Members of the civil defense carry a bed in a makeshift room at a Covid-19 quarantine center in New Delhi.
Amit Shah, the man who leads India’s fight against Covid-19 and Prime Minister Narendra Modi’s senior lieutenant, is among government leaders touting the country’s low death rate as an achievement.
At the end of June, Mr Shah said India had seen far fewer deaths from the virus than the global average and other countries like the United States, Brazil and the United Kingdom showed that ” countries like India, even compared to developed countries, had fought this fight very well, ”he said in an interview with New Delhi-based Asian News International.
Officially, India’s death rate is nearly 20 times lower than that of the United States, even though it has the world‘s fastest growing epidemic and the third highest number of cases overall – now including Amit Shah, who confirmed on Sunday that he had been hospitalized with the virus. But independent experts warn India has failed to properly record deaths and say better data collection is needed if the country is to bring the outbreak under control.
“The problem is a mixture of bad data culture and a bloated and corrupt bureaucracy,” said Steve H. Hanke, professor of applied economics and founder and co-director of the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise at Johns Hopkins University in Baltimore, citing a report by the Carnegie Endowment for International Peace.
“Missing or poor quality data is always a major problem when trying to formulate public policy in health – or any other – he said.“ It is equivalent to pilot d ‘a plane flying blind. “
The country of 1.3 billion people has more than 1.8 million confirmed infections and nearly 40,000 deaths, according to the most recent data from Johns Hopkins University. Its mortality per 100,000 population is around 2.82 compared to 47.33 in the United States and 44.92 in Brazil, according to the data.
Unregistered deaths
Bloomberg reached out to officials in the capital New Delhi, the financial hub of Mumbai and the industrial hub of southern Chennai for data on the total number of deaths each month from March through July for 2019 and 2020. The Chennai figures have showed that the total number of deaths this year was higher than last year. year, with a peak in June, while Mumbai provided two different data sets that could not be compared. Numerous appeals to Delhi municipal corporation officials gave no data.
Death registration data in India was spotty even before the virus hit. The vast majority of deaths, especially in rural villages, take place at home and are usually not registered. For others, the cause of death is often trivial – old age or heart attack. Experts estimate that only 20-30% of all deaths in India are properly medically certified.
The pandemic has extended the country’s already dilapidated health infrastructure to the breaking point, highlighting any loopholes that already existed. Data collection is a prime example. Covid-19 data from the federal and state governments is either without a breakdown by sex and age – crucial when assessing the impact of the disease – or without comparison with deaths recorded during similar time periods in previous years.
So far, infections in India show no signs of peaking. Last week, the country added more than 50,000 infections almost every day, as cities and states that appeared to be in control of the epidemic reported grim stories of overwhelmed hospitals. With India’s testing rate one of the lowest in the world among hard-hit countries, experts say the true extent of its outbreak is likely much higher than official data indicates. .
The Department of Health and Family Welfare did not respond to requests for comment.
Review the data
At least three major cities – New Delhi, Mumbai and Chennai – revised their data on Covid-19 deaths significantly upward in June. The reasons for the revisions varied. In New Delhi, local city officials said data on hospital deaths did not match reports of virus-related burials and cremations. In Chennai, the capital of Tamil Nadu, and in Mumbai, delays or bureaucratic gaps in collecting data from multiple sources were cited.
Last week, Tamil Nadu again revised death data – this time statewide – adding more than 400 deaths from March to June. There have been a slew of reports from other cities ignoring the death reporting guidelines of the leading medical research organization, the Indian Council for Medical Research, which states that all ‘suspected’ deaths from Covid -19 should be included in the death tally.
“Mortality data is essential because it provides unbiased estimates of trends in Covid deaths,” said Prabhat Jha, professor of global health and epidemiology at the Dalla Lana School of Public Health at the University of Toronto . Jha is one of the leading mortality data experts in India and the lead investigator of the Million Death Study in India. “Data is the best way out of the epidemic,” he said, urging governments “to quickly release much more data on cases, deaths and hospitalizations”.
The missing data on deaths will worsen as the virus sweeps across Indian villages, said T. Sundararaman, New Delhi-based global coordinator of the People’s Health Movement, an organization that brings together local activists, academics and groups. civil society working on public health. The problem of underreporting of virus deaths is compounded by all the delays in the way data is collected and passed through Indian bureaucracy, he said, as well as the time between infection and dead.
“The mortality data released today is for cases of infections reported 15 days ago – in those 15 days we added 500,000 new cases,” Sundararaman said in a telephone interview. “We are looking at the current number of deaths by the current number of cases” instead of dividing by the cases from two weeks ago. “In that case, our death rate will actually be 6%, which I think is what it should be – around 4% to 6%.”
“All of these missed deaths, all of these missed cases are clusters in the making,” he said. “The real problem is that you are failing to follow a properly data-driven public health policy.”
Beds vs Doctors
The poor quality of India’s health data is a symptom of its overburdened public health system.
As the disease progressed, each city or state affected by the infection began to announce additional hospital beds for patients with Covid-19. Tens of thousands of beds were added – but there was no explanation as to how these beds were staffed.
Setting up beds is easy, but there’s no point unless you have the extra staff to care for patients in those beds, said the general manager of a leading private hospital in northern India, asking not to be identified on the grounds of confidentiality concerns. Ultimately, India’s death rates will be among the highest in the world, the director said, offering a lesson on how not to handle a pandemic.
This is a flaw that Sundararaman also notes. “We have increased the number of beds, but recruitment is not keeping pace. Nurses, paramedics, lab technicians – we need to create jobs now.
