As India battles through one of the world’s deadliest surges of the Covid-19 pandemic, this week India’s health minister Harsh Vardhan insisted that its fatality rate from the disease remained “the lowest in the world”.
It was a statement that jarred with the devastating images and accounts that have flowed out of India in the past fortnight, of hospitals and morgues filled to capacity, people dying on pavements from scarcity of oxygen, and crematoriums and graveyards visibly overflowing with bodies.
India’s official death toll has continued to rise relentlessly. On Saturday, it was another record-breaking day, with 401,993 new cases and 3,523 deaths. Yet health experts widely believe the official daily figures do not come close to reflecting the real number of deaths.
With Covid-19 patients unable to get into hospitals, many have been dying at home, often without ever getting tested. Meanwhile, state governments and local authorities stand accused of rampant miscounting, covering up and obfuscating the true death toll in their states. Over the past month, in the Karnataka city of Bangalore – where case numbers are among the fastest rising in the country – the figure for Covid-related deaths registered in crematoriums was twice the official death toll.
The allegations of a cover-up have been particularly prevalent in Uttar Pradesh, where the state government is controlled by the ruling Bharatiya Janata Party (BJP), and the hardline chief minister, Yogi Adityanath, has insisted that the state has no shortage of oxygen and threatened to prosecute those who “spread panic”. Authorities have denied any cover-ups.
In the city of Muzaffarnagar, in Uttar Pradesh, data collected by the Observer shows a vast discrepancy between the official death toll recorded by the local authority and the accounts given by those who run its crematoriums and graveyards.
According to official statistics, Muzaffarnagar had just 10 Covid deaths over four days in late April. However, Ajay Kumar Agarwal, president of Muzaffarnagar’s city crematorium, said this was not even close to the scale of bodies he was handling.
“In normal times, we were cremating three bodies a day, but in the past 10 days it has increased,” he said. “One day it was 18, another day it was 20, then 22, and one day 25. In the past 10 days, we haven’t had any less than 12 bodies a day– 90% of them corona deaths.”
With only seven pyres in Muzaffarnagar’s city crematorium, Agarwal said they were so overwhelmed they were having to cremate the bodies on open ground, and send some to another crematorium 20 miles away. “The situation here is pathetic,” he said,
Agarwal alleged that “incorrect” figures were being published, and dismissed suggestions that the city had experienced any days this week with no Covid deaths or just two deaths. “The administration does not make the correct death figures public,” he said. “I don’t understand why they’re hiding them. Maybe they don’t want people to panic.”
Sanjay Mittal, at Muzaffarnagar’s only other crematorium, New Mandi, recounted similar scenes. He said he had “never seen such a situation in my life – we are burning pyres from morning till evening”.
According to Mittal, prior to the pandemic, the New Mandi crematorium usually saw five bodies arrive in a day. But on 27 April they received 21 bodies, on 28 April it was 15, and on 29 April it was 18. He could not confirm how many had been Covid-19 positive.
“It is midday and we’ve already had 12 bodies. Who knows how many it will be by the end of the day,” he said on Friday.
A similar recent surge in bodies was also reported by Abdul Quadir, who runs the Muslims cemetery in Muzaffarnagar. “Before corona, we buried two to three bodies a week, but now six to seven bodies arrive every day,” he said. “Only three of these bodies so far have come from hospital, the rest died at home and had not been tested.”
Official government data confirms very low Covid-19 testing rates in Muzaffarnagar; on Tuesday 27 April, no tests were done in the area, while on 29 April, only 561 tests were done, which all came back positive.
A doctor from the Indian Medical Association in Uttar Pradesh, who asked not to be named, said many people were dying from diseases such as pneumonia and lung fibrosis, which they contracted as a result of Covid-19 complications. He said: “The number of those deaths is very high, but they’re not being counted as coronavirus deaths.”
He added: “We accept that the number of dead from coronavirus is much higher than the district administration public data. Those bodies we see piling up at the crematoriums are mostly people who were undergoing treatment at home, then died there. The number of such deaths is also high but they are mostly not recorded in official data. The testing rate here is very low compared to the need.”
The Muzaffarnagar chief medical officer did not respond to requests for comment.
Murad Banaji, a mathematician who has modelled India’s Covid-19 pandemic, said “multiple streams of evidence show undercounting of Covid deaths is a big problem in India”. He added: “Before we start congratulating ourselves about what a low fatality rate India has, the first thing that needs to be made clear is we don’t have a good idea of how many people are dying of Covid in the country.”
According to Banaji’s estimates, India’s death toll is likely to be at least three times higher than official figures. This is based on calculations from cities such as Mumbai where he examined the number of “excess deaths” that were recorded in the city during 2020, when the pandemic first hit (excess deaths refer to the number of fatalities that exceed the average number of deaths usually recorded in a place every year).
Banaji discovered that in Mumbai there was an unprecedented spike in such deaths, and for every Covid-19 death recorded, there was one excess death not designated as caused by Covid.
“Not all those excess deaths may have been from Covid-19,” explained Banaji. “But from what we can gather from international data and studies, most probably were, and in Mumbai’s’s case, my estimate is a minimum of 60% to 70% of those additional excess deaths were from Covid.”
Such calculations would push Mumbai’s real death toll from 13,000 to about 21,000. However, Banaji emphasised that for rural and impoverished areas of India, in states like Bihar and Uttar Pradesh, which have limited health infrastructure, death recording and Covid testing, the number of unreported Covid deaths was “likely to be huge, much greater than in a city such as Mumbai”.
The implications of India failing to accurately report the true death toll of the pandemic are extensive. If, as many believe, undercounting occurs most in marginalised communities, the true toll of the pandemic on these groups is likely never to be recognised, and this will have an impact on distribution of resources following the pandemic and on accountability for local authorities or governments. Similarly, experts fear it may impede the ability of the state to build an effective vaccination strategy to combat future surges.
“If we don’t have the data to fully understand what’s happening with this pandemic now,” said Banaji, “how can India possibly prepare for the future?”
This content first appear on the guardian