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Friday, October 23, 2020

Explained Ideas: Why India’s Covid mortality data must be read with caution

The emphasis should be a lot more on data disaggregated by geographies and vulnerabilities, looking beyond broad-brush summary aggregates.

By: Explained Desk | New Delhi | Updated: October 8, 2020 10:23:59 am
Questions have been raised about the accuracy of Covid-19 mortality data. The WHO had defined what counts as a Covid-19 death. At a testing facility in the national capital. Express Photo by Praveen Khanna

While the overall number of Covid-19 patients in India is rising — it is currently the third highest in the world after the US and Brazil — it has been argued that mortality rate (1.55 per cent) is among the lowest in the world. However, Rajib Dasgupta (‘Global pandemic, local response’) warns against any complacency. He cites the medical journal, The Lancet, which recently cautioned India about “the dangers of false optimism”.

Dasgupta, chairperson at the Centre of Social Medicine & Community Health, JNU, lists the possible reasons for Asian countries experiencing lower Covid-19 mortality as compared to countries in Europe.

He writes, “The initial high mortality in Spain and France has been attributed to several reasons: More than 75 per cent of the deaths were among those aged more than 75 years and living in care homes; high prevalence of comorbidities, obesity and smoking among those infected; disproportionate number of health care providers infected early on (15 per cent of total cases) rendering the health services weak; and, shortage of diagnostic tests and personal protective equipment.”

He recalls three leading factors that are reported to strongly influence the risk of dying from Covid‐19: “Male sex, advanced age (more than 60 years), and the presence of comorbidities such as diabetes, hypertension, chronic respiratory diseases, cancer and cardiovascular disorders. The Indian age distribution is skewed in favour of the young, and contributes to the overall lower mortality.”

Questions have been raised about the accuracy of Covid-19 mortality data. The WHO had defined what counts as a Covid-19 death.

“A death due to Covid-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness, in a probable or confirmed Covid-19 case, unless there is a clear alternative cause of death that cannot be related to Covid disease (e.g. trauma). A death due to Covid-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions that are suspected of triggering a severe course of Covid-19”.

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Dasgupta points out that many states have set up expert committees to verify Covid-19 deaths and official mortality figures are released after vetting by the experts.

Dasgupta calls attention to a research paper by National Bureau of Economic Research that used “age-specific COVID-19 mortality rates from 17 comparison countries, coupled with India’s distribution of cases (mirroring the age composition), to ‘predict’ what India’s CFR would be with those age-specific rates”.

He writes: “In most cases, the predictions are lower than India’s actual performance, leading them to suggest that India’s CFR is, if anything, too high rather than too low and caution against misplaced complacence. The critical point being that an overwhelming concern with the overall CFR focuses on crude aggregates (and not age specific rates) and may cloud the fact that the news may not be as comfortable it appears to be.”

Dasgupta argues that “the emphasis should be a lot more on data disaggregated by geographies and vulnerabilities, looking beyond broad-brush summary aggregates.” This is necessary for planning localised responses.

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