The second wave of COVID in India was a human tragedy beyond belief. By the end of June 2021, India had reported around 4,00,000 deaths. As mind-boggling as the scale of death was, things could always have been worse. India's deaths relative to its daily infections still showed a low rate of mortality. But there were always persistent murmurings and allegations that India's real death count was far higher than what had been projected.

How much higher exactly? Well, a recent study by the Washington-based Centre for Global Development found that excessive deaths in India during the pandemic could be as much as 10 times higher than what was actually reported. To be clear, excess deaths are a calculation of how many more people are dying in an area across a defined period of time as compared to usual. This means that not all of these excess deaths the study refers to will be due to COVID. Indeed, establishing an accurate COVID death toll would likely be considerably difficult as conceded by the writers of the report though they did assert that the actual death toll would still be a lot higher than the official count.

There are reasons to suspect that the COVID count is likely different from what was given as the official count. First, it is unlikely that all deaths due to COVID were actually counted as COVID deaths. Persistent stigma regarding the virus, particularly early on in the pandemic, meant that many who were infected never actually got tested. 

Additionally, several states in India including Bihar and Maharashtra have in recent months revised their COVID death toll. Bihar even had to launch a state-wide audit to understand the scale of under-reporting. There were even suspicions raised that some states were adding a backlog of previously unrecorded deaths to new death tolls though no such allegations were ever proven. There is also the obvious doubt over how well the spread and devastation of COVID was actually tracked when it reached rural India where robust healthcare systems are not exactly in handy supply.

There are, of course, so many other studies and reports that study COVID mortality in India. The reason for this is because India's COVID struggle has been deemed unusual as it has exhibited an unusually low rate of mortality relative to its case count. And it is likely that such studies will continue and even expand. Consider that the Centre for Global Development report has also asserted that there was undercounting of deaths during the first wave of COVID earlier as well. The Centre has, of course, refuted claims of deaths being undercounted.

On Wednesday, the Union Health Ministry conceded that while there could be instances of COVID cases themselves being undercounted due to "principles of infectious disease and its management", it asserted that missing out on deaths entirely was entirely unlikely. The ministry did, however, note that proper recording of deaths in states and UTs could have been delayed in the second wave as health systems in India were straining but that this delayed count was later reconciled. A statement by the ministry also conceded that "It is a well-known fact that there shall always be some differences in mortality recorded during a profound and prolonged public health crisis such as COVID pandemic."

In a sense, this is entirely true and it is also quite likely that no accurate picture of COVID and its scale will emerge any time soon and that much of the establishment of fact would have to wait till after the pandemic. But there is some urgency to establishing an exact toll as well. The death toll would be a relevant bit of information that India will have to deal with as it confronts the problem of calculating how it will hand out COVID ex-gratia payments to those who died due to COVID.

Certain states are already paying compensation but not for all deaths. With the currently established death toll, the Centre has already stated in an affidavit that it is not financially viable to compensate each victim with Rs four lakh as an ex-gratia payment. Currently, the Centre is trying to figure out how exactly it can proceed with the ex-gratia payments and has asked for more time. Understandably, a drastic revision of the death toll during this process can be problematic. 

(With agency inputs)