While the number of daily cases far exceeds what other countries have reported, experts warn that official COVID-19 figures from the second most populous country in the world are likely a massive undercount.
But why is India’s data considered inaccurate? Are the data less precise than what other countries report? And which figures give a good indication of the crisis?
Does India count all cases?
India doesn’t have all coronavirus cases, but no country can.
Around the world, official counts usually only report confirmed cases, not actual infections. Cases are missed because the tests are so random and because some people infected with the coronavirus have mild symptoms, if any.
The more limited the tests, the more cases are missed. The World Health Organization has said countries should perform 10 to 30 tests per confirmed case.
India is performing around five tests for each confirmed case, according to Our World in Data, an online research site. The United States conducts 17 tests per confirmed case. Finland performs 57 tests per confirmed case.
“There are still a lot of people who don’t get tested,” said Dr. Prabhat Jha of the University of Toronto. “Entire houses are infected. If a person gets tested at home and says they are positive and everyone in the house is starting to have symptoms, it is obvious that they have COVID, so why get tested?
Jha estimates, based on modeling from a previous outbreak in India, that the true infection numbers could be 10 times higher than official reports.
What about the dead?
Deaths are a better indicator of the shape of the pandemic curve, Jha said, but there are issues with the data here as well.
“The biggest gap is what’s happening in rural India,” Jha said.
In the countryside, people often die in their homes without medical attention, and these deaths are grossly underreported. Families bury or cremate their loved ones themselves without officially registering these cases.
Seventy percent of all-cause deaths in the country occur in rural India in any given year.
Rural deaths can be counted, as Jha’s work with the Million Death Study has shown. The pre-pandemic project used in-person surveys to count deaths in rural India, capturing details of symptoms and circumstances with the results of “verbal autopsies” reviewed and recorded by doctors.
Many low- and middle-income countries have similar undercoverages of death data, Jha said, but India could do better.
“It’s a country that has a space program. Simply counting the dead is a basic function, ”he said. “India should do much, much better. “
Does it matter?
Knowing the size and scope of the epidemic and how it is evolving helps governments and health officials plan their responses.
Even with known issues with the data, the trajectory of COVID-19 cases and deaths in India is an alarming reminder of how the virus can explode in a largely unvaccinated population when precautions are lifted.
“What is happening in India is important to the whole world,” said Dr Amita Gupta, president of the Johns Hopkins India Institute, in a conversation on Facebook. “We care from a humanitarian perspective, from a public health perspective and from a health security perspective.”