The NYT article about India's true death count

The New York Times is reporting that India’s true death toll from Covid-19 is possibly many multiples higher. Duh! (Unfortunately subscription required).

For those who are interested in a slightly different perspective behind these stunning headline numbers, I present some thoughts here. Without access to NYT's data it is difficult for me to draw any conclusions but I do wish to offer some perspective.

First, even if the death toll is 600,000 this would still be comparable to deaths from other diseases like Tuberculosis in a given year.

Second, these numbers conflate deaths FROM Covid and deaths WITH Covid. So, even if the precipitating cause is respiratory illness or cardiovascular disease, a death is chalked up to Covid-19 if Covid-19 is present. But if death was caused by (say) influenza these would not be notifiable and this would not make the headlines. A key sentence from the NYT article: “Four out of five deaths in India are not medically investigated.”

This matters. First, whether a death is caused by Covid-19 or not depends crucially on the definition. Some countries define a Covid-19 death only as those where Covid-19 is present in post-mortem RT-PCR tests. These countries (like Singapore) are reporting fewer Covid-19 deaths. Others that take a more expansive view where a death is considered a Covid-19 death as long as Covid is present or EVEN SUSPECTED are reporting a higher death count. Not all Covid-19 deaths are Covid-19 deaths though in the haze of panic they appear to be!

These are also not “excess deaths” that are happening on top of all other deaths; many of these deaths would have happened in any case. This is “displaced mortality” rather than “excess mortality”.

The NYT article does not show an awareness of these subtleties.

Furthermore, and I may well be proved wrong on this with better data, for most countries Covid-19 is not altering background mortality. This simply means that the pattern of death from Covid-19 is similar to the usual pattern of death, primarily from old age.

Even now Covid-19 is killing primarily the elderly. But in India rotavirus and diarrhea kill thousands of children every year. This typically does not make the headlines.

For all those who will write in to accuse me of being a callous jerk or an apologist for the country’s ruling government, let be clear. I am not a supporter of the country’s ruling party. I believe they have mismanaged some of this and have been responsible for some super-spreader events. But it is still important to maintain a sense of perspective. We are fixating on Covid-19 too much in a country where death comes in many different shapes and forms.