A study analysing the registered COVID-19 deaths in Chennai district found a high degree of excess deaths. A figure of nearly 5.18 excess deaths for every 1,000 people has been reported in the study published in Lancet Infectious Diseases . The study also found that during the second wave of COVID-19 in Chennai, there was an increase in the percentage of pandemic-associated deaths with an increase in the measure of socio-economic community disadvantage. The study was conducted by researchers from the University of California, Berkeley; the University of Chicago, Illinois; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Centre for Disease Dynamics, Economics and Policy (CDDEP), New Delhi; and the Government of Tamil Nadu, Chennai.
In the period spanning the days between March 1, 2020 and June 30, 2021, the total number of deaths registered in Chennai district exceeded the expected number by about 25,990, the study found. Totally, 87,870 deaths were registered in areas of the Chennai district. This amounted to nearly 5.18 excess deaths for every 1,000 people. This can be compared with the figures on excess all-cause mortality from studies conducted across the U.S., nationally and within major cities, and in European countries — as of June 30, 2021 these settings recorded 1-2 excess deaths per 1,000 individuals.
Comparing the deaths reported as COVID-19 deaths with the above figures, the paper estimates that there was under-counting by a factor of approximately at least 3.18 (3.14 - 3.23) overall; of 2.15 (2.08 - 2.21) during the first wave; and of 4.38 (4.34 - 4.43) during the second wave. “The extent of under-reporting may be higher in places where there are challenges in access to testing which is important for attributing a death to COVID-19,” says Ramanan Laxminarayan of the CDDEP, one of the authors of the paper and who designed the study.
When asked about the lower number of excess deaths during the first wave as compared to the second wave, Indian Administrative Service (IAS) officer Chandra Mohan, one of the authors of the paper, says that while during the first wave only 2% - 6% of patients required oxygen supply, during the second wave, with a different variant of the virus being in circulation, there was higher incidence of severe disease and nearly 25% patients required oxygen and hospitalisation. “Everyone was overwhelmed, and the poor were more vulnerable because of the speed and severity of the Delta variant,” he says.
Further, during the second wave, neighbourhoods with lower socio-economic status (in accordance with the classification in the 2011 census) showed an increase in pandemic-associated mortality in proportion to the increase in each measure of community disadvantage, showing from 0.7% to 2.8% increase in pandemic-associated mortality per 1 standard deviation increase in each measure of community disadvantage. The researchers used 13 socio-economic indicators such as household crowding, lacking on-site latrines, lacking bank accounts, etc. As Dr. Laxminarayan explains, “Contrary to what we may have believed, the lockdown in the early stages did protect socio-economically disadvantaged communities both because of lower transmission and possibly because they were protected from other causes of death, including traffic accidents and injuries.” He opines that during the second wave, lack of access to healthcare facilities may have been a contributing factor to higher mortality in these communities.