Counting all those who died of Covid

Two diametrically opposing narratives have emerged around the answer to this question: On the one hand are the official data published by the government and on the other, the estimates published by every other source. The government has held firmly to its estimate that just over half a million people have died because of Covid — that is, people whose infection status was confirmed close to the time of their death. But, of course, many people who died during the pandemic never had a chance to get their Covid tests done or could have died for indirect reasons mentioned above, and this is true for all countries. This is why the “excess mortality” method has been accepted globally to get to the truth of the actual numbers who were struck down.

The search for this truth has involved many different actors and includes journalistic accounts of funeral pyres and bodies floating down rivers; civil society accounts of the numbers of dead bodies brought to crematoria and morgues; the government’s own data on the numbers of families claiming compensation for a Covid death; and a series of studies involving hundreds of scientists and institutions, and published in the world’s leading journals. All of these diverse sources tell a similar story.

The earliest of these studies were focused on specific locations, such as cities or states; these were the first to report far greater numbers of the dead than those recorded officially. These have now been supplemented by three large, scientifically peer-reviewed, estimates of the mortality at the national level, two of which are global studies. The first study was published in Science in January; it estimated that the true number of people who had died in India exceeded three million, a figure six to seven times higher than reported officially. The second study, published last week in the Lancet, reports that even this massive number was an under-estimate: The total number of excess deaths was four million. India alone accounted for nearly a quarter of the global excess mortality, with more deaths than the next four countries (US, Russia, Mexico, Brazil) combined. Assuming that most of these excess deaths are due to Covid, India’s under-counting of Covid is of the order of eight-fold, in comparison to the global average of about three-fold. There is, unsurprisingly, a huge variation between states, with a handful (Bihar, Assam, UP, MP) under-reporting deaths by as much as twenty-fold while Kerala under-reported just two-fold (the one outlier is my home state of Goa, estimated to have fewer Covid deaths than those reported by the government!). The third report, still to be made public, is the product of a year-long research by experts from around the world convened by the WHO. It also reports that excess mortality in India was about 4 million and that more than a third of the additional nine million deaths globally occurred in India.

It is hard to believe that all these studies, from different authors in India and abroad, using different estimation methods, all leading to similar results and, importantly, consistent with local studies using actual death registries, are incorrect or the result of a well-orchestrated global conspiracy against India. These data not only remind us of the terrible losses in these past two years but also dramatically upend the widely held belief that India was miraculously less affected by the pandemic or that, within the country, states with far weaker health systems did better than those with better health systems. The truth, it appears, was the opposite: The problem was that we were simply not counting the dead. Yet, the government’s position has been to reject all of this science, even refusing to approve the WHO’s report on excess mortality (apparently, ours is the only country to push-back the WHO estimates).

There is no shame in admitting that India was horribly hit by the pandemic. This was an extraordinary humanitarian crisis, the worst to befall the country since it was partitioned 75 years ago. But it seems that we are once again appearing to look the other way and move on, hoping that the sands of time will cover up our memories and that the deep wells of resilience our communities have built will help us heal. As a mental health professional, I don’t think this is likely to happen without the truth.

Trauma, especially of the kind we have experienced collectively, rarely vanishes on its own, and this is even less likely when there is a denial of the tragedy. The flourishing of hateful feelings on both sides of the border is a signal of how unresolved trauma poisons our society and haunts future generations. Long-term recovery will need resolution of the pent-up rage and grief through truth and reconciliation.

It is time for the government to release the data on total numbers of deaths due to any cause in the past two years to settle this matter. I suspect that the truth will lie somewhere between the official estimates and the scientific estimates, perhaps closer to the latter. And then, the government should commission a truly independent inquiry. This is not an exercise to allocate blame to any individual or political dispensation, for the tragedy spanned all sectors and states, and the devastating Delta wave was not predicted by most people (including many public health experts, such as this author); the need is for the truth to be acknowledged in the spirit of transparency, accountability and rebuilding trust between the state, scientific community and people.

It is in everyone’s interest to know the truth, not only to better prepare our country for future pandemic but also to heal our wounds from the past. Above all, we owe it to those who died to dignify their passing by, at the very least, counting them.

The writer is The Pershing Square Professor of Global Health at Harvard Medical School