India Coronavirus (Covid-19) Cases: More than 2,000 Coronavirus related deaths were reported on Tuesday, almost five times the number reported on the previous day, which itself was unusually high. Of course, all these deaths did not happen in the last two days. These numbers are actually a result of a massive data matching exercise which has revealed large numbers of deaths that have remained unreported so far.
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Nearly 1,000 of these previously unreported deaths have come from Mumbai alone. Maharashtra, which has recorded the maximum number of Coronavirus-related deaths in the country, reported more than 1,400 deaths on Tuesday, of which, it said, only 81 had happened on that day. The remaining were all unreported deaths from various parts of the state. Maharashtra now has a total of 5,537 deaths, of which Mumbai accounts for 3,167 while Thane has 641 and Pune 588.
Delhi reported 437 deaths on Tuesday, which took its toll to 1,837. Delhi said this figure included all the deaths that have till now been ascertained as Covid-related by the death audit committee.
The numbers have increased from Tamil Nadu as well. On Monday, the state reported 44 deaths, and followed it up with 49 on Tuesday. The state had earlier been reporting between 10 and 15 deaths every day.
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While the exercise of the last two days has removed some of the discrepancies in the death numbers that were becoming increasingly evident, there is still a lack of transparency in the way states have been reporting this data. States are reluctant to count all deaths of Coronavirus-positive patients, and have instead set up death audit committees to ascertain whether the deaths happened due to complications arising of the infection or was primarily a result of some pre-existing illnesses. There is a lag of several days, sometimes over a week, in reporting deaths. None of the states reveal how many cases have been referred to the death audit committee, and when. Ascertaining the real cause of the death is not a straightforward exercise, even for the experts on the death audit committee, and thus often their rulings are contested.
The revelations of the last two days has pushed up the death rate of COVID19 disease in India by more than half a percentage point, from about 2.8 per cent on Sunday to 3.4 per cent now. The death rate in India is still lower than many other countries, and also well below the global average of about 5.3 per cent.
But a group of researchers from Mumbai and Thiruvananthapuram has now argued that the commonly-used method for calculating the death rate was not truly representative of the actual situation, and that the real mortality due to COVID19 disease could be much higher.
The death rate, also referred to as case fatality ratio (CFR), is calculated by dividing the total number of deaths with the total number of infections, and expressed as a percentage. For example, India’s CFR on Monday, with 9990 deaths and 3.43 lakh cases, can be calculated to be 2.91 per cent.
But these researchers from International Institute of Population Sciences (IIPS) in Mumbai, a deemed university and autonomous organisation under the Ministry of Health and Family Welfare, and Thiruvananthapurm-based Centre for Development Studies (CDS), a research centre backed by Kerala government and Indian Council of Social Science Research, argue that this is erroneous.
In a study that is now available for review, the researchers point out that the deaths happening today are of people who got infected a few days earlier. Also, even if the infections suddenly stopped today, deaths would continue to happen for the next few days, of the people who are already infected or are in hospitals. Therefore, they argue, the denominator to be used in calculating the CFR should not be current caseload, but an earlier caseload. The researchers say that an internationally accepted time lag to be used for this purpose was 14 days.
Thus, the number of dead today needed to be measured against the caseload of 14 days earlier to arrive at a more accurate picture of the mortality, they say. If that yardstick is applied, the current CFR in India jumps to 5.03 per cent. For the study, data till May 14 had been used, and in that case the CFR jumped from 3.23 per cent to 8.01 per cent.
“The case fatality ratio is illusive in that the same with 14 days delay for India is at least two times higher,” Sanjay Mohanty, professor at the Department of Fertility Studies at IIPS Mumbai, said. He also pointed to a study in The Lancet journal which had used the same method in March to calculate the CFRs of different countries.
But the current CFR is considered to be erroneous for a completely different reason as well. Scientists and epidemiologists define CFR as the ratio of deaths to the total number of infections not just the infections that have been reported, after being detected through testing. Since a large number of infected people are believed to be asymptomatic, and not everyone is being tested, the actual number of infections is an elusive number, particularly when the disease is still spreading. After the epidemic is over, scientists have methods to reach a reliable estimate of the actual infections. In such a scenario, using only the detected positive cases to calculate the CFR can lead to a big over-estimate of mortality due to the disease. Scientists expect that the real CFR, once the epidemic is over, would be well below one per cent.
While far too many deaths were reported on Tuesday, the number of new positive cases showed a marked decline. On three previous days, more than 11,000 new cases were discovered across the country, but on Tuesday this number fell to about 10,600. Maharashtra, Tamil Nadu and Delhi, the three states with maximum caseloads, all reported relatively lesser numbers of new cases compared to what they have been doing in the last few days.
Ladakh, which has shown an unusual surge in the last few days, once again reported almost 100 new cases. The Himalayan region now has a total of 649 cases, 514 of which were discovered in the last five days.
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