Karuna John and Deborah Grey | SabrangIndia

Are India’s official Covid-19 mortality numbers grossly under-reported?

Tue, 03 Aug 2021 05:37:41 +0000

It was only the RJD MP Manoj Jha, who took Parliament by storm when he stood up in the Rajya Sabha on July 20 to remember those who succumbed to Covid-19 that the government seems to have forgotten.

His speech that went viral was in fact an apology, that he reiterated his recent Indian Express column saying, “It is the responsibility of the House to apologise to all those whose bodies were floating in the Ganga. Never in Parliament’s history, between two sessions, we have had to read obituaries of 50 people” adding “This pain is personal, I don’t want to talk about numbers. My number, your number. Look for numbers in your grief.”

However, it is these very numbers that are at the cause of these problems. The Covid-19 reportage, via the official websites, pages and social media handles of the Ministry of Health and Family Welfare (MoHFW), have been challenged by various studies as being grossly under-reported. The most glaring discrepancies have been highlighted by various studies with regard to the total number of deaths that have been reported during Covid-19 peaks in the country, including those who died due to the shortage of ventilators and Oxygen supply in hospitals, and the unavailability of oxygen cylinders for individuals who were critically ill.

However, according to the government, which has issued denials on the Press Information Bureau (PIB) website, headlining them as “Myth Vs. Facts” India follows ICMR guidelines which in turn “are based on WHO recommended ICD-10 codes for correct recording of all Covid-19 deaths”. The MoHFW states that “Civil Registration System (CRS) ensures institutionalised registration of births and deaths in the country” and as that has been in force “for decades in India, missing out on Covid-19 deaths unlikely”.

This was the government’s stand on July 27 in which it completely denied “media reports, based on a yet-to be peer-reviewed study which was uploaded on MedRxiv recently, alleging that at least 2.7 to 3.3 million Covid-19 deaths happened during the two waves of Covid-19 in India, quoting three different databases ‘pointing towards at least 27% excess mortality over a year.’” This alluded to the report authored by Abhishek Anand, Justin Sandefur and Arvind Subramanian, who had reiterated in their IE column that “confronting the scale of the tragedy will help India draw lessons and etch them deep into the nation’s collective consciousness to foster a ‘never again’ resolve.”

The data analysis report by Arvind Subramanian from the Center for Global Development and Brown University, Justin Sandefur from Center for Global Development and Abhishek Anand from Harvard University, concluded that India under-counted deaths. It stated that the actual deaths during the Covid pandemic are likely to “be in the several millions not hundreds of thousands”. This made this “arguably India’s worst human tragedy since partition and independence.”

What does the independent study say?

The study by Subramanian, Sandefur and Anand excess mortality estimates from three different data sources from the pandemic’s start through June 2021. As per the report published on the Center for Global Development website, “First, extrapolation of state-level civil registration from seven states suggests 3.4 million excess deaths. Second, applying international estimates of age-specific infection fatality rates (IFR) to Indian seroprevalence data implies a higher toll of around 4 million.” Finally, the “analysis of the Consumer Pyramid Household Survey, a longitudinal panel of over 8,00,000 individuals across all states, yields an estimate of 4.9 million excess deaths.”

Thus, the government’s official figure of around 4,00,000 deaths is way under, not one, but three figures arrived at by examining three different sources of data.

Here’s a comparative table comparing alternative estimates of All-Cause Excess Mortality (in millions)

Source: Report by Arvind Subramanian, Justin Sandefur and Abhishek Anand

Inherent flaws in each model

The study acknowledges that “uncertainty afflicts all estimates,” and that “the three estimates are quite divergent in their assessment of the timing of Covid-related mortality (keeping in mind that the duration of the two waves is very different, 11 and 3 and a half months, respectively).” It also acknowledges that all three “point to significantly greater deaths than the official estimates.” The authors also conclude, “Relatedly, it seems that the first wave was also more lethal than is widely believed.”

State-wise figures

The authors found data collection challenging because, “Official data on mortality are not collected and reported in a timely manner that would allow excess mortality to be estimated. India’s Sample Registration System (SRS), managed by the central government, conducts annual mortality surveys but has only published numbers through 2019.”

It adds, “In the second wave, as the death toll rose, investigators forced state governments to release data on civil registration of deaths (CRS). As of June 29, 2021, excess deaths in 2020 and 2021 based on death registrations.” The study finds that the disaggregated data for the seven states (Andhra Pradesh, Bihar, Chhattisgar, Karnataka, Kerala, Madhya Pradesh, Tamil Nadu and Uttar Pradesh) accounts for about half of India’s total population.

Here’s a table with data for the seven states:

Source: Report by Arvind Subramanian, Justin Sandefur and Abhishek Anand

Now, even when it comes to this data the authors are cautious because, “First, even for these seven states excess mortality may be mismeasured because CRS typically under-counts final estimated deaths in the SRS. Based on 2019 data, under-counting relative to SRS varies from zero for the Southern states to 37 percent for Uttar Pradesh and 48 percent for Bihar. NFHS-5 data for 2019-20 (but available for only 4 of the seven states) suggests that even the CRS is under-stating the magnitude of the problem: for example, NFHS indicates that the under-counting of deaths in Bihar is 67 not 48 percent and for Andhra Pradesh is 20 percent not zero.”

The authors also find, “Second, in terms of Covid mortality, it is possible that the rest of India is different from the seven states. Sero-prevalence could be different between more rural Bihar and dense, urban Maharashtra. Fatality rates could similarly be different between Kerala’s well-run health system and Rajasthan’s which is more challenged.”

The authors are also wary about UP’s statistics. They say that “the number for Uttar Pradesh in the second wave does not appear to pass the smell test.” Finally given how “CRS data for most states stops in May, so that they almost certainly fail to capture all of the second wave.”

With all these riders, the authors arrive at the following figures:

Source: Report by Arvind Subramanian, Justin Sandefur and Abhishek Anand

When it comes to Infection Fatality Rates (IFR), the study acknowledges that many states had conducted seroprevalence studies. It specifically points out “the third sero-survey done in December 2020- January 2021 and a recent WHO-AIIMS survey covering the period mid-March to early June. The former placed India’s infection rate at about 22 percent. The latter placed India’s infection rate at 57.7 percent, and 63.5 percent in the age group below 18 and above respectively.” But concludes that in the absence of reliable mortality data, they authors were compelled to rely on international estimates of IFRs.

They used the United States’ Center for Disease Control (CDC)’s best estimates of age-specific IFRs which were based on the meta-analyses of Levin et. al. (2021), and combined them with Indian demographic characteristics and the age-pattern of Indian infection rates to derive a plausible measure of IFR for India. The results are tabulated below:

Source: Report by Arvind Subramanian, Justin Sandefur and Abhishek Anand

The authors conclude, “Combining the Indian sero-prevalence data and applying the best estimate of international age-specific IFRs to Indian demography and sero-prevalence patterns, yields excess deaths of 1.5 million and 2.4 million in the two waves, respectively. Together, the toll of Covid until June 2021 is estimated at 4 million. Even though the second wave encompasses three months compared to eleven months for the first, the estimated death toll is significantly greater.”

Government dismisses findings

The MoHFW said that this “mis-informed reports are totally fallacious” to state that India’s Covid death rate may be about 7-8 times higher than the officially reported toll. The ministry stated that the Government “has been transparent in its approach to Covid data management and a robust system of recording all Covid-19 related deaths already exists.” The Centre also put the onus on states and Union Territories who it said had “been entrusted with the responsibility to update the data on a continuous basis.” It stated that the states were “advised to conduct thorough audits in their hospitals and report any cases or deaths that could have been missed with a district and date-wise details so as to guide a data-driven decision making.” Adding that “in addition to this reporting by States/UTs, the robustness of statute based Civil Registration System (CRS) ensures all the births and deaths in the country get registered. The CRS follows a process of data collection, cleaning, collating and publishing the numbers, which although is a long-drawn process, but ensures no deaths are missed out. Because of the expanse and the amplitude of the activity, the numbers are usually published the next year.”

On the delays being alleged in recording the deaths in the devastating second wave of Covid-19, the government stated that “the health system across the country was focused on effective clinical management of cases requiring medical help due to which correct reporting and recording of Covid deaths could have been delayed but later was reconciled by the States/UTs.” It maintains that while some cases could go undetected as per the principles of Infectious Disease and its management, missing out on the deaths is unlikely” and said this was expected as “there shall always be some differences in mortality recorded during a profound and prolonged public health crisis such as COVID pandemic.”

The complete statement may be read here: https://pib.gov.in/PressReleasePage.aspx?PRID=1739439

The Union Health and Family Welfare Minister, Mansukh Mandaviya had also informed the Rajya Sabha via a written answer that State Governments and Union Territories did not specifically report any deaths due to lack of oxygen and lack of hospital facilities during the second wave of the coronavirus pandemic. Health Minister Mansukh Mandaviya’s answer read:

“Detailed guidelines for reporting of deaths have been issued by the Union Health Ministry to all states/UTs. Accordingly, all states/UTs report cases and deaths to the Union Health Ministry on a regular basis. However, states have at times reported backlog deaths in case of late reporting from hospitals and districts but, no such reports of patients dying due to shortage of oxygen and lack of hospital facilities in the country have been received by the Ministry from any State/UT.”

This when in May 2021, social media was abuzz with SOS calls for oxygen, and alerts of shortages even from the biggest hospitals in the national capital. Deaths due to shortage were also recorded from Jaipur Golden Hospital in Delhi. Hospitals like Maharaja Agrasen, Batra, Max had moved the Delhi High Court citing lack of oxygen supply. Eight Covid patients including the gastroenterology department’s head died in Batra Hospital due to oxygen shortage just on May 1.

The entire report by Arvind Subramanian, Justin Sandefur and Abhishek Anand may be read here:

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Regime shamelessly rewards hate offenders and stooges promoting a divisive agenda

Sat, 10 Jul 2021 12:52:02 +0000

Image Courtesy:cnbctv18.com

If you thought the present ruling dispensation at the Centre couldn’t sink any lower after Sadhvi Pragya Thakur, who was allegedly involved in the Malegaon blast case, became a Member of Parliament, think again. In the recent Cabinet reshuffle, the regime has rewarded its loyal stooges, many of whom have a questionable track record when it comes to human rights, some are serial hate offenders.

The starkest example of how the regime has spat in the face of those who believe in harmony and secularism is the elevation of Anurag Thakur, who is best known for chanting, “Desh ke gaddaron ko, goli maaro s****n ko!” (Shoot the traitors!) It is noteworthy, that the Election Commission had also banned Thakur from campaigning in the run up to the Delhi elections. But the regime has rewarded him with two plum ministries: Information & Broadcasting (I&B) that he takes over from Prakash Javadekar and Sports that he takes over from Kiren Rijiju, who in turn takes over the Ministry of Law from Ravi Shankar Prasad.

Then there is Bhagwant Khuba who has been given two posts: Minister of State in the Ministry of New and Renewable Energy; and Minister of State in the Ministry of Chemicals and Fertilizers. In 2020, the MP from Bidar had reportedly asked the Karnataka Government to “blacklist” a school for staging a play against the Citizenship Amendment Act. The Shaheen School was charged for Sedition for portraying PM Modi in a poor light in relation to CAA and NRC. The school’s principal and staff were booked for “promoting enmity between different groups”.

Khuba backed the Sedition charges against the parents of students in the play and teachers of the school as well as the police interrogation of the minor students. However, The District Court of Bidar, Karnataka made a fundamental observation while granting anticipatory bail in the Sedition case. The court made a prima facie observation that ingredients of section 124A of Indian Penal Code (IPC) which deals with the offence of sedition, are not made out in this case. The court also observed that the drama has not caused any disharmony in the society.

Newly inducted Shobha Karandlaje too has such a chequered past, that one of the first things she did after taking charge, was delete her old controversial tweets. Though she had joined Twitter in 2010 and has over 2,82,700 followers, the only tweets visible on her handle are from July 7, 2021 onwards, all previous ones having been deleted. So why is Karandlaje controversial?

In 2017, Karnataka Police had filed a case against Shobha Karandlaje after she tweeted that “jihadis” were involved she said was attempted “rape and murder” of a 14-year-old girl in Uttara Kannada’s Honnavar town. The girl had later revealed that fearing a stalker, she had inflicted the wounds on herself to end her life. Karandlaje was reportedly booked under Section 153 (promoting enmity between groups) of the Indian Penal Code.

Moreover, in May 2021, according to a News18 report, Congress leader and former MLC Ivan D’Souza had filed a complaint against Udupi- Chikkamagaluru MP Shobha Karandlaje. It was alleged that she made a false statement that leaders of the Christian community are advising believers not to take the vaccine against Covid-19. Her reported statement was condemned by the Mangaluru diocese, Catholic Sabha Udupi and Malankara Orthodox church. According to the news report Karandlaje had reportedly said at a press conference at Chikkamagaluru that people were advised not to receive the Covid vaccines, by churches in the Malnad region.

Bhupendra Yadav has been appointed Minister of Environment, Forest and Climate Change; and Minister of Labour and Employment. In August 2020 he had launched serial hate offender Kapil Mishra’s book Delhi Riots 2020: The Untold Story. He had even tweeted in support of the book saying it exposed “jihad waged against the State by Urban Naxals.”

Delhi Riot 2020: The Untold Story dedicates a chapter to how there is jihad being waged against the State by urban Naxals. This is something we must not ignore.

— Bhupender Yadav (@byadavbjp) August 22, 2020

Loyalists rewarded, defectors from Opposition parties welcomed

The inclusion of former Assam Chief Minister Sarbananda Sonowal into the Cabinet was along expected lines. Sonowal had overseen the mammoth process of conducting the National Register of Citizens (NRC) process in Assam. He was also the main driver of two citizenship related litigations in the Supreme Court. After Himanta Biswa Sarma was made Chief Minister following the recently held state assembly elections, speculation was rife that his predecessor Sonowal would get a plum post in the Union Government. In the recent Cabinet reshuffle, Sonowal was named Minister of Ports, Shipping and Waterways; and Minister of AYUSH.

Another loyalist who had unwaveringly backed the government’s stand on citizenship, is G Kishan Reddy. He was previously MoS Home, but has now been rewarded with three Cabinet Ministerial berths: Minister of Culture; Minister of Tourism; and Minister of Development of North Eastern Region. In 2020, he had defended the anti-Muslim stand of the Citizenship Amendment Act (CAA) saying, “Half of Bangladesh will be empty if India offers citizenship to them. Half of Bangladeshis will come over to India if citizenship is promised,” adding, “The Government of India is ready to review the CAA if it has one word against anyone of the 130 crore citizens, but not for Pakistani or Bangladeshi Muslims.”

The retention of Sadhvi Niranjan Jyoti of “Ramzaade and H****zaade” fame is further proof that the regime tacitly supports those who spew hate. In 2014, the saffron-clad Sadhvi had at an election rally in Delhi’s Shyam Nagar reportedly said, “Aapko tay karna hai ki Dilli mein sarkar Ramzaadon ki banegi ya H****zaadon ki. Yeh aapka faisla hai.” (Translation: You have to decide whether Delhi will get a government of those born of Ram or bas***ds.) The backlash was so severe that the PM had to reportedly intervene and issued a diktat to the party leaders for not speaking out of turn. But now, it appears all that may have just been for the optics.

In 2015, she advised Hindu women against marrying outside the community and in 2016 she vociferously opposed reservations for Muslims. She was previously Minister of State (MoS) Food Processing. This time, she has been given charge as MoS in two Ministries: Ministry of Consumer Affairs, Food and Public Distribution; and the Ministry of Rural Development.

Army Gen (retd.) VK Singh takes over as MoS Road Transport and Highways from Mansukh Mandaviya who in turn takes over from Dr. Harshvardhan as Minister of Health and Family Welfare. Singh has also been made MoS in the Ministry of Civil Aviation. He is perhaps best known for coining the term ‘presstitute’, a pejorative used for journalists. He has used it repeatedly for different journalists and publications:

Friends what do you you expect from presstitutes. Last time Arnab thought there was ‘O’ in place of ‘E’ #TimesNowDisaster

— Vijay Kumar Singh (@Gen_VKSingh) April 7, 2015

Saw report by presstitutes of IE, hilarious front page justification of Coupta. Confirms who cooked up routine move to denigrate army.1/2

— Vijay Kumar Singh (@Gen_VKSingh) February 21, 2014

Singh had also drawn flak in October 2015 for allegedly comparing the death of two Dalit children in Uttar Pradesh to a dog being hit with a stone. The India Express quoted him as saying, “Kabhi sthaniya ghatnaon ka sarkar se talluk mat rakhiye.” (Translation: Don’t link every local mishap to the Central government) and “To har cheez par, ki wahan par pathar maar diya kutte ko to, sarkar jimmewaar hai. Aisa nahi hai.” (Translation: For everything, even if someone throws a stone at a dog, the government is not responsible.)

However, later Singh claimed that the analogy was unintentional and that his words were being taken out of context. He told News 18, “Some people have created a misnomer because of his imaginative linking. But if because of someone linking the two things together and insulted any sentiments, I apologise for that. I respect BabaSaheb (BR Ambedkar), I have followed his ideas and respect the constitution of India. There is no question of belittling anyone. This was two different conversations that were linked together. I am not like some other leaders who eat in five-star hotel and then go to a Dalit family.”

Jyotiraditya Scindia, scion of the erstwhile royal family of Gwalior, was perhaps the biggest gainer in the recent Cabinet reshuffle. Scindia takes over from Hardeep Singh Puri as Civil Aviation Minister. Another defector to be rewarded big is Narayan Rane who gets to be Minister of Micro, Small and Medium Enterprises (MSME).

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