The true COVID-19 death toll in India is likely to be greater than 1.2 million persons

Abstract

India is a collection of federal states with each state responsible for health care, COVID-19 testing, and reporting of COVID deaths. Some states, which are mainly urban, are far more affluent than others and this greatly influences expenditure on COVID testing. COVID testing will also be mainly concentrated in easy to reach urban areas. The death reporting process in India has been overwhelmed by COVID-19 and little effort seems to have been made to document anything other than a medically confirmed COVID death. The government of India seems content to allow vast undercounting to continue possibly to portray the illusion that all is under control. After adjusting the reported deaths for the proportion of the population in each state which is rural it can be estimated that the real death toll (as of 5th June 2021) is probably more than 1.2 million persons. The figure of 1.2 million is less than that currently reported in many South American countries and hence is considered to be an underestimate. For example, Peru has recently revised its estimate of COVID-19 deaths from 69,000 up to 185,000 which implies 102% excess mortality compared to pre-COVID levels.