The Union government, as well as the governments of many states (including even progressive states like Tamil Nadu), have been accused of either ignoring (in the case of the former) or actively orchestrating (in the case of the latter) the under-reporting of deaths from the coronavirus disease (Covid-19).
How do you under-report Covid-19 deaths?
Technically, there are two ways to accomplish this, one generic and the other specific.
Every year, a certain number of deaths in India go unreported. Families do not bother to register the deaths because there is nothing to gain by doing so. The dead are buried or cremated locally and informally (which means a graveyard or cemetery is rarely their final resting place), and the families do not bother to register the deaths because there is nothing to gain by doing so. In fact, it is possible that applying for and receiving a death certificate will cost money. Conversations I have had with government officials, volunteers at NGOs, and statisticians all converge on the point that these numbers have been coming down over the years. Over the past seven years, especially, India’s efficiency of welfare-delivery has greatly improved, with at least some of this welfare being in the form of a cash transfer into an Aadhaar-enabled bank account. In such cases, should the next of kin want to claim the balance lying in these after the account-holder’s death, they need a death certificate. It’s a simple cost-benefit equation.
Two, it’s easy to misreport a cause of death in the current situation, where states want to show off how well they handled Covid-19. For example, some of the same government officials and volunteers at NGOs tell me anecdotally that diseases like typhoid are causing an increase in deaths in some of India’s poorest states. According to HT’s own reporting, testing is insufficient in many rural areas, and when someone dies, local health officials can pretty much decide how they died.
Only a few states follow the guidelines set forth by the Indian Council of Medical Research for testing the dead for Covid-19. Even when people who test positive for Covid-19 and are hospitalised for the illness die, death audit committees — which exist in almost every state — frequently attribute Covid-19 deaths to co-morbidities.
Apart from the obvious deception, under-reporting has a negative impact on our understanding of the pandemic, as well as its current and future trajectory in the country. I also believe that lying about it is more disrespectful to the dead than photographing funeral pyres or hundreds of shallow graves in riverbeds. Both the federal government and the states must address this issue for reasons of morality, good governance, and science (this is definitely more worthy of their attention and time than an editorial in The Lancet or the nomenclature of a variant of the virus).
I’d like to suggest that the office of the Registrar General and Census Commissioner work with the states (which, in turn, will have to work with municipalities and corporations) on compiling a 12-year database of deaths. The long period average, between 2010 and 2019, by district and cause, can be the base. The deviation from these in 2020, irrespective of the mentioned cause of death, represent the excess deaths on account of Covid-19. And it is important to start updating this year’s deaths in the database too. Only this will provide a true picture of the pandemic’s cost, in terms of human lives, in India. And only this will provide an accurate epidemiological perspective of the pandemic’s run through the country — and help prepare for the third wave. Only by doing so will we be able to get an accurate epidemiological picture of the pandemic’s spread across the country — and prepare for the third wave.
