Coronavirus India: Why India’s COVID-19 death rate is so low

Mystery surrounds how India has escaped the pandemic relatively unscathed, with experts speculating that the total death toll has been vastly underreported.

Bella Fowler

2 min read

April 30, 2020 - 6:33AM

Stranded students from various districts during coronavirus lockdown in Prayagraj, India. Picture: AP Photo.

The mystery surrounding India's low COVID-19 death rate has prompted speculation into how the country, which has a population of more than 1.3 billion, has escaped the pandemic relatively unscathed.

While there are close to 30,000 coronavirus infections in India, the country has recorded just 934 deaths, far lower than the tens of thousands of virus victims in parts of Europe and the US, the hardest hit by COVID-19.

According to experts, low testing rates and underreporting – whether knowingly or not – could be a plausible explanation.

While some experts say India's strict lockdown measures are the reason why death rates are so low, and others claim the country's young population is helping to keep fatalities down, one physician told the BBC the answer remains unclear, adding that more testing in the early stages of the crisis would have provided clarity.

"To be totally frank, I don't know and the world doesn't know the answer," Indian-American physician and oncologist Siddhartha Mukherjee said.

“It's a mystery, I'd say and part of the mystery is we are not doing enough testing."

A doctor takes a swab sample of a resident during a COVID-19 coronavirus testing in Mumbai. Picture: AFP.

The BBC also reported India may have unknowingly underreported its cases of coronavirus deaths, given close to 80 per cent of deaths occur in the home, and counting hospital deaths alone would not be sufficient to collate an accurate number of COVID-19 fatalities.

Nor would a count from funerals at crematoria and burial grounds, given many people who die in India are cremated in the countryside.

Policemen patrol during coronavirus lockdown in Prayagraj, India. Picture: AP Photo.

In addition, some Indian doctors have reported that people who died of COVID-19 symptoms weren’t tested, while others who have died in recent months could have been misdiagnosed.

As severity of the pandemic has become clearer, it has come to light that most affected countries have inadvertently underreported deaths.

Professor Jean-Louis Vincent, from Belgium's Erasme University Hospital, told the BBC underreporting of COVID-19 deaths was happening "in many countries, including India".

"When you are told the person had some fever and some respiratory problems before death, you may suspect COVID-19. But it may be something else," he said.

"Death is often preceded by an infection, sometimes minor. If you do not test, you may attribute many deaths to COVID-19 or deny its role altogether."

A recent Financial Times analysis of fatalities during the pandemic in 14 countries, not including India, also found that the death toll may be almost 60% higher than reported in official counts.

According to experts, underreporting of COVID-19 deaths is happening “in many countries”. Picture: AFP.

India's official nationwide lockdown began on March 25, and is expected to end on May 3.

When Prime Minister Narendra Modi first asked its 1.3 billion people to stay indoors, it was considered the world's biggest lockdown, with authorities enforcing the rules tightly. Modi faced criticism for ordering the lockdown with barely four hours' notice.

The countrywide restrictions came about weeks after India's Ministry of Health advised all states to avoid mass gatherings.

One religious group ignored the advice, leading to an enormous outbreak of 4291 cases.

Religious group Tablighi Jamaat gathered in at a mosque in New Delhi from March 13 to 15, with the number of coronavirus infections stemming from the event amounting to nearly a quarter of all COVID-19 cases reported so far in India.