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On May 7, as India launched military strikes in Pakistan, the government quietly released a tranche of data that to a great extent reveals the true cost of the Covid-19 pandemic.
India recorded at least 3.74 million excess deaths in 2020 and 2021 compared to two pre-Covid years, 2018 and 2019, according to the data on registered births and deaths released last week.
Excess deaths or mortality refers to the difference between the total number of deaths during a pandemic or any other natural disaster compared to the number of deaths that would have been expected under normal conditions. The difference is an indicator of the likely death toll, as it captures deaths that went unreported.
The total deaths in 2018 and 2019 was 14.5 million. But the number of deaths in the two pandemic years – 2020 and 2021 – was 18.3 million, shows data from the civil registration system, which is the official record of births and deaths registered with the local government bodies.
This indicates 3.74 million excess deaths. In contrast, India’s official Covid-19 toll till date is 5.33 lakh. The first death due to the virus was reported in March 2020.
That is to say, India possibly undercounted Covid-19 deaths by seven times. If the government releases civil registration data for 2022, the gap could be higher. The civil registration system records events such as births, deaths and still births.
“The latest report confirms what we already know. India had undercounted its deaths caused by Covid-19,” said public health expert Chandrakant Lahariya.
The excess mortality figures in India is closer to the World Health Organisation’s estimates of excess deaths during the Covid-19 pandemic in the country.
The mathematical model by the WHO had estimated 4.74 million excess deaths for India in the period between January 2020 to December 2021.
When the WHO had released its report on excess mortality in 2022, the Indian government had objected and questioned the “validity and robustness of the models” used by the international organisation.
Since many births and deaths go unregistered, especially in rural regions, the government also conducts a sample registration system survey to estimate deaths.
The civil registration system counted 3.7 million excess deaths in 2020 and 2021, compared to 2018 and 2019. However, according to the sample registration system, there are 1.9 million excess deaths in the same period – which is four times the official Covid-19 toll.
Scroll looked deeper into the state-wise CRS and SRS data to understand how Covid-19 mortality varied by state. Our analysis of the state-wise CRS and SRS data shows that Gujarat, Bihar, and Chhattisgarh were worst hit by the pandemic, even though their official tolls remained low.
What the latest government data shows
Across India, the total number of deaths recorded in 2021 was 10.2 million and the corresponding figure for 2020 was 8.1 million, CRS data shows.
The figure is a big jump from pre-Covid years.
In 2018, India registered deaths of 6.9 million people and in 2019, 7.6 million.
While the overall registered births between 2020 and 2021 decreased slightly by 0.1 %, deaths rose by a significant 25.9%.
Moreover, data from the SRS indicates that the Covid-19 pandemic affected rural areas more than urban centres. The death rate in rural areas stood at 7.9, while it was 6.6 in urban areas – a reflection of the difference in healthcare facilities in these regions.
States guilty of massive undercount
In some states, the estimate of excess deaths was higher than others.
In Bihar, there was a 65.9% jump in the total registered deaths in the first two years of Covid-19 pandemic compared to the two pre-Covid years of 2018 and 2019.
The state recorded 3.78 lakh excess deaths in the state in this period. Its official Covid-19 toll till date is 12,315 deaths – which means the state’s likely toll is 30 times the official figure.
The death rate – the number of deaths per 1,000 people – in the state also rose from 5.5 in 2019 to 6.6 in 2021, data from the SRS report shows.
Dr Shakeel from Jan Swasthya Abhiyaan in Bihar blamed the state’s poor health infrastructure for the devastating impact of the pandemic. “People had nowhere to go for treatment,” he told Scroll.
Another state which massively underreported its death toll was Gujarat.
The state has reported only 11,101 deaths due to Covid-19 from 2020 till 2025.
But if excess mortality of just 2020 and 2021 is considered, the Covid-19 toll stands at 3.53 lakh – that is to say, the state undercounted deaths by at least 31 times.
Moreover, compared to 2018 and 2019, Gujarat saw a 39.5% jump in registered deaths in the pandemic years.
The rise in Gujarat’s death rate has also been the sharpest compared to other states, from 5.6 in 2019 to 8.5 in 2021.
Similarly, Chhattisgarh’s death rate rose from 7.3 to 10.1, SRS data shows.
Uttar Pradesh, the most populous state, recorded 3.74 lakh excess deaths in 2020 and 2021 compared to 2018 and 2019. This is 15 times more than its official total Covid-19 toll of 23,743.
Madhya Pradesh’s Covid-19 toll, too, could be 28 times higher than it reported. The state recorded 3 lakh excess deaths, but has only 10,788 Covid-19 deaths in official records.
In the south, Telangana and Andhra Pradesh also underreported their Covid-19 deaths.
Andhra Pradesh recorded 2.33 lakh excess deaths, 15 times more than its official toll so far of 14,733. Telangana’s official Covid-19 toll is 4,111, about 17 times less than the excess deaths found in 2020 and 2021 – 72,730 more people died compared to 2018 and 2019.
Better performers
The gap between excess deaths and the Covid-19 toll is narrow in only a few states like Kerala, Delhi, Rajasthan, Maharashtra, and Karnataka. This means that these states made an effort to count and report Covid-19 deaths truthfully.
Shakeel blamed the lax Covid-19 fatality reporting on a poor system of classifying medical deaths in many states. “The cause of death certification is still not undertaken in many hospitals in Bihar,” Shakeel pointed. “If that was done, our official Covid toll would be much higher.”
Across India, only 23.4% of registered deaths are medically certified to list the cause of death.
This article first appeared on Scroll.in
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