Was Covid’s true toll in India UNDERCOUNTED? India saw steep drop in deaths in 2022, but...

India saw 8.6 million deaths in 2022, marking a 15% drop from the previous year and making it the least deadly year of the Covid-19 pandemic. This sharp decline in deaths suggests a return to normal mortality levels as vaccines became more widespread and infections turned less severe.

According to new government data released on Thursday (June 05), this drop indicates the country may be moving past the worst of the pandemic. However, there are still signs of stress on the healthcare system, and some Covid-19 deaths may have gone uncounted.

Reports reveal possible underreporting by states

Two reports from the Office of the Registrar General of India (ORGI), under the home ministry, highlight the changes in death registrations and causes in 2022. These are the Vital Statistics of India Based on the Civil Registration System (CRS) and the Medical Certification of Cause of Death (MCCD) report.

While the CRS recorded 8.6 million deaths in 2022, this was down from 10.2 million in 2021, a year when the pandemic hit India hard. The rise from 7 million deaths in 2018 to 10.2 million in 2021 was largely linked to the Covid crisis.

Although deaths have reduced, the MCCD report shows that excess deaths in 2022 were still higher than the official Covid-19 death tally provided by states. This gap suggests that many Covid-related deaths might not have been fully counted.

At least 12 states and union territories appear to have undercounted deaths. These states reported 6,076 Covid-19 deaths, while the MCCD data attributed 12,818 deaths to the virus in those same areas.

Fewer deaths, but death rate data still awaited

The Sample Registration System (SRS), which calculates the crude death rate (CDR) per 1,000 people using surveys, is yet to release its 2022 report. Based on projections, the estimated CDR for 2022 is 6.3 – close to the levels seen in 2018 and 2019, when the rate was 6.2.

In 2021, the CDR rose sharply to 7.5, reflecting the deadly impact of the second wave of the pandemic. In 2020, however, the rate dropped to 6.0, likely due to a decrease in accidental deaths during lockdowns.

The gap between SRS and CRS estimates was around 0.5 to 1.0 per thousand population in earlier years, but this difference disappeared in 2020 and 2021.

Covid-19 deaths may be higher than official data shows

Nationally, 50,435 Covid-19 deaths were reported in official bulletins in 2022. However, based on the 2019 CDR, deaths should have totalled around 8.55 million – nearly 95,000 fewer than what was registered. This difference points to possible excess deaths that may be linked to Covid but not officially recorded as such.

Interestingly, while states reported fewer Covid-19 deaths, the MCCD reported 25,393 Covid-related deaths across India in 2022. This is less than the 50,435 reported by the states themselves. The MCCD only covers about 20% of registered deaths, with the extent of coverage differing from state to state.

In 2021, the MCCD recorded 413,580 Covid-19 deaths, compared to 332,510 reported by pandemic bulletins.

Half of all deaths in 2022 occurred without medical attention

The CRS data also shows another worrying trend. In 2022, over 50% of registered deaths happened without the deceased receiving any medical attention. This number stood at 50.7%, up from 47.3% in 2021 and 45% in 2020. In 2019, the figure was 34.5%.

This rise suggests the healthcare system, although recovering, will not returned to full strength by 2022.