January 28 2022
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Big Problem when Indians can't prove family died from Covid

Published on October 9, 2021 3:50 AM
To be considered a Covid case, the deceased must have been diagnosed with a positive Covid test or have been The country's underfunded public health infrastructure means that in normal times, only 86% of deaths nationwide were registered in government systems. And only 22% of all registered fatalities were given an official cause of death, certified by a doctor, according to community medicine specialist Dr. Hemant Shewade.
Delhi, India - As India's brutal second coronavirus wave ravaged the country this spring, Ankit Srivastava went from hospital to hospital, trying to find help for his ailing mother.

But hospitals in the Indian city of Varanasi had run out of space, oxygen, medicine, tests -- everything.

"They told us everywhere was bad and people were lying on the hospital floors, and that there were no beds at all," the 33-year-old said.

His mother died before she could be tested for Covid-19. This week, India's government unveiled a compensation program that would provide 50,000 rupees (about $670) to the families of past and future Covid-19 victims. That's more than half of what most people in the country earn annually, according to the government's most recent estimate of income per capita for the 2019-2020 financial year.

In theory, the program should help people like Srivastava. But experts believe the true death toll may be many times the official tally of 450,000 -- and the families of some victims may end up missing out on compensation because they either don't have a death certificate or the cause of death is not listed as Covid-19.

The Indian government has promised no families will be denied compensation "solely on the ground" that their death certificate does not mention Covid-19. But days after the compensation plan was announced, the rules remain unclear -- and that's causing stress for many Indians struggling to feed their families after losing a breadwinner during one of the world's worst Covid outbreaks.

COVID-19 pandemic in India

The COVID-19 pandemic in India is a part of the worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 . As of 27 September 2021, according to official figures, India has the second-highest number of confirmed cases in the world with 33,678,786 reported cases of COVID-19 infection and the third-highest number of COVID-19 deaths at 450,127 deaths. However these figures exhibit severe under-reporting.

The first cases of COVID-19 in India were reported on 30 January 2020 in three towns of Kerala, among three Indian medical students who had returned from Wuhan, the epicenter of the pandemic. Lockdowns were announced in Kerala on 23 March, and in the rest of the country on 25 March. On 10 June, India's recoveries exceeded active cases for the first time. Infection rates started to drop in September, along with the number of new and active cases. Daily cases peaked mid-September with over 90,000 cases reported per-day, dropping to below 15,000 in January 2021. A second wave beginning in March 2021 was much more devastating than the first, with shortages of vaccines, hospital beds, oxygen cylinders and other medical supplies in parts of the country. By late April, India led the world in new and active cases. On 30 April 2021, it became the first country to report over 400,000 new cases in a 24-hour period. Experts stated that the virus may reach an endemic stage in India rather than completely disappear; in late August 2021, Soumya Swaminathan said India may be in some stage of endemicity where the country learns to live with the virus.

India began its vaccination programme on 16 January 2021 with AstraZeneca vaccine and the indigenous Covaxin. Later, Sputnik V and the Moderna vaccine was approved for emergency use too. As of 17 August 2021, the country had administered over 550 million vaccine doses.


On 12 January 2020, the WHO confirmed that a novel coronavirus was the cause of a respiratory illness in a cluster of people in Wuhan, Hubei, China, which was reported to the WHO on 31 December 2019.

On 30 January 2020, India reported its first case of COVID-19 in Thrissur, Kerala, which rose to three cases by 3 February 2020; all were students returning from Wuhan. Apart from these, no significant rise in transmissions was observed in February. On 4 March 22 new cases were reported, including 14 infected members of an Italian tourist group. Transmissions increased over the month after several people with travel history to affected countries, and their contacts, tested positive. On 12 March, a 76-year-old man, with a travel history to Saudi Arabia, became the first COVID-19 fatality of India.

A Sikh preacher, who had a travel history to Italy and Germany, turned into a superspreader by attending a Sikh festival in Anandpur Sahib during 10–12 March. Over 40,000 people in 20 villages in Punjab were quarantined on 27 March to contain the spread. On 31 March, a Tablighi Jamaat religious congregation event in Delhi, which had taken place earlier in March, emerged as a COVID-19 hotspot. On 2 May, around 4,000 stranded pilgrims returned from Hazur Sahib in Nanded, Maharashtra to Punjab. Many of them tested positive, including 27 bus drivers and conductors who had been part of the transport arrangement.

In July 2020, it was estimated based on antibody tests that at least 57% of the inhabitants of Mumbai's slums may have been infected with COVID-19 at some point.

A government panel on COVID-19 stated in October 2020 that the pandemic had peaked in India, and could come under control by February 2021. This prediction was based on a mathematical simulation referred to as the 'Indian Supermodel', assuming that India reaches herd immunity. That month, a new SARS-CoV-2 variant, Lineage B.1.617, was detected in the country.


India began its vaccination programme on 16 January 2021. On 19 January 2021, nearly a year after the first reported case in the country, Lakshadweep became the last region of India to report its first case. By February 2021, daily cases had fallen to 9,000 per-day. However, by early-April 2021, a major second wave of infections took hold in the country with destructive consequences; on 9 April, India surpassed 1 million active cases, and by 12 April, India overtook Brazil as having the second-most COVID-19 cases worldwide. By late April, India passed 2.5 million active cases and was reporting an average of 300,000 new cases and 2,000 deaths per-day. Some analysts feared this was an undercount. On 30 April, India reported over 400,000 new cases and over 3,500 deaths in one day.

Multiple factors have been proposed to have potentially contributed to the sudden spike in cases, including highly-infectious variants of concern such as Lineage B.1.617, a lack of preparations as temporary hospitals were often dismantled after cases started to decline, and new facilities were not built, and health and safety precautions being poorly-implemented or enforced during weddings, festivals , sporting events , state and local elections in which politicians and activists have held in several states, and in public places. An economic slowdown put pressure on the government to lift restrictions, and there had been a feeling of exceptionalism based on the hope that India's young population and childhood immunisation scheme would blunt the impact of the virus. Models may have underestimated projected cases and deaths due to the under-reporting of cases in the country.

Due to high demand, the vaccination programme began to be hit with supply issues; exports of the Oxford–AstraZeneca vaccine were suspended to meet domestic demand, there have been shortages of the raw materials required to manufacture vaccines domestically, while hesitancy and a lack of knowledge among poorer, rural communities has also impacted the programme.

The second wave placed a major strain on the healthcare system, including a shortage of liquid medical oxygen due to ignored warnings which began in the first wave itself, logistic issues, and a lack of cryogenic tankers. On 23 April, Modi met via videoconference with liquid oxygen suppliers, where he acknowledged the need to 'provide solutions in a very short time', and acknowledged efforts such as increases in production, and the use of rail, and air transport to deliver oxygen supplies. A large number of new oxygen plants were announced; the installation burden being shared by the center, coordination with foreign countries with regard to oxygen plants received in the form of aid, and DRDO. A number of countries sent emergency aid to India in the form of oxygen supplies, medicines, raw material for vaccines and ventilators. This reflected a policy shift in India; comparable aid offers had been rejected during the past sixteen years.

The number of new cases had begun to steadily drop by late-May; on 25 May, the country reported 195,994 new cases—its lowest daily increase since 13 April. However, the mortality rate has remained high; by 24 May, India recorded over 300,000 deaths attributed to COVID-19. Around 100,000 deaths had occurred in the last 26 days, and 50,000 in the last 12. In May 2021, WHO declared that two variants first found in India will be referred to as 'Delta' and 'Kappa'. Karnataka announces a COVID-19 Memorial.

On 25 August 2021, Soumya Swaminathan said that India 'may be entering some kind of stage of endemicity where there is low level transmission or moderate level transmission going on' but nothing as severe as before, in other words India is learning to live with the virus.

Response shortages and criticism

The role of the National Centre for Disease Control during the COVID-19 pandemic has been questioned including the subdued sharing of data collected by the IDSP. Disease surveillance in India through IDSP faces perpetual shortage of funds and manpower resulting in a weak nationwide data collection system. The IDSP does not track deaths taking place outside hospitals, or deaths due to COVID-19 of those not tested, one of the many reasons under-counting is built into the system. The lack of epidemiologists in senior decision making positions of COVID-19 related committees has been evident, including the absence of state-level epidemiologists in a number of states. In April 2020, the health ministry asked states to go on a hiring spree and fill vacancies for epidemiologists.

Indian Council of Medical Research has been criticised for did not updating the 'treatment protocol for COVID-19' between July 2020 and April 2021. The 'National Task Force for COVID-19' did not meet during February and March despite members claiming it was obvious a second wave was in the making. A number of warnings pertaining to a surge in cases in March, shortages in life-saving equipment and a second wave were downsized and went unheeded. A number of problems were found with the forecasting and modelling by the National COVID-19 Supermodel Committee by independent commentators. In early May 2021, the committee said that they hadn't been able to predict the second wave accurately. A lot of problems with India's failing response to the second wave was the general and long term issues of the public health system in India.

Drug shortages

In January 2020, Indian pharma companies raised the issue that drug supplies could be hit if the pandemic situation in China became worse. India sources about 70% of its pharmaceutical ingredients from China. In March 2020, India restricted export of 26 pharmaceutical ingredients; this restriction pointed to impending global shortages. During the second wave of the pandemic in India shortages of certain drugs caused some COVID-19 patients to go to the black market. In April 2021, other important COVID-19 related drugs also faced lowered stocks and sharp rise in cost of raw materials.

Rural and semi-rural India

Over 70% of India's population, i.e. over 740 million people in India, live in rural areas. The share of COVID cases in rural and semi-rural India increased from 40% in mid-July 2020 to 67% in August 2020. This increase in covid cases was largely attributed to the movement of COVID infected migrant workers from urban areas back to their native villages. Issues aggravating the situation in rural and semi-rural areas include a severe lack of human resources in the health field. The second wave also saw migrants coming back from urbans areas, indicated by the sharp rise in employment generation through MGNREGS.

By May 2021, more than half the cases in Maharashtra and Uttar Pradesh were from rural areas. Another indicator of the situation in villages is the rush of villagers to semi-urban and urban areas in search of healthcare, 'about 30–35 per cent of the patients in hospitals in Bhopal are from villages and small towns located within a 200 km radius. It's the same story in Indore.' On 16 May 2021 a UP government official confirmed the report that corpses of people who succumbed to the virus in the rural areas had been dumped in the Ganges River due to lack of funds. Following this report, the UP state government announced that it will pay ?5,000 to poor families to cremate or bury the bodies of the dead.

Undercounting of cases and deaths

Undercounting of total cases and death figures was reported during the first wave in 2020. The discrepancies were detected by comparing official death counts released by the governments to the number of deaths reported in obituaries, at crematoria and burial grounds, etc. Some states were reported to have not added suspected cases to the final count contrary to WHO guidelines. Similar undercounting was reported during the second wave in 2021. There have been large gaps noted between official death figures and the sudden increase in the number of bodies being cremated and buried. Several crematoria that had been in disuse earlier were brought back into operation to keep up with the demand.

A series of articles in The Hindu newspaper estimated that compared to previous years, the number of additional deaths during the pandemic was about four times the official COVID death toll in Chennai, Kolkata and Mumbai, and could be up to ten times higher in the state of Gujarat. However, it is not clear what proportion of these are due to covid and what are due to other factors such as overcrowding of medical facilities, lock-down, etc. A report by the Center for Global Development stated that the second wave of COVID-19 in India was the 'worst tragedy since the partition'. The report, based on serosurveys, household data and official data, pointed towards a significant underreporting of deaths, with estimates ranging from about 1 million to 6 million deaths overall, with central estimates varying between 3.4 and 4.9 million deaths.

On the evening of 11 April, two reporters from the Gujarati language newspaper Sandesh and a photojournalist staked out the mortuary of the 1,200-bed state-run COVID-19 hospital in Ahmedabad. Over 17 hours, they counted 69 body bags coming out of a single exit before they were loaded into waiting ambulances. Next day, Gujarat officially counted 55 deaths, including 20 from Ahmedabad. Again on the night of 16 April, these journalists visited 21 cremation grounds around Ahmedabad and counted more than 200 bodies, with photographic and video evidence. The next day Ahmedabad counted only 25 deaths. Similar disparities in numbers were seen on other days. The Gujarat government denied the under-counting and stated that they were following federal protocols.

A study conducted by the University of California, Berkeley, and units of Harvard University, estimated in August 2021 that more than 16,000 excess deaths had occurred in 54 municipalities in Gujarat between March 2020 and April 2021. The study used data from civil death registers in a subset of Gujarat's 162 municipalities. The authors stated that the 'vast majorit'y of these deaths could likely be attributed directly to Covid-19. The government's estimate of the death toll from Covid-19 for the entire state was approximately 10,000 for the same period.