Hint of underreporting of deaths during first year of pandemic

Recorded casualties are expected to increase year-on-year because of a spike in population as well as improved reporting, say experts

G.S. Mudur   |   TT  |  New Delhi   |   04.05.22 : India’s births-and-deaths recording system captured 8.12 million deaths from all causes during 2020, or 480,000 excess deaths over the previous year’s count, hinting at some underreporting of deaths during the first year of the Covid pandemic.

The Civil Registration System (CRS) statistics report from the Registrar General of India for 2020 released by the Centre on Tuesday said the number of registered deaths increased to 8.12 million in 2020 from 7.64 million in 2019.

The Union health ministry’s documented 148,000 Covid-19 deaths during 2020 would be part of these 480,000 excess deaths from all causes over the previous year’s count. But this 2020 excess is puzzlingly lower than the 690,000 excess deaths in 2019 over the 2018 count.

Health experts say the count of recorded deaths would be expected to increase year-on-year because of an increase in population as well as improved reporting under greater levels of public awareness about the need to register all deaths.

The count in 2018, for instance, was 490,000 higher than in the previous year. In 2019, the count was 690,000 higher than in 2018. Experts speculate that the fall to 480,000 during 2020 could have been due to underreporting under the stringent three-month lockdown or other circumstances in 2020.

The CRS report said Covid-19 was “one of the major causes” for underreporting in Telangana and that the general public had “faced difficulties” in reporting events under the pandemic. The Covid-19 epidemic also disrupted training and inspection of registration systems in some states.

Multiple studies from independent research groups over the past year have estimated on the basis of extrapolation and modelling that India’s Covid-19 death toll exceeds 3 million, significantly higher than the health ministry’s official count of around 523,000. The health ministry has argued that India has a strong death recording system that will yield reliable counts.

Experts say the 2020 CRS report will not help resolve the controversy on India’s actual Covid-19 death toll because the second Covid-19 wave in 2021 was far more brutal than the one in 2020. The official Covid-19 death toll in 2021 was over 332,000.

A top health official said those trying to estimate Covid-19 deaths should consider the CRS report. “These are actual numbers from a robust registration system, not modelling,” said Vinod Paul, chair of the national Covid-19 task force and member (health) at Niti Aayog, the government’s top think tank.

“The extra (480,000) deaths in 2020 over 2019 include all deaths — deaths from all causes, including heart (cardiovascular) deaths, children’s deaths and Covid-19 deaths too,” Paul said.

The CRS report said Maharashtra, Bihar, Gujarat, Bengal, Andhra Pradesh, Tamil Nadu, Karnataka, Madhya Pradesh, Rajasthan, Assam and Haryana had contributed significantly to the 6.2 per cent increase in the number of deaths from 2019 to 2020.

Maharashtra was among the states hit the hardest by Covid-19 during 2020 and 2021.

The CRS report has also reflected underreporting of births with the number of registered births decreasing from 24.8 million in 2019 to 24.2 million in 2020, or a 2.4 per cent reduction. Eleven states — Uttar Pradesh, Telangana, Gujarat, Jharkhand, Delhi, Karnataka, Chhattisgarh, Andhra Pradesh, Maharashtra, Kerala and Bengal — contributed significantly to this fall in registered births in 2020.