The COVID-19 pandemic death toll in India: can we know better?

• Published in: BMJ global health 2023-08, Vol.8 (8), p.e012818
• Main Authors: Gupta, M, Rao, Chalapati, Yadav, Arun Kumar, Jat, Munita, Dhamija, Rajinder K, Saikia, Nandita
• Format: Article
• Language: English
• Subjects: COVID-19; Estimates; Households; Management information systems; Mathematical models; Mortality; Pandemics; Population; Registration; Surveillance; Voters
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-012818

Background Timely and accurate mortality statistics are essential for health policy, monitoring and evaluation of health programmes, and epidemiological research.1 The COVID-19 pandemic brought into sharp focus the critical need for reliable mortality data to monitor its impact across time, place and person. [...]the surveillance community turned its attention to evaluate pandemic impact through the assessment of ‘excess’ mortality, defined as the increase in observed deaths in a defined time period, as compared with mortality expectations based on prepandemic trends. [...]mathematical models were formed to derive both prepandemic mortality patterns as well as excess mortality attributable to the COVID-19 pandemic for such populations.3 The inherent limitation of these mathematical models are the assumptions on which calculations are based, as well as potential inaccuracies in primary data used as model inputs, which together create considerable uncertainty in estimated mortality patterns.4 In India too, the national government implemented mortality reporting according to the WHO pandemic surveillance guidelines, but these data were inadequate for the same reasons.5 In response to public interest in tracking the pandemic, various compilations of pandemic period mortality data were reported by independent investigators in national newspapers.6 This article evaluates the characteristics of pandemic period mortality data available from different sources for India, and potential biases in them that could impact accuracy of mortality models and excess mortality estimates. The most recent report is for 2020, released in June 2022.7 Although the CRS has evolved over the past five decades with significantly improved data completeness at national level, the system performance has remained patchy across the country.8Table 1 Input data sources and their characteristics which recorded deaths during COVID-19 pandemic in India Input data source Description Populations covered Data period Potential data biases Civil Registration System Data obtained from state CRS department websites/provided through public information requests Andhra Pradesh, Bihar, Gujarat Chhattisgarh, Haryana, Himachal Pradesh, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Rajasthan, Tamil Nadu, Uttar Pradesh, West Bengal Monthly data from January 2018 till May 2021 (except) Gujarat—March–May 2021 Website data lower than deaths published in annual CRS reports for 2018–2020 in all states For 2021, n