195,000 official deaths and 17m cases: Is India under-reporting its Covid crisis as hospitals run out of oxygen?

Discrepancy observed between number of cremations and burials and official Covid-19 death toll

Official data on both the number of Covid-19 infections and deaths in India is probably significantly under-reported, a health expert says.

“This is because India’s testing capacity is overwhelmed and there are delays in test results, and not everyone who should ideally be getting tested is being tested,” Anant Bhan toldThe Independent. 

India is in the throes of a devastating second wave of the pandemic, reporting more than 300,000 cases for the fifth straight day on Monday.

Hospitals have reported shortages of beds and medical oxygen and officials have taken to social media to send out desperate pleas for help. The total number of cases has crossed 17 million.

The crisis has overwhelmed India’s healthcare system. Delays are being reported in RT-PCR testing and patients are being turned away from hospitals.

The under-reporting of the death toll came to light after data from crematoriums and burial grounds was widely reported.

India recorded 2,812 deaths in the 24 hours up to Monday morning, taking the death toll to 195,123, but medical experts warn these figures do not accurately show the scale of the tragedy and they could be five times as bad.

“It’s a complete massacre of data. From all the modelling we’ve done, we believe the true number of deaths is two to five times what is being reported,” Bhramar Mukherjee, an epidemiologist at the University of Michigan, told The New York Times.

The state of Gujarat reported 157 fatalities on Sunday and 152 deaths on Saturday. However, figures from hospitals in several districts paint a completely different picture.

The Hindu quoted a source saying 100-125 bodies alone are sent out daily from a civil hospital in Ahmedabad, Gujarat. In Gujarat’s city of Surat, 101 bodies were sent from two hospitals to crematoria by Sunday evening.

The Gujarat government has denied under-reporting allegations, saying every death is being investigated and recorded by the death audit committee.

Dr Bhan said a number of deaths which could be due to Covid-19 might not be getting catalogued and that is evident by the discrepancy between the data from mortuaries, crematoria and graveyards and the official data.

A discrepancy between the official tally and crematorium data has also been observed in the state of Madhya Pradesh. Data from three cremation or burial facilities in state capital of Bhopal showed that as many as 597 bodies were cremated and buried following Covid-19 protocols from 16 April to 20 April, according to The New Indian Express. The state government data said only 348 deaths were reported in the same period.

Even in Lucknow, the capital city of the state of Uttar Pradesh, the official number of Covid deaths between 11 April and 16 April was 145. Just two of the city’s main crematoria reported more than 430 cremations under the Covid-19 protocol in that period, Bloomberg reported.

Oommen John, a public health researcher, told The Independent that under normal circumstances, almost all deaths would be certified by a qualified medical professional who would attribute a cause of death.

He said: “In the current scenario, that is not feasible and alternate mechanisms would be in place. But they might not be in a position to correctly attribute the cause of death in the absence of a Covid report.”

He added that another reason is that even family members might hide the information that a person tested positive for Covid-19 or had symptoms suggestive of Covid because the protocol for getting a certificate for a Covid-related death is very complex.

Rajib Dasgupta, professor of community health at India’s Jawaharlal Nehru University, said deaths may indeed get under-reported in an epidemic of any disease in any country.

“Many times deaths may be attributed to co-morbidities and not to Covid-19 per se,” he said.