In India, the process of reporting Covid-19 deaths follows a “bottom-up” approach as opposed to a top-down system, the Union Health Minister said

The central government on Thursday questioned reports which claim that the number of fatalities from the virus in the country has been 'vastly undercounted'.

Refuting such allegations, the government in a release said that the guidelines laid down by the Indian Council of Medical Research (ICMR) in this regard are being followed and that the Ministry of Health and Family Welfare has always advised states to conduct death audits in their hospitals to report any cases of death that may have been missed.

"Given the robust and statute-based death registration system in India, while some cases could go undetected as per the principles of infectious disease and its management, missing out on the deaths is unlikely," the Ministry of Health and Family Welfare said in an official press release.

"This could also be seen in the case fatality rate, which, as of 31st December 2020, stood at 1.45% and even after an unexpected surge observed in the second wave in April-May 2021, the case fatality rate today stands at 1.34%,” it added.

The center pointed out that media reports quoting findings from some recent studies, US & European countries’ age-specific infection fatality rates, have been used to calculate excess deaths in India based on the sero positivity.

“The extrapolation of deaths has been done on an audacious assumption that the likelihood of any given infected person dying is the same across countries, dismissing the interplay between various direct and indirect factors such as race, ethnicity, genomic constitution of a population, previous exposure levels to other diseases and the associated immunity developed in that population,” it said.

Furthermore, the center said that the sero-prevalence studies are not only used to guide strategy and measures to further prevent the spread of infection to the vulnerable population but are also used as another basis to extrapolate deaths. The studies also have another potential concern that the antibody titers may diminish over time, leading to underestimation of true prevalence and corresponding overestimation of Infection Fatality Rate.

Moreover, the reports assume that all the excess mortality figures are COVID deaths, which is not based on facts and totally fallacious. “Excess mortality is a term used to describe an all-cause mortality figure and attributing these deaths to COVID-19 is completely misleading,” the release said.

Further explaining the method of reporting Covid-19 deaths in India, the central government said that the process follows a "bottom-up" approach, as opposed to a top-down system.

Districts report the number of cases and deaths to the state governments and to the Union ministry on a continuous basis, the press release detailed, adding that the entire system is run according to guidelines laid down by the ICMR since as early as May last year.

These ICMR guidelines are, in turn, issued as per ICD-10 codes recommended by the World Health Organization (WHO) for monitoring.

Notably, Union Health Minister Mansukh Mandaviya refuted allegations that the ministry was hiding Covid-19 deaths.

He said the central government only compiles and publishes data sent by the state governments.