New Delhi, India – A new study suggests the true death toll from the COVID-19 pandemic in India, the world’s most populous country, during the first phase of the pandemic may be eight times higher than the official government figure.
The initial wave of the virus took the world by surprise, leaving governments and health systems scrambling to respond, but India appeared to avoid the worst of the impact after imposing a strict lockdown. In 2021, India was devastated by the delta variant, with hospitals running out of beds and oxygen, people gasping for air outside health facilities and rows of smoldering pyres dotting crematoriums across the country.
But new research suggests that while the first wave was not as deadly as the 2021 wave, it caused far more damage than previously realised.
What did the new study prove?
The study, co-authored by 10 demographers and economists from leading international institutes, found that India experienced 1.19 million excess deaths in 2020 compared to 2019 during the first wave of the pandemic.
This is eight times India’s official COVID-19 death toll of 148,738 in 2020. The study was published in the journal Science Advances on Friday.
The survey figures, based on the Government of India’s National Family Health Survey (NFHS) 2019-21, a comprehensive report on the state of health and family welfare in the country, are 1.5 times the World Health Organisation’s (WHO) estimated number of COVID-19 deaths in India in 2020.
The total number of deaths from the virus in India by the end of 2021 was 481,000.
But new research also reveals deep-rooted inequalities among the pandemic’s victims based on gender, caste and religion.
Has COVID killed some communities disproportionately?
According to the study, the life expectancy of upper-caste Hindu Indians fell by 1.3 years in 2020. In contrast, the life expectancy of people from “scheduled castes,” a community that has faced the worst discrimination under the caste system for centuries, fell by 2.7 years.
Indian Muslims were hardest hit, with their life expectancy falling by 5.4 years in 2020.
These communities already had lower life expectancy at birth compared to high-caste Hindus before the pandemic, the study found. “The pandemic has exacerbated this disparity,” the study added. “This loss in life expectancy is comparable in absolute magnitude to or greater than the loss in life expectancy experienced by Native Americans, blacks, and Hispanics in the United States in 2020.”
“Muslims have faced marginalization for a long time, but it has become even more acute in recent years,” said Aashish Gupta, one of the study’s authors and Marie Skłodowska-Curie Research Fellow at the University of Oxford.
“There’s no data to suggest that one group or community was more infected than another,” Gupta told Al Jazeera, “but our findings make it clear that when Muslims did get COVID, they were really marginalized, faced stereotypes and had trouble getting medical care. Marginalized communities were left to fend for themselves.”
The trend is “consistent with what we know about how the disease affects mortality,” said T. Sundararaman, a public health expert who served as executive director of the National Health Systems Resource Center, a think tank for India’s health ministry.
“The results are more pronounced among the more marginalized … it all adds up,” he said.
Women were more vulnerable than men
The study also found that women were hit harder than men: In India, men’s life expectancy fell by 2.1 years in 2020, while women’s life expectancy fell an additional year. This contrasts with the global trend, where men overall saw a bigger decline in life expectancy during the pandemic.
“There are several facets that contribute to the decline in women’s life expectancy, including long-standing gender discrimination and unequal resource allocation in a predominantly patriarchal society,” Gupta said. “We knew that women were particularly vulnerable in Indian society, but the disparity was shocking to us.”
In India, the rise in deaths among the youngest and oldest people was steepest, but researchers warned this could be due to disruptions to public health services, including childhood vaccinations, tuberculosis treatment and other indirect effects of COVID-19.
What do these new figures tell us about India’s COVID-19 response?
According to the Indian government, 481,000 people have died from the pandemic, but the WHO estimates the actual death toll at between 3.3 million and 6.5 million, higher than any other country.
The Narendra Modi-led government has rejected the WHO figures, claiming that the model the UN body uses for its calculations may not be applicable to India.
But this isn’t just an issue for international organizations. Independent public health experts and researchers have repeatedly accused the Indian government of underestimating the death toll during the pandemic. “The government’s efforts fall far short of what is needed to address inequalities in access to healthcare,” Sundararaman told Al Jazeera. “The government needs to make the data public and open it to scrutiny. There is nothing to be gained by not engaging in these studies,” he added, referring to the latest study findings.
“Publish the data”
When the pandemic hit, Gupta said researchers like him believed “governments would understand the importance of accurate mortality data,” but, he said, “what was available before is no longer being made public.”
The new study only extrapolates numbers for 2020 because there isn’t enough high-quality data to interpret the numbers for 2021, when the delta variant became prevalent. “Everywhere you look there are data gaps,” Gupta added. “We expect the 2021 estimates to be even higher than 2020.”
“Our understanding and future research shows that delta waves were much more deadly than 2020,” said Prabhat Jha, director of the Centre for Global Health Research in Toronto, one of the experts who supported the WHO’s calculation of excess deaths.
“Full-time estimate [of the pandemic] “The number of excess deaths in 2020 was approximately 3.5 million to 4 million, of which approximately 3 million were due to delta waves,” Jha said, adding that the new study’s 2020 estimate was “much higher” than expected.
Jha noted that the interruption of data collection for the NFHS survey during the pandemic was a factor that may have affected the quality of the data used in the new study.
But Gupta argued that the authors “conducted numerous data checks that suggest the quality of the data has not been compromised by the pandemic.” The study authors also noted that the sample was “representative of a quarter of the population.”
All the experts agree on one thing: With greater transparency in the data collected by the government, India may finally be able to know how many people it has lost to the pandemic.
“The Indian government can put an end to this entire debate by publishing data that provides direct evidence of excess deaths,” Jha said.
