As virus cases rise, so do questions on toll
NEW DELHI » When Narayan Mitra died July 16, a day after being admitted to a hospital for fever and breathing difficulties, his name never appeared on any of the official lists put out daily of those killed by the coronavirus.
Test results later revealed that Mitra indeed had been infected with COVID- 19, as had his son, Abhijit, and four other family members in Silchar, in northeastern Assam state, on India’s border with Bangladesh.
But Narayan Mitra still isn’t counted as a coronavirus victim. The virus was deemed an “incidental” factor, and a panel of doctors decided his death was the result of a previously diagnosed neurological disorder that causes muscle weakness.
“He died because of the virus, and there is no point lying about it,” Abhijit Mitra said of the finding, which came despite national guidelines that ask states to not attribute deaths to underlying conditions in cases where COVID- 19 has been confirmed by tests.
Such exclusions could explain why India, which has recorded more than 5.1 million infections — second only to the United States — has a death toll of about 83,000 in a country of 1.3 billion people.
India’s Health Ministry has cited this as evidence of its success in fighting the pandemic and a basis for relaxing restrictions and reopening the economy after Prime Minister Narendra Modi ordered a
strict lockdown of the entire population earlier this year.
But experts say the numbers are misleading and that India is not counting many deaths.
“We are undercounting deaths by an unknown factor,” said Dr. T. Jacob John, a retired virologist.
The Health Ministry has bristled at past allegations of an undercount in fatalities, but it refused to comment this week on whether states were reporting all suspected and confirmed virus deaths.
Determining exact numbers during the pandemic is difficult: Countries count cases and deaths differently, and testing for the virus is uneven, making direct comparisons misleading.
In India, recording mortality data was poor even before the pandemic struck. Of the 10 million estimated deaths each year, fewer than a quarter are fully documented, and only one- fifth of these are medically certified, according to national figures.
Most Indians die at home, not in a hospital, and doctors usually aren’t present to record the cause of death. This is more prevalent in rural areas, where the virus is now spreading.
Dr. Prabhat Jha, an epidemiologist at the University of Toronto who has studied deaths in India, said countries should err on the side of overestimating deaths if they want to make progress in fighting the virus.
“It is better to have no estimate than an underestimate,” Jha said.
The Health Ministry guidelines echo this concern, asking states to record all suspected virus deaths, including “presumptive deaths” — those who likely died of COVID19 but weren’t tested for it.
But those guidelines are advisory, and many states don’t comply.
In Mahrashtra, India’s worst affected state, with more than 1 million cases, suspected deaths aren’t recorded in the tally, said Dr. Archana Patil, the state’s health director.
Other states, such as Assam, have created panels of doctors who differentiate between “real virus deaths” and those from underlying illnesses.
In some cities such as New Delhi or Mumbai, these panels occasionally have added missed deaths to the tally.
But Dr. Anup Kumar Barman, who heads the panel in Assam, said Assam state was following the federal guidelines and was citing the virus only in those deaths resulting from respiratory failure, pneumonia or blood clots, Barman added.
Assam has recorded more than 147,000 infections but fewer than 500 deaths as of Wednesday.
In West Bengal, a similar panel was shelved in May and the state said it subsequently would follow federal guidelines.
Of the 105 deaths of those testing positive for COVID- 19 in April, the panel found found that 72, or nearly 70%, weren’t caused by the virus.
P. V. Ramesh, who until July 8 headed COVID- 19 management for Andhra Pradesh state in southern India, said coronavirus deaths “at home, in transit or while arriving at hospitals don’t get counted.”
The government’s emphasis on the low death toll despite the rising number of reported infections has resulted in people thinking the virus wasn’t necessarily fatal, leading to a “false sense of protection,” said Dr. Anant Bhan, who researches public health and ethics in the city of Bhopal. That has led to people letting their guard down by not taking precautions such as wearing masks or maintaining social distance, Bhan said.
Workers at crematoriums, meanwhile, have reported an increase in receiving bodies — whether from the virus or not.
At a crematorium in Lucknow, the capital of India’s most populous state, Uttar Pradesh, worker Bhupesh Soni said 30 people were being cremated every day, compared with five or six before the pandemic.
A cremation normally takes about 45 minutes, but Soni said there have been days when he has worked for more than 20 hours.
“It is an endless flow of bodies,” he said.