India may have seen most COVID-19-related deaths globally — close to 5 million

Official figures show 531,843 deaths; mortality could be 10 times the reported figures, show WHO estimates 

By Nandita Banerji
Published: Wednesday 24 May 2023
Hospitals battled to treat patients amid a chronic shortage of beds and medical oxygen during the second wave of COVID-19 cases in India. Photo: iStock__

India has officially reported around half a million deaths due to the novel coronavirus disease (COVID-19) till May 24, 2023. However, the number may have been 10 times higher just by the end of 2021, showed the latest estimates by the World Health Organization (WHO). COVID-19 could have led to around 5 million deaths in 2020-2021 — the highest of all 194 WHO member states.  

The World Health Statistics 2023 was released May 19, 2023 by WHO, which stated the official global death toll due to the infectious disease caused by the SARS-CoV-2 virus was around seven million, but the true figure can be closer to 20 million. A quarter of these could have been in India. 

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Officially, 531,843 deaths have been reported by India till May 24. The WHO estimates looked at deaths from January 2020 to December 2021. By December 31, 2021, the official death toll in India was 481,080. 

The real death toll has long been suspected to be much higher. But in light of the challenges posed by using reported COVID-19 data, excess mortality is considered a more objective and comparable measure of the mortality impact of COVID-19 across countries. 

India may have faced 4,734,515 or 4.7 million more deaths due to all causes than the official figures, according to WHO estimates of excess mortality associated with COVID-19 pandemic

Russia took second place, with estimated 1.09 million excess deaths, followed by Indonesia at 1.06 million. The United States’ excess mortality was estimated at a little below a million deaths. 

The excess high for India was 6,479,562 and the excess low was 3,315,581. This means the excess deaths could range from around 3.3 million and could have been as high as 6.4 million. The WHO’s South-East Asia region, which includes India, accounted for 12 per cent of global reported COVID-19 deaths. 

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The true COVID toll has been speculated since early in the pandemic. In November 2021, excess deaths were estimated at six times the reported deaths as of October 29, 2021, in India, according to the Institute for Health Metrics and Evaluation, a health research group with the University of Washington.

The first cases of COVID-19 were reported in India on January 2020. However, the most devastating phase of the pandemic in the country was seen during the second wave of cases, which struck India in March 2021. In April 2021, India became the first in the world to report over 400,000 new cases in a single day. 

News reports from various parts of the country showed shortages of vaccines, medicines and other medical supplies. Hospitals battled to treat patients amid a chronic shortage of beds and medical oxygen and there were numerous distressing images of families begging for medical help. 

The official figures do not offer a comprehensive picture of the health burden attributable to COVID-19 or the total number of lives lost as a result of the pandemic, the WHO said. However, excess mortality is a crucial indicator of the true impact because it accounts for the net effects of the pandemic on all-cause mortality.

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The true toll of the COVID-19 pandemic is significantly higher as it has indirectly affected mortality through mechanisms such as disruptions to healthcare services and changes in care-seeking behaviours, the health statistics report said. 

Some deaths attributable to COVID-19 may not have been officially certified as such, as testing may not have been conducted before the individual’s passing. In addition, countries have varied in their application of death certification protocols related to COVID-19, the global health body said. 

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