Recently the debate on Covid-19 mortality in India has gathered steam with the prestigious Economist magazine reporting figures which are several times higher than the official estimates. Earlier also, such higher estimates have been reported abroad and talked about within India. However, this does not necessarily mean that Covid mortality in India is as high as The Economist or others would have us believe.
The Economist and other front-ranking foreign publications appear to have been in a hurry to show very high Covid mortality in India but have not been able to give very convincing reasons and data in support of their assertions.
There is need for a more careful and nuanced approach to this issue, instead of being carried away by some admittedly disturbing images.
When we see corpses floating down rivers, it is no doubt a very tragic and distressing sight. But there can be more than one reason for this phenomenon. One possibility is that given the pandemic scare, the real and/or perceived risk of performing the last rites in the customary way and the perceived risks associated with coming close to a body, some persons may choose the easier option of dumping bodies in a nearby river. After all, this is not an entirely unknown practice and such cases scale have occurred in the past. In times of a big pandemic scare, the possibility clearly exists of more dead bodies in rivers without the pandemic being responsible for all or most of these deaths.
The reality is that significant excess mortality has taken place, as suggested by a lot of anecdotal evidence. What is in dispute really is whether most of the excess mortality has been caused by Covid-19. When we see excessive activity at places where last rites are performed, or when sporadic data indicates this, this is evidence of overall excess mortality but not necessarily of extremely high Covid-19 mortality.
We know three facts very clearly. Firstly, that a very large number of cases which are being talked about as Covid-19 are in fact instances of co-morbidity, and in quite a few of these cases other factors may be more dominant. A second and related aspect is that death with Covid virus is not necessarily death by Covid-19, a distinction whose importance has been pointed out by several senior scientists.
Thirdly, it is a fact that the available medical care for many life-threatening non-Covid diseases (including infectious diseases ) and injuries as well as for difficult maternity cases has declined sharply during the last 16 months or so (as available limited health services were concentrated more on Covid and as there were lockdowns) and this is likely to result in a significant rise in mortality.
In addition, there has been a significant increase in hunger, malnutrition, exposure to weather extremes and mental stress during this period and all this too becomes an aggravating factor contributing to excess mortality. In some cases, the wrong medical approach to Covid, for example unnecessary or excessive use of steroids at the wrong stage, may also have resulted in some deaths.
Hence what is likely is that the rise in mortality is more likely to have been caused by non-Covid adverse factors than is commonly realised. In this situation, it does not help to rush to prove very high Covid mortality rates, especially when the data base for such assertions may be very weak. This will not help in evidence-based policy formulations.
This brings us to a wider issue. While mortality data is very important for overall health policy and planning, in many countries there are delays in availability of mortality data, even more in the context of data in public domain. In addition, there are also problems relating to less than adequate and reliable data.
While the need for improving reliability of mortality data and ensuring its early availability has always been there, this need has increased in Covid times. To help policy formulation, more reliable data on mortality is needed and should be made available early.
One policy issue which has been much debated all over the world in recent months is whether Covid-related lockdowns are justified. The mortality data on Covid for various countries and for different periods can be compared to help in this, but at the same time it should be ensured that data is reliable and comparable.
To aid policy making, we need early and better access not just to data relating to Covid mortality but to data relating to all excess mortality. To give an example, some studies have tried to compare data for Sweden, which avoided the path of lockdowns, with data for some other European countries which had lockdowns. But scholars have pointed out that it is not enough to compare Covid related mortality; all excess mortality should be compared. The reason given for this is that while lockdowns may have reduced Covid-related mortality, these are likely to have led to increased mortality due to other causes.
When the experience of Sweden was compared to some other European countries a similar trend was revealed – somewhat higher Covid mortality but overall lower excess mortality, with the other advantages of continuing essential economic, medical and other activities. Of course, mistakes were made even there, and it is now realised that with greater care of the elderly and with some other efforts more lives could have been saved from Covid.
These on-going experiences and results of studies can change depending on various factors, but one thing is clear. If accurate, unbiased data is available on mortality (particularly overall excess mortality) at an early date, it can be helpful in framing better policy. Even if there is delay in national data, a quicker system of limited but independent, unbiased and reliable surveys can be worked out. Evidence-based response really needs reliable data, not just on Covid but on all excess mortality.
The writer is a journalist and author. His recent books include Planet in Peril and Protecting Earth for Children.