Figures corroborate Telangana High Court’s concerns with drastic undercounting of COVID deaths.
The number of “excess deaths” registered in the Greater Hyderabad Municipal Corporation (GMHC) ever since COVID-19 hit (from April 2020 to May 2021), is over 10 times the officially recorded figure of 3,275 deaths for the corresponding period in the entire State of Telangana. There were an estimated 32,752 “excess deaths” — 18,420 between April and December 2020 and 14,332 between January and May 2021.
Excess deaths in the GHMC were calculated based on the number of death certificates issued. The month-wise number for the last two years was accessed by The Hindu and compared with data for 2016 to 2019 that were obtained via an RTI. The 2021 figures were analysed till May 31.
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For the first five months of 2021, the 14,332 excess deaths in the city corporation limits were 8.2 times more than the official COVID19 death toll of 1,740 for the entire State. These “excess deaths” were calculated as the difference between the 36,041 certified deaths in 2021 and the average number of certified deaths in the same period in the pre-pandemic years between 2016 and 2019 (21,709).
The excess deaths in the corporation could not be compared to the GHMC’s official COVID-19 death toll as the State does not publish the district-wise pandemic fatalities, unlike many other States in the country. In fact, on two instances, the Telangana High Court had pulled up the State government for not furnishing the proper tally of COVID-19 deaths.
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On September 4, 2020, the High Court observed that the low daily tally of deaths published by the government was “unbelievable”. Recently on April 27, 2021 the High Court wondered if the State government was resorting to “window dressing” over the number of deaths.
“If the State furnished fudged figures of deaths due to coronavirus, then people would not fear deaths due to the virus. It will be more damaging and [would] harm [the] public,” Chief Justice Hima Kohli had observed then.
It is important to note that excess deaths could also include deaths due to other causes because of the inability or the lack of access to health services that were diverted to cater to the pandemic. However, most of these excess deaths in a pandemic peak should largely represent COVID-19 related deaths.
The number of actual deaths might be even higher than what the GHMC had registered. According to the latest National Family Health Survey (2019-20), only 74% of deaths were registered with the civil authorities in Telangana. In urban areas, like GHMC, the number rose to 79%.
“The caseload and the number of deaths did not match in Telangana where all the deaths are not registered. We need to reconcile the numbers by identifying and verifying the deaths which is a post-facto exercise. But it is a politically-loaded decision,” says Dr. B.R. Shamanna, an epidemiologist with the University of Hyderabad.
Estimating Hyderabad’s death count
As the official death count for Hyderabad has not been made available, we did a comparison with other cities in south India to arrive at the estimated undercount. For instance, as of June 12, 27% of all deaths in Tamil Nadu occurred in the capital, Chennai, while 47% of all deaths in Karnataka occurred in Bengaluru city.
If the trends in Bengaluru held, the Hyderabad corporation would have recorded close to 820 deaths in 2021. The excess deaths in Hyderabad, 14,332 would be then 17.5 times more than the estimated reported deaths. Correspondingly if the trends in Chennai held, the undercount factor would be 30.5 times. If these trends are extrapolated to the entire State, the actual death toll could range from 57,000 to 1,00,000.
During first wave
In 2020, the total reported deaths due to COVID-19 (from April to December) in Telangana was 1,535. But there were 18,420 “excess” deaths in the Hyderabad corporation alone in 2020 — the difference between the certified deaths registered in the same months for 2020 and the average for the previous four years (2016-2019).
This suggests that COVID-19 deaths could have been undercounted by a factor of 12 for 2020, much higher than the undercount factor in the second wave. If official COVID-19 deaths in the corporation alone were considered, the undercount factor could have been double (24 times) in 2020.
Text messages and calls to the Telangana Director of Public Health for a reaction to these figures remained unanswered.
“We have to conduct a verbal autopsy to understand the cases and reasons so that we are accurate. Other epidemics like measles have been controlled due to such exercises. Only then we will get a good handle over the pandemic,” said Dr. Shamanna.
(With inputs from Serish Nanisetti; Rakesh Dubbudu, Sumant Sen and Jasmin Nihalani helped with data compilation)
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