Covid-19 tally in India: Are some states hiding death numbers despite rising cases?

Coronavirus deaths in India: On Friday, as India added 95,735 cases and registered 1,172 deaths, the country’s case fatality rate dipped to 1.68%. Another reason for the dip in case fatality rate may be better clinical management.

India may have been registering more deaths than any other country but, given more infections have been detected due to increased testing, the case fatality rate — total deaths upon total cases — is among the lowest of major Covid-infected nations.

On Friday, as India added 95,735 cases and registered 1,172 deaths, the country’s case fatality rate dipped to 1.68%. Another reason for the dip in case fatality rate may be better clinical management. At the start of the pandemic, hospitals were overflowing and there was no cure but, over time, management has gotten better. That is also the reason that death rate has come down from a high of 3.3% in June.

However, there is wide disparity in case fatality rate across states. It is evident that case fatality rate will decline as states detect more infections — Delhi’s rate has come down from 4.1% to 2.3%; similarly, Bengaluru’s fell from 5.9% to 1.5% and Bihar and Odisha also seem to be following this trend. However, the states have the lowest case fatality ratio.

Bihar’s case fatality rate was 0.6% on September 10, whereas Odisha’s was 0.4%.

Despite faring worst in terms of health infrastructure—Bihar has a doctor population ratio of 0.26 per 1,000 against the WHO-prescribed standard of one per 1,000, whereas its nurse to doctor ratio is 0.1 against the prescribed norm of 3—fatalities seem to be under control.

This is even more surprising if results of an ICMR study “Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India” from May are taken into consideration. Taking a sample of 144, the study found that the case fatality ratio amongst the infected was 1.4%.

The mismatch is also evident from the data for deaths per million. While Delhi had a high 247.9 death per million on September 10 when India had registered a rate of 54.74 the ratio for some states was way lower.

Bihar, for instance, had a death per million of just 6.21, whereas Odisha had a rate of 12.51. Given that Bihar has added more cases than Delhi in the last month and given Delhi undoubtedly has better infrastructure, the death per million in the country’s capital jumped from 220.8 to 247.9 between August 10 and September 10.

In contrast, the rate in Bihar went up from 3.1 to just 6.21. In terms of actual numbers, Bihar added 150 deaths fewer than Delhi did, despite adding 16,000 more cases. States that started experiencing infections around the same time as Bihar also registered more deaths.

In the case of Karnataka, for instance, deaths per million doubled from 50.3 to 100.8, while Andhra Pradesh saw a 2.3 times rise to 85.97 per million. The evidence of states under-reporting deaths is not uncommon. Earlier in the pandemic, it was found that Maharashtra had under-reported 1,300 deaths, which led to its case fatality rate shooting up from 3.7% to 4.9%.