As of the latest data, India has reported more than 35.22 million cases of SARS-CoV-2 infection, second only to the United States. However, India has long had a clear COVID-19 mortality "paradox", with the official figure for cumulative COVID-19 deaths now estimated at 480,000.
On January 6, local time, a research team from Canada, India and the United States published a paper online in the top academic journal Science, entitled "COVID mortality in India: National survey data and health facility deaths" (COVID mortality in India: National survey data and health facility deaths). Prabhat Jha, an epidemiologist at the University of Toronto's Centre for Global Health Studies, and others have pointed out through a new analysis that the number of COVID-19 deaths in India is much higher than the officially reported figure, and as of September 2021, the cumulative number of COVID-19 deaths in India is 6-7 times higher than the official report, with more than 3 million cases.
If this finding is correct, it will draw attention to other countries with unusually low mortality rates and push up the current total influenza epidemic worldwide, science magazine reported. The World Health Organization (WHO) estimates that the number of COVID-19 deaths worldwide is currently around 5.45 million.
In fact, an earlier Jha analysis supported the claim that COVID-19 mortality rates in India were unusually low, but this more in-depth study completely overturned the earlier analysis. Jha said his early underestimation was based on the first wave of infections in the fall of 2020, when the virus may not be as deadly as the Delta virus that led to a massive surge in infections in India in the spring of 2021. At the same time, he has focused on the big cities, where mortality rates may be lower than in rural areas. Even before the pandemic, death registration in the country was already uneven. But he said those factors couldn't be the whole thing, and "there must be other things we don't understand." ”
The research team also mentioned in the article that the total number of COVID-19 deaths reported in India is generally considered underreported because the certificate of COVID-19 deaths is incomplete and it is wrongly attributed to chronic diseases, and most deaths occur in rural areas and often lack access to medical care.
To fill gaps in the internationally-level data, the research team used data from an independent polling agency, along with two government sources, to requantify India's COVID-19 mortality rate. The independent poll data comes from a nationally representative telephone survey conducted by CVoter that reported mortality, the "COVID Tracker" survey, which covered 140,000 adults (including sub-studies of 57,000 people in 13,500 households who more accurately reported COVID-19 and non-COVID-19 deaths among immediate family members). In addition, they analyzed government reports from hospitals and similar institutions and looked at officially registered deaths.
The results of the latest analysis show that between June 2020 and July 2021, COVID-19 deaths accounted for 29% of deaths in India (95% CI 28%-31%), equivalent to 3.2 million (3.1 million to 3.4 million) deaths. Of these, 2.7 million (2.6 million to 2.9 million) died between April and July 2021. A sub-survey of 57,000 adults showed a similar increase in mortality as COVID-19 and non-COVID-19 deaths peaked.
Regarding the huge disparity in the number of deaths, Jha told Science that politics is one of the reasons, "the Indian government is largely trying to depress the number of COVID-19 deaths." Some, including him, have also accused the government of not publishing data from the so-called Sample Registration System (SRS), which regularly surveys 1 percent of India's population and tracks births and deaths.
Princeton University epidemiologist and economist Ramanan Laxminarayan was not surprised by the new study analysis. "My starting point is that unless you can tell me why India is different, I'm going to assume that India is the same as any other country." "I don't believe in any form of exceptionalism unless it has a good reason," he said. Laxminarayan also added that almost every country underestimates the COVID-19 mortality rate, "I think all governments want to downplay the extent of death." ”
On December 22, 2021, Laxminarayan et al. published a study in The Lancet, at the time mentioning that India has been severely affected by the COVID-19 pandemic, however, we still know little about india's COVID-19-related death burden due to deficiencies in disease surveillance and more. The team used all-cause mortality data from Chennai, the capital of Tamil Nadu, to assess changes in mortality in Chennai during the pandemic.
Laxminarayan et al. concluded at the time that the number of deaths reported in India was "a significant underestimation of pandemic-related mortality rates".
Shahid Jameel, a virologist at Ashoka University in India, said the Jha team's nationwide estimates were also "broadly consistent" with two other studies. "India has paid a heavy price for not having good real-time death data, especially during the first wave of the pandemic. This led to complacency and caused terrible casualties in the second wave of the outbreak. ”
It is worth noting that the Omicron strain is causing another surge in cases in India. According to New Delhi TV on January 3, 75% of patients infected with COVID-19 in major cities such as Mumbai, Delhi and Kolkata are infected with the Omiljung strain.
Regarding the current surge in Omiljung in India, Jha warned that India should not expect the strain to lead to milder diseases, as data from other countries show. "I'm very cautious about these assumptions because they're based on selected populations and you can't bring them from South Africa or the UK or Canada to India," he said. ”
Jha is wary of "wishful thinking", such as the idea that India's previous high infection rates and mass vaccinations will produce population-level immunity against variants that cause serious disease. "We just don't know enough about how these different variants behave in immune populations," he said. ”