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. 2022 Feb 11;375(6581):667-671.
doi: 10.1126/science.abm5154. Epub 2022 Jan 6.

COVID mortality in India: National survey data and health facility deaths

Prabhat Jha  1 , Yashwant Deshmukh  2 , Chinmay Tumbe  3 , Wilson Suraweera  1 , Aditi Bhowmick  4 , Sankalp Sharma  4 , Paul Novosad  5 , Sze Hang Fu  1 , Leslie Newcombe  1 , Hellen Gelband  1 , Patrick Brown  1
Affiliations

COVID mortality in India: National survey data and health facility deaths

Prabhat Jha et al. Science. .

Abstract

India’s national COVID death totals remain undetermined. Using an independent nationally representative survey of 0.14 million (M) adults, we compared COVID mortality during the 2020 and 2021 viral waves to expected all-cause mortality. COVID constituted 29% (95%CI 28-31%) of deaths from June 2020-July 2021, corresponding to 3.2M (3.1-3.4) deaths, of which 2.7M (2.6-2.9) occurred in April-July 2021 (when COVID doubled all-cause mortality). A sub-survey of 57,000 adults showed similar temporal increases in mortality with COVID and non-COVID deaths peaking similarly. Two government data sources found that, when compared to pre-pandemic periods, all-cause mortality was 27% (23-32%) higher in 0.2M health facilities and 26% (21-31%) higher in civil registration deaths in ten states; both increases occurred mostly in 2021. The analyses find that India’s cumulative COVID deaths by September 2021 were 6-7 times higher than reported officially.

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Figures

Fig. 1.
Fig. 1.. Percentages of adults reporting daily death in household, expected percentage in 2020, and daily confirmed COVID deaths in India, 1 June 2020 to 1 July 2021.
COVID Tracker deaths (red line, left vertical scale) represent COVID deaths reported daily (smoothed for rolling 7-day averages) at age 35 or older, less a subtraction value of 0.59% to represent nonhousehold reporting. Expected all-cause deaths (gray dashed line, left vertical scale) per year of 3.4% (see text), with 7-day smoothed weekly adjustment from variation observed among 480,000 deaths in the Million Death Study from 2004 to 2014. Confirmed COVID deaths (blue bars, right vertical scale) are daily reports from Covid19india.org (2).
Fig. 2.
Fig. 2.. Monthly reporting of deaths as COVID (including COVID-associated) and non-COVID by month for 2019 to 2021 in a substudy of 57,000 adults in 13,500 households within the COVID Tracker survey (2).
Table S3 provides the input data. (A) 2020 deaths; (B) 2021 deaths.
Fig. 3.
Fig. 3.. Reported deaths from all causes in India’s Ministry of Health and Family Welfare Management Information System covering 0.2 million health facilities nationally, 2020 and 2021, versus average of 2018–2019, by month.
The inset shows the increases in selected states and nationally for the April–May 2021 relative to the 2018–2019 averages for the same months of comparison. Table S6 provides the input data.
See this image and copyright information in PMC

References

    1. “The Coronavirus App” (Scriby, Inc, 2021); https://coronavirus.app/map.
    1. COVID-19 India Data Operations Group, “Covid19India.org” (2021); https://www.covid19india.org/.
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    1. Office of the Registrar General, India, “Vital Statistics of India based on the Civil Registration System 2019” (2021); https://censusindia.gov.in/2011-Common/CRS_2019/CRS2019_report.pdf.
    1. C. Z. Guilmoto, Estimating the death toll of the Covid-19 pandemic in India. medRxiv 2021.06.29.21257965 [Preprint]. 2 July 2021. https://www.medrxiv.org/content/10.1101/2021.06.29.21257965v1. - DOI

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