Covid-19: What you need to know today

The Union government, and the governments of many states (Uttar Pradesh is a case in point, but the list includes even progressive states such as Tamil Nadu) have been accused of turning a blind eye to (in the case of the former) or actively orchestrating (in the case of the latter) the under-reporting of deaths from the coronavirus disease (Covid-19). How do you under-report deaths from Covid-19? Technically, this is possible in two ways, one generic and the other, specific.

One, every year, in India, a certain number of deaths do go unreported. The dead are buried or cremated locally and informally (which means a graveyard or cemetery is rarely their final resting place) and the families do not bother to register the deaths, because there is nothing to be gained by doing so. In fact, applying for and receiving a death certificate may actually involve costs. Conversations I have had with government officials, volunteers at NGOS, and statisticians all converge on the point that these numbers have been coming down over the years. Over the past seven years, especially, India’s efficiency of welfare-delivery has greatly improved, with at least some of this welfare being in the form of a cash transfer into an Aadhaar-enabled bank account. In such cases, should the next of kin want to claim the balance lying in these after the account-holder’s death, they need a death certificate. It’s a simple cost-benefit equation.

Two, in the current scenario, where states want to showcase their effective handling of Covid-19, it’s easy to misreport a cause of death. For instance, some of the same government officials and volunteers at NGOS tell me that, anecdotally, they are seeing a spike in deaths from diseases such as typhoid in some of India’s most backward states. HT’S own reportage shows that in many rural areas, testing is inadequate, and when someone dies, local health officials can pretty much decide how they died.

Few states follow Indian Council of Medical Research guidelines on testing the dead for Covid-19. And even when those who test positive for Covid-19, and are hospitalised for the illness pass on, death audit committees — most states have one — often ascribe Covid-19 deaths to co-morbidities.

Apart from the sheer dishonesty involved, such under-reporting affects our understanding of the pandemic itself, and its current and future trajectory in the country. I also believe lying about this disrespects the dead more than publishing photographs of funeral pyres or hundreds of shallow graves on river-beds. For reasons that have to do with morality, good governance, and science, both the federal government and the states need to address this issue (this is definitely more worthy of their attention and time than an editorial in The Lancet or the nomenclature of a variant of the virus).

I’d like to suggest that the office of the Registrar General and Census Commissioner work with the states (which, in turn, will have to work with municipalities and corporations) on compiling a 12-year database of deaths. The long period average, between 2010 and 2019, by district and cause, can be the base. The deviation from these in 2020, irrespective of the mentioned cause of death, represent the excess deaths on account of Covid-19. And it is important to start updating this year’s deaths in the database too. Only this will provide a true picture of the pandemic’s cost, in terms of human lives, in India. And only this will provide an accurate epidemiological perspective of the pandemic’s run through the country — and help prepare for the third wave.

Few states follow Indian Council of Medical Research guidelines on testing the dead for Covid19. And even when those who test positive for Covid-19, and are hospitalised for the illness pass on, death audit committees — most states have one — often ascribe Covid-19 deaths to comorbidities.

In the current scenario, where states want to showcase their effective handling of Covid-19, it’s easy to misreport a cause of death. HT’S own reportage shows that in many rural areas, testing is inadequate, and when someone dies, local health officials can pretty much decide how they died.