argues that the model used by WHO to estimate deaths in the counterfactual scenario is flawed. Furthermore, it suggests that the way in which actual deaths are calculated – by a combination of official reports, external non-governmental websites and news reports – is questionable.
Feedback on Specifications Brief
The official response from the government has been short on specifics. It provides no alternative route to these estimates other than an emphasis on relying on official records.
In its response to the WHO, the Indian government has argued that its own civil registration system, or CRS, is of sufficiently high quality that the numbers it provides can be used in place of model estimates. Data from the CRS for 2020 is now available, but was released just two days before the WHO released its report and therefore could not be included in its estimates. CRS numbers point to an increase of 470,000 deaths in 2020 compared to 2019, although all of these are very unlikely covid-19 deaths, WHO estimates yield numbers for pandemic deaths in 2020 that are larger by a factor of about 2.
Available CRS data does not estimate how many deaths actually occurred in India in 2020, but only those that were registered, known to have a distinct urban-rural divide. Since the CRS only counts registered deaths, the quality of its numbers can only be understood in comparison to other methods. India’s sample registration system tracks a set of representative households to estimate deaths in a given year. It could have been a useful point of comparison. However, SRS did not happen in 2020.
CRS has been argued to reduce deaths especially in some of the most populous states of India, especially for women and children. Low levels of death registrations are believed to occur in the highly populated states of Uttar Pradesh and Bihar and are likely to drop further during the pandemic. Given these, it is possible that the discrepancy between official and WHO estimates may simply reflect inadequacies in our mechanism for counting deaths.
There is a universal consensus that the vast majority of deaths from COVID-19 during the pandemic may be linked to the delta wave, which struck India between February and June of 2021. Even in the WHO’s calculation, the contribution of the year 2021 is more than this. 80% of the overall estimate of epidemic mortality. Till now the representatives of the government have remained silent on this. CRS data for 2021 will be available next year only.
Responsibility towards the dead and those left behind
Why is it important to count the dead? One reason, of course, is closure. It is difficult to find an Indian who has not experienced a direct COVID-19 death of a family member or an untimely death as an indirect result of the infection. To insist on the sanctity of an official record that potentially undermines them would disregard our responsibilities to the dead and those left behind, without providing sufficient reason to believe that record.
We may ask whether any potentially low count of deaths indicates deliberate mismanagement or whether it simply points to the difficulty of maintaining accurate records in a country of the size and complexity of India. We may ask how the Indian public health system has fared compared to other countries, at least in defining the public health program of this century.
But here’s the big question: How should the Indian government respond to independent, external measures of its performance on any issue where these measures diverge from the official narrative? In recent years, the Indian government has shown some prick in such matters. In this particular case, it has been largely bolstered by the relatively undisputed media, which has favored its refusal to acknowledge the pandemic’s potential toll as “patriotic disobedience,” in the words of mathematician and COVID-19 modeller Murad . Banji.
As they say, “it is an absurd version of patriotism that discards data and evidence, and disrespects the millions of families to whom COVID-19 brought tragedy”.
However, it is possible to do a better job. Indian statistician and modeler are equal to none in the world. The methodology adopted by WHO is transparent and publicly available. The government can easily set up an independent panel of experts to evaluate and improve the WHO’s estimates.
The numbers that come with such a panel may not match with the official records. Such an exercise, however, would establish the government’s commitment to an accurate and transparent calculation of the impact of COVID-19 on India.
Gautam I. Menon is Professor of Physics and Biology at Ashoka University, Sonepat. The views expressed here are personal.