Estimating the death toll of the Covid-19 pandemic in India

The absence of reliable registration of Covid-19 deaths in India has prevented the proper assessment and monitoring of coronavirus pandemic. India’s relatively young age structure tends to conceal the severity of Covid-19 mortality, which is concentrated in older age groups. In this paper, we present four different demographic samples of Indian populations for which we have information on both their demographic structures and death outcomes. We show that we can model the age gradient of Covid-19 mortality in India and use this modeling for estimating the level of Covid-19 mortality in the country. Our findings point to a death toll of about 2.2 million persons by late May 2021. Once India’s age structure is taken into account, these figures correspond to one of the most severe cases of Covid-19 mortality in the world.

Background

India has recorded after February a second outbreak of coronavirus that has affected the entire country. The accuracy of official statistics of Covid-19 mortality has been called in question and the real number of Covid-19 deaths is thought to be several times higher than reported. In this paper, we assembled four independent population samples to model and estimate the level of Covid-19 mortality in India.

Methods

We first used a first population sample with age and sex of Covid-19 victims to develop a Gompertz model of Covid-19 mortality in India. We applied and adjusted this mortality model on two other national population samples after factoring in the demographic characteristics of these samples. We finally derive from one of these samples the most reasonable estimate of Covid-19 mortality level in India and confirm this result with the use of a fourth population sample.

Findings

Our findings point to a death toll of about 2.2 million persons by late May 2021. This is the largest number of Covid-19 deaths in the world. Once standardized for its age and sex structure, India’s Covid-19 mortality rate is above that of Brazil or the USA.

Interpretation

Our analysis shows that existing population samples allow for an alternative estimation of deaths due to Covid-19 in India. The results confirm that only one out 7 Covid-19 deaths appear to be registered in India. The estimates point to a very Covid-19 mortality rate, which is even higher after age and sex standardization. The magnitude of the pandemic in India requires immediate attention and calls for a strong response based on a combination of non-pharmaceutical interventions and the scale-up of vaccination to make them accessible to all, with an improved surveillance system to monitor the progression of the pandemic.