ABSTRACT
BackgroundIndias official death totals from the COVID pandemic are widely regarded as under-reports. MethodsWe quantified all-cause excess mortality in India, comparing deaths during the peak of the first and second COVID waves (Jul-Dec 2020 and April-June 2021) with month wise deaths in 2015-19 from three sources: Civil Registration System (CRS) mortality reports from 15 states or cities with 37% of Indias population; deaths in 0.2 million health facilities; and a representative survey of 0.14 million adults about COVID deaths. ResultsDuring the first viral wave, the median excess mortality compared to CRS baseline was 22% and 41%, respectively, in included states and cities, rising to 46% and 85% during the second wave. In settings with 10 or more months of data across the two waves, the median excess mortality was 32% and 37% for states and cities, respectively. Deaths in health facilities showed a 27% excess mortality from July 2020-May 2021, reaching 120% during April-May 2021. The national survey found 3.5% of adults reported a COVID death in their household in April-June 2021, approximately doubling the 3.2% expected overall deaths. The national survey showed 29-32% excess deaths from June 1, 2020 to June 27, 2021, most of which were likely to be COVID. This translates to 3.1-3.4 million COVID deaths (including 2.5-2.8 million during April-June 2021). National extrapolations from health facility and CRS data suggest 2.7-3.3 million deaths during the year. ConclusionsIndias COVID death rate may be about 7-8 times higher than the officially reported 290/million population.
ABSTRACT
National predictions of the course of COVID mortality can be used to plan for effective healthcare responses as well as to support COVID policymaking. We developed the Global COVID Assessment of Mortality (GCAM), a statistical model with continually improving precision that combines actual mortality counts with Bayesian inference, to predict COVID trends, currently until December 1, 2020. In Colombia, the GCAM analysis found the peak of COVID mortality around August 12 and an expected total of COVID deaths of 24,000-31,000, or 48%-92% over the total through August 21. In Peru, a first mortality peak occurred around May 24, and given the current trajectory, a second peak is predicted around September 6. Peru can expect 29,000-43,000 COVID deaths, representing an increase of 7%-55% over COVID deaths through August 21. GCAM projections are also used to estimate medical surge capacity needs. To gauge the reliability of COVID mortality forecasts, we compared all-cause mortality from January through June 2020 with average all-cause mortality in previous years in Colombia and Peru, and found that the excesses were consistent with GCAM forecast, most notably a doubling of overall mortality from May 25-June 7th of weeks in Peru. The GCAM results predict that as a percentage of all adult deaths in previous years, Colombia can expect about 13% excess from COVID deaths, whereas Peru can expect 34% excess. Comparisons of GCAM analyses of several other countries with Colombia and Peru demonstrate the extreme variability that characterizes COVID mortality around the world, emphasizing the need for country-specific analyses and ongoing monitoring as more mortality data become available.