The high death toll of the first two years of the Covid-19 pandemic is a profound tragedy and a massive societal failure at multiple levels, says the latest report by The Lancet medical journal’s Covid-19 Commission. Putting accountability on the World Health Organization (WHO), the Lancet Commission said the UN health body acted “too cautiously and too slowly on several important matters”.
The costly delay by the WHO to declare a “public health emergency of international concern” and to recognize the airborne transmission of SARS-CoV-2 escalated the situation to a bigger crisis, it said.
Talking about India, the Lancet commission report agrees with many other research findings that mortality from Covid-19 in India was vastly undercounted during the Delta (B.1.617.2) wave of April-June 2021.
The report says India was among the first countries to impose travel restrictions, suspend international flights, and impose a strict lockdown early in the pandemic. In March 2020, India had 654 cumulative confirmed cases of Covid-19, and the adopted restrictions aimed at preventing community transmission and give the health-care system time to ramp up. After the lockdown was relaxed in May, India saw a surge of cases during June and July.
Two key factors escalated the number of infections during March 2021. First, the highly infectious Delta variant emerged, and other variants of concern reached India from other countries. Second, several programs such as elections, public protests, and religious festivals brought large aggregations of people together without face masks.
Every level of government – central, state and local – was not prepared to check the speed and the scale of the Delta surge. Both public and private hospitals were overloaded and complete breakdowns in the medical-logistics supply chain added to the critical shortage of oxygen, hospital beds, and pharmaceuticals. In smaller towns and rural areas, large numbers of patients went untreated.
Damaging lockdown
A stringent lockdown helped to slow the spread of Covid-19 but brought severe economic and social hardships. Gross domestic product contracted by 24% for the second quarter of 2020 and 7.3% for the year 2020. An estimated 120 million jobs were lost for the duration of the lockdown, and millions of migrant workers returned to their homes, villages under severe distress, some trekking extremely long distances on foot, with little money, food or water.
With such an alarming situation, India, whose population is 1.38 billion, reported roughly 20 million Covid-19 infections and 250,000 deaths attributed to the disease between January 1 and June 30, 2021, but the actual numbers are estimated to be vastly higher. The seroprevalence of Covid-19 IgG antibodies in non-vaccinated individuals older than six years increased from 24% in December 2020 and January 2021 to 62% in June and July 2021, confirming that hundreds of millions of people were infected during the Delta wave.
The Institute for Health Metrics and Evaluation (IHME) estimates that there were around 417 million infections and 1.6 million deaths from Covid-19 in India between April 1 and July 1, 2021, compared with just 18 million reported cases and 252,997 reported deaths.
Instead of providing a convincing actual death number, Indian government was engaged in a war of words with global health bodies and countering everyone’s numbers.
After the Delta surge, cases decreased markedly and vaccination efforts speeded up; as a result, by September 1, 2022, more than 76% of the eligible population of India had been vaccinated with a single dose and more than 70% were fully vaccinated.
Heavy price
The under-reporting of deaths may help the political leadership to avoid public embarrassment in the short run, but such a manipulated approach will damage the public health system in the long run. India paid a heavy price for not having good real-time data on Covid deaths, especially during the first wave, as this situation led to complacency and a terrible toll in the second wave.
A robust estimation of excess deaths is always good to understand the pandemic’s effect. India should not have dismissed the actual death counts and instead undertaken its own estimation on excess deaths based on registration data in the Civil Registration System/ Sample Registration System.
Estimating mortality is pivotal to informing resource allocation and evaluating public health interventions. Information on death rates and other burdens also supports wider aims of societal governance and public accountability. Equally important is establishing robust safeguards to avoid distortion of official statistics for political motives.
This is why many will agree with the Lancet Commission bringing out the issue of excess Covid deaths in India, as this caution will help future improvements to system capacity and mitigate potential political influences on how reporting occurs, and what gets reported.