How To Count The Covid Dead

Context: An accurate count of mortality during a pandemic is possible if a database is created on the basis of demographic principles rather than epidemiological models based on suspect assumptions.

Issues in counting deaths: The problems in counting deaths are two-fold:

• Counting the death:
  • The history of birth, death and marriage registration in India goes back to the Registration Act, which was promulgated in 1886 throughout British India on a voluntary basis.
  • The Registration of Birth and Death Act was enacted in 1969 to register and compile the statistics under the Office of the Registrar General and Census Commissioner of India.
  • According to the last civil registration annual report 2019 published in 2021, the level of birth registration in India is close to 93%: This means nine out of 10 births in India are registered.
  • Methods and approaches were put in place to make a near-accurate assessment.
  • During Covid-19, the excess deaths are estimated by epidemiologists and epidemic modelers with no formal training.
  • Moreover, the stigma and associated protocols of Covid mortality are very likely to lead to misrepresentation of deaths at the point of death itself.
• Assigning the cause of death:
  • Since 1969, the Registrar General has also collected medical certification of cause of death and produced a report on this measure.
  • The latest available report of 2019 says that 20.7% of total registered deaths have this information.
  • In most cases, on examination of the death registration data, the cause of death is reported as “old age” or “unknown”.
  • There could be a reasonable share of deaths on account of failing to access critical care in Covid- 19 times; thus, associating all excess deaths (if at all estimated with demographic principles) with the pandemic will be not only naïve but also simplistic.

Way Forward:

• Gathering Information: On assumption of transmission, risk of severity of the ailment, access to proper healthcare and, above all, the stage at which care-seeking happened can improve accuracy.
  • Their reliability is based on the accuracy of the inputs used and the assumptions made. This could be done by counting the number of deaths that could have occurred without the pandemic.
  • The Civil Registration System (CRS) datasets provide the periodic life tables of Sample Registration System (SRS)that have the advantage of offering the age cumulation of deaths and, therefore, will be useful in terms of age-sex characterization of deaths.
  • In addition to this, there are alternative information sets in periodic large-scale surveys such as NFHS with information on deaths in households.

• Assigning Covid-19 deaths: The real designation of Covid-19 deaths will be possible only for institutional deaths registered under strict guidelines for categorization of death due to Covid-related complications.
  • The most feasible option is to obtain excess mortality as a surplus over the routine count of mortality.

Conclusion: An inquiry on excess deaths need not be attempted, but it should ideally be assessed as a deviation from the normal course of mortality backed by demographic principles and sound information base rather than epidemiological models based on suspect inputs and numerous assumptions.