New study finds excess Covid-19 deaths in Gujarat

The number of excess deaths in 90 of Gujarat’s 162 town municipalities in the pandemic’s first year was twice higher than the entire state’s official Covid-19 death count even before the delta wave peaked in May 2021, says a new study published on Wednesday.

Carried out by researchers at Harvard University’s public health school and Indian collaborators, the study provides fresh evidence of India’s undercounting of Covid-19 deaths.

Relying on civil death registration records obtained from 90 municipalities including Gandhinagar, the study found over 21,000 excess deaths between March 2020 and April 2021, which is more than twice Gujarat’s official Covid toll of 10,000 plus in the same period.

India’s Covid death reporting remained a controversial subject for the last two years with the Union Health Ministry sternly opposing every scientific study and a World Health Organisation report demonstrating a much higher count than the official one.

For an accurate count, Covid-19 patients need to have access to healthcare; health care providers need to have the knowledge and clinical or laboratory tools necessary to diagnose Covid-19, and those recording deaths on death certificates need to have the requisite training to note Covid-19 as an underlying cause of death.

One or more of these conditions is often not met, resulting in underestimates of officially reported Covid-19 related deaths.

This time the researchers used de-identified data from civil death registers obtained by a group of journalists under the Right to Information Act, to make accurate estimates of excess deaths in Gujarat, which has a reliable death registration system in place.

The data represents a population of at least 4.9 million (according to the 2011 census) or approximately 8 per cent of the Gujarat population of 60.4 million. It encompasses all recorded deaths from January 2019 to May 2021.

Across 90 municipalities, 77,781 total deaths were recorded over the course of the pandemic, from March 2020 onwards.

While deaths were higher in 2020 (50,866) and 2021 (26,915 up to April) compared to 2019 (42,246), the sharpest increase was observed at the start of the second wave of the pandemic in March-April 2021.

In the last week of available data, 85 of the 90 municipalities we studied, experienced increases in mortality over 100 per cent. Forty-seven of the 90 municipalities experienced increases in mortality over 500 per cent during the same week.

"We estimated 21,300 excess deaths since March 2020, representing a 44 per cent increase over the expected baseline, most of which occurred at the start of the second wave in March 2021," they reported in PLOS Global Public Health.

"Over 80 per cent of the municipalities experienced increases in mortality over 100 per cent in all demographic groups except the two youngest age cohorts. In over 50 per cent of the municipalities, the 40-65 years groups experienced an increase of over 500 per cent."

The Gujarat government accepted in the Supreme Court that there were 10,000 more Covid-19 deaths than the official toll. "Our results suggest that in 90 municipalities alone there were 21,300 excess deaths from March 2020 to April 2021, far exceeding the official count."

"The vast majority of these excess deaths likely represent direct deaths from Covid-19, in the absence of any other known catastrophe. A small percentage of these would include deaths from the indirect impact of the pandemic, and from causes unrelated to the pandemic," they added.