National registry’s certified Covid-19 death toll in 2020 puts Centre’s number under scrutiny

The number of Covid-19 deaths in 2020 were higher than Union Health ministry’s figure presented in Parliament

Despite having only 22 per cent of registered deaths with a medically attributable cause, India in 2020 has recorded more than 1.6 lakh Covid-19 deaths – a figure higher than the official Covid toll of 1.48 lakh – according to a new government report, raising questions on the authenticity of the Union Health Ministry’s claim on the Covid-19 toll once again.

The report on the Medical Certification of Cause of Death, 2020 by the Registrar General of India says only 18.11 lakh or 22.5 per cent of 81.15 lakh registered deaths have a medical certificate on the cause. Of them 1.6 lakh were due to Covid-19.

The ministry in March informed the Parliament there were 1,48,738 Covid-19 deaths in 2020.

Of the 22.5 per cent deaths with medical certification, there were 5.8 lakh deaths (32 per cent) caused by heart diseases, 1.81 lakh deaths caused by respiratory system failure (10 per cent) and more than 1.6 lakh Covid-19 deaths (8.9 per cent).

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The nearly 9 per cent deaths attributed to Covid-19 is almost the same proportion of estimated excess deaths in India during 2020 calculated by two independent studies including one by the WHO.

“The absolute Covid-19 deaths of 160,000 is greater than the confirmed Covid-19 deaths of around 150,000 in 2020, even though the MCCD document vastly under-reports (only 1.8 million deaths out of an estimated 10 million national total). So another government of India's own source shows that official Covid-19 deaths have been under-reported in 2020,” Prabhat Jha, an epidemiologist at the University of Toronto, who is not associated with the RGI report, told DH over email.

In the past few months several studies including one led by Jha and another by the World Health Organization estimates India’s excess deaths between 3.2 to 4.74 million during the two pandemic years.

The Union Health Ministry, however, denied the conclusion of each of these studies, arguing flawed methodologies. Union Health Minister Mmansukh Mandaviya also aired India’s objections on the WHO report at the World Health Assembly last week.

The ministry said the RGI’s Civil Registration System that documented 474,000 excess registered deaths in 2020 over the count in 2019 should be viewed as “authentic data” on deaths, claiming that CRS in 2020 had registered 99.9 per cent deaths – a claim questioned by the experts.

“We need a question in the September 2022 census. Was there a death in the house from January 1, 2019 onwards? If yes, pleas share the age, sex and date of death,” said Jha, who had earlier led the Million Death Study to understand India’s diseased pattern.

India’s progress in medical attribution of deaths remains sluggish from 20.2 per cent in 2010 to 22.5 per cent a decade later. It was 20.7 per cent in 2019 and 21.1 per cent in 2018. In only eight states and union territories, more than 50 per cent of the registered deaths are medically certified.

“The MCCD relies mostly on urban hospitals in some states. It is not representative of the whole of India. Getting to 100 per cent coverage of MCCD will likely not be possible until far more deaths shift to occurring in facilities, which is still decades away,” Jha said.