Excess deaths during Covid-19 in line with pre-2020 trend, says govt sources citing data

New Delhi: India's cumulative excess mortality for 2020-2021 was 9.3 per cent higher than expected deaths, a figure which was lower than that of the US, Italy and Russia, official sources said, referring to the latest Civil Registration System (CRS) data.

Sources pointed out that the number of deaths documented in the CRS has been increasing over time, even in the years preceding the COVID-19 outbreak in 2020, they said.

The excess mortality is the additional number of deaths, due to all causes during a crisis such as COVID-19, above the number of deaths expected to be reported during "normal" conditions.

The annual increment observed in a given year, compared to the previous year, has varied from 1.3 per cent in 2016 to 9.93 per cent in 2019, with the average increase over three preceding years (2016 to 2019) estimated at 6.42 per cent per annum.

The annual secular increase in deaths registered in CRS can be attributed to several reasons, including a larger population cohort, maturing reporting processes and increased awareness of the need for registration, leading to higher registration levels, sources said.

The annual secular increase is the long-term, consistent increase in deaths over a year.

This trend has been further accentuated over the years by the mandatory requirements for death certificates linked to pension schemes, social security benefits, and property issues. Besides, COVID-19 death compensation required death certification, prompting registration under CRS, the sources stated.

"Our teams conducted preliminary analyses of CRS data to assess cumulative excess deaths in the years 2020 and 2021," an official source said.

Based on the three-year (2016-19), annual rate of increase of 6.42 per cent mentioned above, the expected number of deaths would be 81,31,869 in 2020 and 86,54,185 in 2021.

However, the observed deaths were 81,15,882 in 2020 and 1,02,24,506 in 2021.

The excess deaths, defined as observed minus expected deaths, were (-)15,987 and 15,70,321, respectively, the source said.

"Thus, the total excess deaths over the two-year period amounted to 15,54,334. As a percentage, this is 9.3 per cent higher than the expected deaths. This translates into about 1,249 excess deaths per one million population," the source said.

It must be emphasised that excess deaths in these years are not equal to COVID-19 direct deaths, the source underlined.

These excess deaths include reported COVID-19 deaths (4,81,080 by the end of 2021), unreported COVID-19 deaths, deaths due to all other causes, and possible indirect effects of COVID-19.

"To benchmark these estimates, subject to more nuanced future analyses, we compared cumulative excess deaths in India for 2020 and 2021 with those of selected countries that provide publicly available data on excess mortality during the same period," the source said.

Excess mortality in high-income countries, expressed as a percentage higher than the expected mortality, was found to be 17.6 per cent in the US, 11.8 per cent in Italy, 11.6 pcer cent in the UK, 29.9 per cent in Russia, 6.7% in France, 5.3 per cent in Germany, and 5.2% in Canada.

Excess mortality in middle-income countries was 43.6% in Mexico and 12.6% in Brazil. The corresponding figure for India was 9.3%, as stated above.

"When expressed differently, India's 1,249 excess deaths per one million were much lower than in the USA (3,021 per million), Italy (2,573), the UK (1,874), France (1,281), Russia (7,240), Mexico (5,217), and Brazil (1,820), but somewhat higher than that of Canada (825) and Germany (1,214)," the source said.

In the past, reports of exorbitantly high excess deaths in India during 2020 and 2021, based on modelling methodology, have emerged in the public domain, sources said.

A WHO report estimated India's excess deaths at 47 lakhs. Another report in a top journal cited a figure of about 41 lakh excess deaths in this period.

The CRS data of the actually counted deaths at a high reporting rate, after accounting for secular increase, yield a much lower estimate of 15,54,334, as elaborated above.

"India mounted a whole-of-government and whole-of-society response to the pandemic emergency. The strategy comprised five science-driven tools: testing, suppressing chains of transmission, clinical care, safe behaviour, and vaccination.

"The virus was ultimately defeated by the made-in-India vaccines, with over 220 crore doses administered in the world's largest vaccination program," another official source said.

Of these, as many as 145 crore doses were administered in 2021 alone. It has been reported in the Lancet that the COVID-19 vaccination program in Bharat in 2021 itself saved 34 lakh lives, the source said.

The Civil Registration System (CRS) in India is a compulsory, independent, and universal system for recording all births and deaths under the Registration of Births and Deaths Act, 1969. These events are reported to the local registrar, based on which each state generates its respective report.

The collated data from state reports are published as the annual vital statistics report by the Registrar General of India (RGI).