The COVID-19 pandemic had a significant and widespread impact on global public health in 2020 and 2021, resulting in a substantial loss of life. However, attributing deaths directly to COVID-19 was challenging, leading the international public health community to stress the importance of measuring the pandemic’s impact in terms of excess mortality.
There has been intense controversy around the likely plausibility of various mortality estimates of COVID19 for India. Highlighting some relevant studies, discuss the way forward in dealing with such issues of assessment in pandemics. (15 marks, 250 words).
Estimates of death due to COVID and its shortcomings
- Excess mortality is determined by comparing observed deaths during the pandemic with expected deaths based on pre-pandemic trends. Ideally, this calculation relies on robust population-based mortality data obtained from death registration systems.
- In the case of India, estimating excess deaths directly attributable to COVID-19 was complicated due to the country’s relatively low death registration rate, which is around 70% and varies widely across different states and districts.
- The severity of the pandemic, particularly during the second wave from April to June 2021, posed a significant challenge.
- Additionally, India’s death registration data did not provide the necessary granularity, such as weekly or monthly mortality data, which is essential for calculating excess deaths.
- To gauge the mortality impact of the pandemic, independent researchers collected mortality records from government Civil Registration System (CRS) offices in 14 states and nine cities across India from January 2018 to May 2021.
- These records were published in media reports and compiled in a data series by The Hindu. Several scientific teams used this data, along with information from the Sample Registration System (SRS) and household surveys, to develop model-based estimates of excess mortality for India.
- Estimates of COVID-19-related deaths varied widely among different studies, with the highest estimate suggesting 4.7 million excess deaths in India during 2020-2021 using available local data as inputs for mortality models.
- These estimates have generated intense debate and controversy, focusing on the statistical methods and data assumptions used in estimation.
- However, most studies were unable to eliminate crucial biases in the input data and data gap-filling assumptions.
- Some studies had insufficient sample sizes, while others suffered from information bias at various levels. As a result, it is likely that the excess deaths related to COVID-19 in India were overestimated.
- The official Civil Registration System report for 2021 is due for release soon, offering the potential for the best primary evidence. However, it may also lead to further debates if factors like improved reporting, delayed registration, and data completeness deficiencies are not appropriately considered while interpreting the data.
- To address this issue, the government should establish a task force consisting of national experts in the field. This task force should be granted access to all microdata from the CRS, SRS, and other relevant data sources.
- Once equipped with the necessary data, the task force can conduct a comprehensive analysis using standard statistical methods, providing measures of excess mortality by gender and age at national, state, and district levels.
- Accurate district-level mortality data is essential for evidence-based health initiatives aimed at addressing maternal and child health conditions, infectious diseases, non-communicable diseases, and injuries.
- Therefore, the detailed analysis will not only conclude the debate on pandemic mortality in India but also enhance the capacity for subnational mortality measurement and inform efforts to improve local data quality.
There is an urgent need to improve the attribution of causes of death, either through medical certification for physician-attended deaths or retrospective interview methods for household events. The combined efforts of the National Task Force for data analysis and initiatives for data quality enhancement will greatly enhance the utility of the CRS for routine local and national mortality measurement in India.