Even after more than a year of devastating outbreaks of COVID-19 worldwide, the intensity and scale of India’s current crisis stands out, with patients desperate for scarce oxygen supplies, requests for help from crowded hospitals and images of corpse bags and funeral pyre.
As the daily case count skyrockets far beyond what other countries have reported, experts warn that the official figures for COVID-19 for the second most populous country in the world are likely to be a massive under-count. But why are India’s data considered inaccurate? Is the data less accurate than reports from other nations? And which numbers give a good indication of the crisis?
Is India counting all the cases?
India is not counting all coronavirus cases, but no nation can. Worldwide, official records generally report only confirmed cases, not actual infections. Cases are lost because the test is very random and because some people infected with the coronavirus have mild symptoms or none at all.
The more limited the test, the more cases are being missed. The World Health Organization says that countries should do 10 to 30 tests per confirmed case.
India is running about five tests for each confirmed case, according to Our World in Data, an online research website. The USA is doing 17 tests for a confirmed case. Finland is doing 57 tests per confirmed case.
“There are still a lot of people who are not taking the test,” said Dr. Prabhat Jha, of the University of Toronto. “Entire houses are infected. If a person takes the test at home and reports that it is positive and everyone else in the household begins to have symptoms, it is obvious that they have COVID, so why take the test? “
Jha estimates, based on modeling a previous outbreak in India, that the actual number of infections could be 10 times higher than official reports.
What about deaths?
The deaths are a better indicator of the shape of the pandemic curve, Jha said, but there are also problems with the data here.
“The biggest gap is what is happening in rural India,” said Jha. In the countryside, people often die at home without medical care, and these deaths are largely underreported. Families bury or cremate their loved ones without any official record. Seventy percent of the country’s deaths from all causes occur in rural areas of India in any given year.
It is possible to count deaths in rural areas, as shown by Jha’s work with the Million Death Study. The pre-pandemic project used personal surveys to count deaths in rural India, capturing details of symptoms and circumstances with the results of “verbal autopsies” reviewed and recorded by doctors.
Many low- and middle-income countries have similar sub-counts of mortality data, Jha said, but India could do better.
“It is a country that has a space program. Just counting the dead is a basic function, ”he said. “India should be doing much, much better.”
Knowing the size and scope of the outbreak and how it is changing helps governments and health officials to plan their responses.
Despite the known problems with the data, the trajectory of COVID-19 cases and deaths in India is an alarming reminder of how the virus can spread to a largely unvaccinated population when precautions are taken.
“What happens in India is important for the whole world,” said Dr. Amita Gupta, president of the Johns Hopkins Institute in India, in a conversation on Facebook on Thursday. “We take care of a humanitarian perspective, a public health perspective and a health security perspective.”