May 6, 2021

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Because the case of the Indian coronavirus and the number of victims are probably underestimated

Because the case of the Indian coronavirus and the number of victims are probably underestimated

Even after more than a year of devastating coronavirus waves around the world, the intensity and scale of the current Indian crisis stands out, with patients desperate for oxygen supplies, requests for help from overwhelmed hospitals and images of bags to corpses and funeral pyres.

As the daily case count far exceeds what other countries have reported, experts warn that the official COVID-19 numbers of the world’s second most populous country are likely a huge underestimate.

But why is India’s data considered inaccurate? Is the data less accurate than reported by other countries? And what numbers give a good indication of the crisis?

The case count

India doesn’t count all coronavirus cases, but no nation can. Worldwide, official counts generally report only confirmed cases, not actual infections. Cases are lost because the tests are so random and because some people infected with the coronavirus experience mild or even no symptoms.

The more limited the test, the more cases are lost. The World Health Organization says countries should have 10 to 30 tests per confirmed case.

A relative of a patient who contracted the coronavirus rests on Monday at his bedside in the emergency room of a New Delhi hospital. India recorded more than 360,000 coronavirus cases in one day for the 12th consecutive day, but experts suspect the real number could be even higher. (Rebecca Conway / Getty Images)

India is running about five tests for each confirmed case, according to Our World in Data, an online research site. Canada and the United States are currently averaging between 15 and 20 tests per confirmed case, although both were much higher in the early moments of the pandemic. Finland is carrying out 57 tests per confirmed case.

“There are still a lot of people who don’t get tested,” said Dr Prabhat Jha of the University of Toronto. “Whole homes are infected. If one person gets tested in the home and reports that they are positive and everyone else in the home starts having symptoms, it’s obvious they have COVID, so why get tested?”

Jha estimates, based on a model of a previous increase in India, that real infection numbers could be 10 times higher than official reports.

Deaths in rural areas can be lost

Deaths are a better indicator of the shape of the pandemic curve, Jha said, but there are problems with the data here too.

“The biggest gap is what’s happening in rural India,” said Jha, who is director of the Center for Global Health Research at St. Michael’s Hospital in Toronto. In the countryside, people often die at home without medical attention, and these deaths are vastly underestimated. Families bury or cremate their loved ones without any official document. Seventy percent of the nation’s deaths from all causes occur in rural India in any given year.

The Sunday Magazine19:44COVID’s brutal toll on India and its impact on Canada’s Indian population

Piya Chattopadhyay talks to Dr Madhukar Pai, a Canadian research chair in epidemiology and global health at McGill University, about the brutal toll this pandemic is having on India and what it means for neighboring countries and the rest of the world. 19:44

Counting rural deaths can be done, as Jha’s work with the Million Death Study has shown. The pre-pandemic project used in-person surveys to count deaths in rural India, capturing details of symptoms and circumstances with the results of “verbal autopsies” examined and recorded by doctors.

Many low- and middle-income countries have similar death figures, Jha said, but India could do better.

“It’s a country that has a space program. Just counting the dead is a basic function,” he said. “India should do much, much better.”

Data can guide responses

Knowing the size and scope of the epidemic and how it is changing helps governments and health officials plan their responses.

Even with the known issues with the data, the trajectory of COVID-19 cases and deaths in India is an alarming reminder of how the virus can affect a largely unvaccinated population when precautions are lifted.

“What happens in India is important to the whole world,” said Dr. Amita Gupta, president of the Johns Hopkins India Institute in a conversation on Facebook Thursday. “We care from a humanitarian perspective, a public health perspective and a health security perspective.”

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