Fellow blog: counting COVID-19 deaths in India

In this blog, Dr. Jayanta Kumar Basu, Bloomberg Data for Health Fellow and UNICEF India CRVS Coordinator, reflects on the challenges of collecting accurate and comprehensive mortality data in the context of COVID-19.

India has been in lockdown since late March and has taken all possible measures to control the transmission of COVID-19, including social distancing, hand-washing and rapid testing. Despite these measures, India has recorded approximately  57 000 COVID-19 cases and 1900 deaths as of early May. The country’s health system is facing some significant challenges, including understanding the trajectory of the virus and determining the best allocation of health resources. 

These challenges are exacerbated by the limited data available. The Government of India’s Integrated Disease Surveillance Program (IDSP) has been collecting data on COVID-19 cases and deaths from designated government and private testing laboratories, and hospitals with testing facilities. While these efforts have been significant, the major limitation is that the government has no way of tracking deaths outside of these laboratories and hospitals. Dependence on data from government-recognised testing facilities alone on disease surveillance is inadequate, as only a limited proportion of India’s population has access to these facilities.

In India, approximately twenty percent of deaths are either not registered, or are registered without important information such as the age and sex of the deceased. Most deaths are not assigned a cause of death by trained medical professionals. In the case of COVID-19, preliminary analysis is focused on analysing the number of deaths from the disease, the number of confirmed cases, and the ratio of these two figures, known as the case fatality rate (CFR). However, due to incomplete death registration, the CFR estimate is unreliable. 

As a result of these limitations, the Government of India has inadequate information on a large section of the population, who are more likely to be below the poverty line, malnourished or otherwise vulnerable. This lack of information increases the likelihood that India’s COVID-19 response will fail to meet the needs of these populations. The COVID-19 response demonstrates the importance of accurate and complete CRVS data, which will support India’s health system to meet the needs of diverse populations and respond rapidly to health crises. 

Image of people being tested for COVID-19 in India

Image: Community COVID-19 screening in Burdwan Town, West Bengal. Photographer: Sanjoy Karmakar. Source: Shutterstock

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