Arrival of patients from other States could explain under-count factor falling below one in 2020
The number of “excess deaths” registered by the Civil Registration System (CRS) in Delhi ever since the COVID-19 pandemic hit (from April 2020 to June 2021) was an estimated 55,239, which is 2.2 times the official reported figure of 24,977 COVID-19 deaths for the same period.
The undercount factor increased to 3.4 if only the January to June 2021 period is considered, rising due to a surge in mortality during the second wave in May and June 2021.
Data on deaths registered from January 2020 to June 2021 in Delhi were sourced by The Hindu via multiple Right to Information (RTI) queries filed with five urban local bodies. Data for the previous years were sourced from the annual reports on the registration of births and deaths in Delhi.
The excess deaths were calculated as the difference between the month-wise total number of registered deaths during the pandemic period and the average of deaths registered for the same months during the pre-pandemic period (2018 and 2019).
If only 2020 is considered, the excess deaths are considerably fewer than the COVID-19 deaths. Thus, the undercount factor was below one. This might be due to the sudden drop in the number of patients from outside Delhi due to a stringent lockdown and border closings during the first wave. The CRS includes deaths among the migratory population too, while the death estimations done by the Sample Registration System considers only the fatalities among the domiciliary population. Back in 2001, the number of registered CRS deaths in Delhi was only 1.1 times that of the estimated SRS deaths. By 2018, registered CRS deaths were more than double (2.25 times) the estimated SRS deaths. This shows the significant increase in patients from outside Delhi who come to the city’s hospitals to access its superior healthcare facilities.
Commenting on the under-count factor falling below one in 2020, Dr. Jugal Kishore, head of the Community Medicine Department at Safdarjung Hospital said, “Our hospital used to receive a lot of patients from Bihar, U.P., Rajasthan, Haryana, and all over the country. But non-COVID patients from other States were very less during 2020, when the lockdown was strict. This year, the lockdown was not that strong and we got more patients from other States. So the undercount factor being below one for 2020 could be explained because of this.”
“Delhi’s reporting system of COVID deaths initially had some problems and there were some fluctuations, but it was later rectified,” said Dr. Kishore.
“Still, there was under-reporting of COVID deaths as tests could not be done or the deaths occurred at home. But Delhi has much better reporting of deaths compared to other States, which is also due to the high media presence in Delhi,” he added.
(With inputs from Nikhil M. Babu)