The missing dead series – Part II: Why are states under-reporting deaths, not just COVID-19 deaths?
Photo Credit: PTI

States under-reporting Covid deaths is well known by now. Some states have been so brazen about it, that the courts have had to step in and give them a tongue lashing.

Among the states that have received the sharpest of rebukes from the courts are Uttar Pradesh (UP), Bihar, Jharkhand, Madhya Pradesh (MP) and Uttarakhand.

NDTV stated that the biggest inconsistency was seen in Bihar where some 75,000 people died of unexplained circumstances, with symptoms like that Covid. Other states including Madhya Pradesh, Andhra Pradesh, Tamil Nadu, Karnataka, and Delhi have also shown discrepancies in their death figures, amounting to 4.8 lakh excess deaths in these five states.

NGOs engaged in ground verification of covid deaths have noted that the actual numbers could be 9-10 times higher than those claimed by the Indian government. Eminent personalities like Silicon Valley entrepreneur, Vinod Khosla tweeted that the figures are grossly understated.

States The Economist in its 12 June 2021 issue “…a rough estimate . . . of between 1.8 million and 2.4 million deaths from the disease “could be expected. That would make the actual Covid deaths as many as six times more than official numbers admit.

The missing dead series – Part II: Why are states under-reporting deaths, not just COVID-19 deaths?

Beyond Covid deaths

But Indian states have always been concealing all kinds of information about people who died in their respective territories. The data provided by the Census of India about registered and medically certified makes one sit up.

All death can be classified as registered, medically certified, and unrecorded.

The desirable is that each death be medically certified.

But a shortage of forensic laboratories in India makes many doctors prefer not registering the cause of death. So, it gets registered without the cause of death.

Nonetheless, the available data does provide some insights.

First, the percentage of medically certified deaths has generally been over 20% of the total number of registered deaths. This points to either a paucity of doctors, or a reluctance on the part of doctors to provide a reason for death. Or both.

Second, stating the cause honestly can be dangerous for the doctor. Does he certify a dead person as having died due to malnutrition? That would antagonise the state, which could make his life miserable. So, he either tells a lie and states that the person died of natural causes, or does not provide any reason.

Third, the percentage of “unknown deaths” has declined from around 47% in 2011 to 21% in 2019. Even so, 21% is embarrassingly high. Losing 23 lakh people each year without a trace is extremely worrying, even frightening.

Fourth, the death rate in India, as given by the World Bank has begun going up. It was 7.194 per 1,000 people in 2015. It has climbed to 7.265 by 2019. Clearly, Ayushman Bharat has not worked.

Fifth, the worst performers on medical certification are Uttar Pradesh. Bihar, Madhya Pradesh, Uttarakhand, and Jharkhand. All these states have medical certification of deaths at less than 10% against a national average of over 20%. They fudge so much data, that unrecorded deaths could actually be over double the national average. The best performers are Goa, Lakshadweep, Chandigarh, Puducherry, and Manipur.

So, what should India do to ensure that the recording of deaths improves? That will be dealt with in the next article.

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