Did the government of India mislead the world regarding the extent of the COVID-19 problem in its constituent states?
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SPECIAL “Open Access” COMMENTARY Spring 2021
Did the government of India mislead the world regarding
the extent of the COVID-19 problem in its constituent
states?
Rodney P Jones, PhD. Healthcare Analysis & Forecasting, Oxfordshire, UK
EMAIL: hcaf_rod@yahoo.co.uk
Abstract: Under-reporting of COVID-19 infections and deaths is as endemic as the virus
itself. Undercounting is consistently associated with a large proportion of the population
living in slums, associated low levels of health care resources, and a poorly functioning
death reporting process. These conditions apply to most of Africa and large parts of Asia. All
governments in these areas have seemingly been happy to go under-the-radar, some have
even stopped reporting, although the citizens and government officials will be aware of the
extent of the problem. As an example of far wider undercounting this article will
concentrate on India since it is in the news especially because of the Indian variant of which
the earliest version was discovered back in October of 2020. The federal collection of states
has widely disparate levels of income and public health resources. Central reporting appears
to be somewhat chaotic and downright deceptive in some cases. It is only in recent days
that the Indian Congress has become aware of huge disparities in the number of death
certificates issued since the beginning of the epidemic versus a tiny number of reported
COVID-19 deaths.
Key words: Death reporting; COVID-19; India; official statistics; processes of government;
pandemic preparedness.
Introduction
In recent months tens of thousands of Indians have developed an ‘altruistic’ desire to ‘visit
their relatives’ in other countries. Or did they all know something that the government of
India did not wish to admit?
Since the COVID-19 pandemic began I have been investigating the issues of under-reporting
of COVID-19 deaths, first in the UK and then in an international context.1 My interest in
deaths came out of research into outbreaks of a new type or kind of disease which I
observed first-hand in 1993.2 Subsequently I have published multiple studies on this topic.3
There is no official recognition that such outbreaks even exist. This is merely an example of
1
http://www.hcaf.biz/2020/COVID_Excess_Deaths.pdf
2
A Previously Uncharacterized Infectious-like Event Leading to Spatial Spread of Deaths Across England and
Wales: Characteristics of the most Recent Event and a Time Series for Past Events (sciencedomain.org)
3
http://www.hcaf.biz/2010/Publications_Full.pdf
1SPECIAL “Open Access” COMMENTARY Spring 2021
how government agencies are generally the last to admit that there may be a serious
problem. However, one of the fundamental observations from these studies is that any
agent capable of killing people will hospitalize multiple time more, and this has been
elegantly demonstrated with COVID-19.4
In the previous two parts to this series5 gross undercounting of COVID-19 deaths has been
linked to countries with low testing capacity. Such countries are usually characterised by a
high proportion of the population living in slums and by a poorly functioning death
registration process. Was there evidence that the numbers relating to COVID-19 emanating
from India were too good to be true?
Mortality reporting in India
On June 15th, 2020 the independent researcher Bharath Kancharla from India published a
detailed analysis of death reporting in India.6 A death registration process is in place
however, data for the whole of India is usually published 3-years in arrears. In 2017 there
were 6.46 million registered deaths out of an estimated 8 million actual deaths, i.e., a
general 25% underestimate. The gap between estimated and registered deaths increases as
state wealth decreases. Uttar Pradesh, Bihar, and Uttarakhand have low registration of
deaths compared to estimated actual deaths. Of the deaths registered, the percentage of
medically certified deaths is 100% in Goa (wealthiest state) falling to just 5% in Jharkhand
(one of the poorest). This should have been enough to alert the rest of the world that death
reporting may be suspect, and especially so during the intense pressures of a pandemic.
In a News reports by the BBC on the 6th May the reporter in Uttar Pradesh (population 200
million) noted 13 cremations in 1 hour at one site, while the official government count was
just 7 for the whole day.7 Recently the Indian Congress Party has become aware that the
number of death certificates issued since the start of COVID-19 has shown a vast increase
while the number of reported deaths has not!8 The Congress Party noted that in Gujarat
deaths in 2021 were double that in 2020 without any ‘official’ explanation. Hundreds of
bodies had been found floating in the river Ganges and nearly 2,000 unidentified bodies had
been found buried in the sands along this river. On the 15th of April 2021 Gujarat had an
‘official’ count of 9,038 COVID-19 deaths,9 for a population of 73 million.10 The Congress
Party allege that the extent of the problem has been subject to a cover up at national and
state level. In my opinion the true deaths are >10-times that official figure.
4 Journal of Health Care Finance (healthfinancejournal.com)
5 http://www.healthfinancejournal.com/~junland/index.php/johcf/issue/view/7
6 Data: How many Deaths are recorded in India every year? (factly.in)
7 BBC India OnTheGroundReportMay6 - YouTube.
8 Cong alleges under-reporting of COVID-19 deaths in states like Gujarat; demands explanation from govt
(republicworld.com)
9 COVID19 STATEWISE STATUS | MyGov.in
10 Population of Gujarat in 2021 - Gujarat Population 2021 (indiaonlinepages.com)
2SPECIAL “Open Access” COMMENTARY Spring 2021
Clearly the citizens of India, the Ambulance service, the police, civil servants will all be aware
of the extent of the real problem, hence, the mass exodus and urgent desire to ‘visit
relatives’ in countries away from the chaos and with a good health service just in case it is
needed. Unwittingly spreading infection far and wide. The Indian variant has now been
detected in over 40 countries.11
Early evidence that reporting was highly suspect
Figure 1 shows the trajectory of “reported” COVID-19 deaths for India compared to a
random collection of countries with reasonable levels of reporting. As can be seen the
trajectory since October of last year is far too good to be true. The data has been expressed
as reported COVID-19 deaths per 1,000 deaths (before COVID) to give a true international
like-for-like perspective. Deaths per 1,000 population are a completely meaningless
measure. The trajectory commences after the first wave and around the time the first
version of the Indian variant was identified.12
Figure 1: Trajectory of reported COVID-19 deaths for various countries. Data from
Worldometers.com13
375 Paraguay Colombia
350 Peru Uruguay
"Reported" COVID-19 deaths per 1,000
325 Brazil Qatar
300 Argentina Nepal
Cabo Verde Seychelles
275
deaths (before COVID)
Croatia Hungary
250 Armenia Italy
225
200
175
150
125
100
75
50
25
0
16/10/2020
30/10/2020
13/11/2020
27/11/2020
11/12/2020
25/12/2020
08/01/2021
22/01/2021
05/02/2021
19/02/2021
05/03/2021
19/03/2021
02/04/2021
16/04/2021
30/04/2021
14/05/2021
11
Indian Covid-19 variant found in 44 countries around world, says WHO (france24.com)
12
PM: India coronavirus variant must be 'handled carefully' - BBC News
13
COVID Live Update: 163,197,978 Cases and 3,384,118 Deaths from the Coronavirus - Worldometer
(worldometers.info)
3SPECIAL “Open Access” COMMENTARY Spring 2021
As can be seen India has a trajectory which is too good to be true. The relatively flat line
from October 2020 to April 2021 is unprecedented compared to any other country. The
problem with such massive under-reporting is that India should have been on every
countries “Red List” from as far back as October last year. Real deaths are probably a
minimum of 3-times up to 10-times higher. The 25% general underestimate of deaths
(mostly from the poorest states) in India would have been amplified during COVID-19 as the
death registration system broke down under the pressure. The poorest will simply burry or
otherwise dispose of the dead in whatever way possible.
The extra deaths will be hidden in the most densely populated poorer states with higher
slum populations. The real question is whether it was politically expedient to hide the true
extent of the risk even before the current surge?
Was the level of COVID-19 testing adequate?
Due to the federal structure in India COVID-19 testing was a state matter and there was no
effective national system to collect the number of tests. Some states were not even
reporting test numbers and outcomes.14 Recall that this is a country with the funds for an
active space programme. The site COVID19india.org seems to have stepped in to fill the gap.
This is a volunteer run, crowdsourced organisation.15
Figure 2: Percentage of “official” tests positive for COVID-19 versus cumulative tests per
million population. India is the red triangle. Data from worldometers.com12
100.0%
Percent tests positive
10.0%
1.0%
0.1%
1,000 10,000 100,000 1,000,000 10,000,000
Tests per million population
14
Decoding India's COVID-19 testing, state by state - News Analysis News (indiatoday.in)
15
Coronavirus Outbreak in India - COVID19india.org.
4SPECIAL “Open Access” COMMENTARY Spring 2021
The “official” number of tests per million population and the percentage of tests positive for
COVID-19 remain low in India (Figure 2) which suggests that testing was historically
disproportionately distributed and reported in lower risk areas such as the wealthier states.
More recent figures are alarmingly high with some areas reporting that 50% of tests are
positive.16
Regarding the risk of death from COVID-19 India has a high prevalence of all the relevant
risk factors with levels of diabetes like that in USA and Brazil,17 plus high rates of
tuberculosis, hepatitis, asthma, pneumonia, other lung diseases, diarrhoeal diseases,
malnutrition, and heart disease.18 Which begs the question why other governments did not
question the too-good-to-be-true risk? Perhaps they did but they also kept quiet?
Over the past 16 days (up to 17th May) most Indian states have been showing exponential
growth in “reported” deaths (Figure 3). The percentage growth over the past 16 days is
therefore high. Highest exponential growth is in Nagaland. Lakshadweep is small numbers.
As discussed above under-counting will vary by state.
Figure 3: Percentage increase in “reported” deaths for Indian states over the 16 days to
17th May 2021.
120%
8 days
100%
14 days
80% 16 days
60%
Growth
40%
20%
0%
Dadra & Nagar Haveli &…
Sikkim
Gujarat
Assam
Odisha
Tripura
Punjab
Tamil Nadu
Haryana
Mizoram
Arunachal Pradesh
Jammu and Kashmir
Karnataka
Manipur
Himachal Pradesh
Meghalaya
Madhya Pradesh
Maharashtra
Andaman and Nicobar
Uttar Pradesh
Bihar
Rajasthan
Uttarakhand
Lakshadweep
West Bengal
Andhra Pradesh
India
Puducherry
Jharkhand
Ladakh
Kerala
Delhi
Goa
Nagaland
Telengana
Chandigarh
Chhattisgarh
16
How Goa Shot to the Highest COVID Positivity Rate in India (thequint.com)
17
Countries ranked by Diabetes prevalence (% of population ages 20 to 79) (indexmundi.com)
18
World Life Expectancy
5SPECIAL “Open Access” COMMENTARY Spring 2021
Other parts of the world are showing high growth in “reported” COVID-19 deaths
Indeed, the rate of increase in deaths in recent weeks is not restricted to India and Figure 4
shows the top 50 countries. As always, this chart is beset with varying degrees of
undercounting.
While Figure 4 is a sobering reminder of international risk may I continue to draw attention
to countries in Africa and other parts of Asia which are also reporting too-good-to-be-true
trajectories. Pakistan and Bangladesh are particularly low.
Recent experience in Chile with a large surge in deaths should also serve as a warning
against undue reliance on high vaccination rates.19
Figure 4: Change in reported COVID-19 deaths per 1,000 deaths (before COVID) up to 14th
May 2021.
27
Jump in last 7 days
Reported COVID-19 deaths per 1,000 deaths
25 Jump in last 14 days
23
21
19
17
before COVID
15
13
11
9
7
5
3
1
Honduras
Costa Rica
Brazil
Ecuador
Turkey
Bolivia
Romania
France
Colombia
Chile
Oman
Montenegro
Georgia
Guam
Iran
Hungary
Greece
Suriname
Croatia
Poland
Jordan
Kuwait
Slovakia
Maldives
Liechtenstein
India
Guyana
Italy
Bulgaria
Ukraine
Guatemala
Peru
Qatar
Tunisia
Nepal
Seychelles
Trinidad and Tobago
Lebanon
Palestine
Curacao
Czechia
Paraguay
Uruguay
Cabo Verde
Aruba
Armenia
Mongolia
Bahrain
Argentina
North Macedonia
Bosnia and Herzegovina
19
Why is Chile experiencing a COVID wave when it's vaccinating at such a high rate? – HotAir
6SPECIAL “Open Access” COMMENTARY Spring 2021
The Indian variant is rapidly spreading in parts of the UK.20 In my opinion, this is not a good
time to abandon all aspects of social distancing or face masks in crowded locations.
The next pandemic?
The reader may be unaware that Respiratory Syncytial Virus (RSV) causes just as many
deaths as influenza, and in some years more. Like influenza, RSV has two predominant
strains and multiple genetic variants. A current infection with influenza protects against RSV
infection. 21 In some circumstances influenza vaccination could therefore act to increase
RSV infection. RSV is a potential candidate for a rogue mutation. A prior infection with
rhinovirus appears to offer protection against influenza A.22 Likewise COVID-19 appears to
have suppressed influenza activity, perhaps partly by protective measures, but also due to
interspecies competition. This then places pressure on influenza to mutate to compete. Add
in outbreaks of the new type or kind of disease, which seems to work by immune
manipulation, and you get a complex web of interactions which could fuel future
pandemics.
Suggested reading
The full series of articles on COVID-19 deaths can be found at
http://www.hcaf.biz/2020/Covid_Excess_Deaths.pdf, these can also be found via Research
Gate. Research on outbreaks of a new type or kind of disease can be found at
http://www.hcaf.biz/2010/Publications_Full.pdf
20
How concerned should we be about the Indian variant? | Daily Mail Online
21
Competition between RSV and influenza: Limits of modelling inference from surveillance data - ScienceDirect
22
Interference between rhinovirus and influenza A virus: a clinical data analysis and experimental infection
study - The Lancet Microbe
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