Huge Undercounting In India's COVID Cases, Fatalities Suggests 1st City-Wide Data Analysis

A large number of COVID-19 infections and deaths did not make it to the data in India and the numbers could be staggering high compared to the official figures, a study has revealed. This has been seconded by a detailed city-wide analysis of the impact of the first coronavirus wave in Tamil Nadu's Madurai. The result showed that the city detected only 1.4 per cent of infections and only 11 per cent of deaths among those aged 15 years and older.

Madurai, which tested at a higher rate than the national average, the risk of death was higher than in the US or England, according to a report published in The Lancet. It indicated that the RT-PCR tests picked up the more severe cases.

Over 1.7 million people reside in the city. It is the eighth-worst COVID-affected district in the state with over 3,700 confirmed positive cases and was hugely affected during the country's first wave, IndiaSpend reported.

Between May 20 and October 31, 2020, more than 4,40,000 RT-PCR tests were carried out in the city using unpublished official data as well as a government-funded, statewide serosurvey conducted in October-November 2020. The analysis showed that male and older people with a history of cancer, diabetes, and other specific medical conditions increased the risk of deaths among COVID patients. The research was led by Ramanan Laxminarayan of Princeton University.

Only 1.4 Infections Reported

Between May and October last year, India as a whole conducted 7.9 tests per 100 people, whereas Madurai conducted 13.5 RT-PCR tests per 100 people, much better than the Indian average. Still, the analysis revealed that the city found only 1.4 per cent of all infections, adding that "case data from other states or cities from India might underestimate total positive cases by a wider margin".

For those who were symptomatic at the time of testing, the possibility of testing positive on an RT-PCR test was 5.4 per cent, which is considered far higher, whereas, for asymptomatic patients, it was 2.5 per cent, even though more asymptomatic than symptomatic individuals were tested. The risk of contracting symptomatic infections rose steadily with age but it was broadly the same for the asymptomatic ones between zero to 44 year age group. However, it increased for people who were older than 44 years.

The serosurvey, conducted on a sample of 1,140 natives of Madurai, meanwhile found that serosurvey participants known to have had contact with a COVID positive patient had a 2.19 times higher probability of showing antibodies than those without known contact. Older people and those with comorbidities were also more likely to have the antibodies. However, men and women were just as likely to have antibodies, indicating a greater level of asymptomatic cases among women given the lower number of females in the official case counts.

About 40 per cent of the city's population aged above 15 years had been exposed to the virus by the end of the serosurvey study period.

More Fatalities Than US

The paper shows that Madurai recorded more COVID fatalities than the US, England, South Korea, Italy, and China for people aged between 0 and 60 years, whereas the death rate was similar for older ages. This could owe in part to the fact that the prevalence of known comorbidities among COVID-19 patients was higher at younger ages in Madurai than in the US and Italy and lower at older ages.

The data revealed that the death risk from the virus was significantly higher in Madurai than those in the US, Europe, China, and South Korea. COVID-19 surveillance in Madurai "captured a more serious clinical spectrum of cases", according to the researchers. To put it in simple words, mild infections went undetected.

The research also suggests the possibility of considerable undercounting of COVID-19 fatalities. Given the count of infections identified by the serosurvey, Madurai should have expected to see more deaths than its official records. The researchers estimate that only 11 per cent of expected deaths from Covid-19 were reported by official figures.

Health Administration Denied Claims

During April 2021 election campaign, Tamil Nadu's finance minister P.T.R. Palanivel Thiagarajan, while speaking to IndiaSpend, said that Madurai's crematoria reported more fatalities than the official statistics and pushed for an independent audit of COVID-19 deaths. However, the state's health administration denied the allegations saying it did not miss substantial numbers of COVID-19 deaths.

"Being an educated state, people in Tamil Nadu have considerably high health-seeking behaviour. So those with severe COVID symptoms will have gone to the hospital and diagnosed with the infection," B. Chandra Mohan, principal secretary in the tourism ministry, told IndiaSpend.

Also, a designated COVID-19 monitoring officer for Madurai district, Mohan added that the Infection Fatality Rate (IFR) models might predict higher deaths but it would be wrong to call them missed COVID deaths. "Based on other serosurveys across the world, IFR projections do not always reflect the true picture," he added.

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