Harsh Mander: How many Indians actually died during the second Covid-19 wave?

During India’s second wave of Covid-19, no family or workplace I know was untouched by the rampage of death, dread and desperation. Pyres were being burnt on city sidewalks, corpses were dropped in mass graves and rivers carried the burden of half-eaten human bodies.

Yet, governments denied the numbers who had died at this time. Even for many of those whose deaths were recorded, officials contested that their lives had been torn away by the deadly virus.

“The dead ask that they be counted,” Anna Kurian, a teacher of English in the University of Hyderabad, told The Wire.

Still, “even if the dead [were] all around us, everywhere, in hospitals and morgues, in ambulances, at cremation grounds, makeshift and established, buried on the banks of rivers, floating down the waters”, we refuse to do so, because we wish to deny our culpability, dent the myth of our greatness and negate the value to the lives that were lost.

For the period of the tumult of the summer months of 2021 when India’s second wave raged across the country, official records placed the number of Covid-19 deaths at the grim figure of nearly 3.73 lakh by mid-June.

On April 26, 2021, the number of recorded cases, at 360,960 in India, was the highest in the world. Reuters reported that just in the capital city of New Delhi, four people were dying every minute. In the six weeks from April 1, the official Covid-19 toll from the start of the pandemic rose by 2.2 times.

Five states – Maharashtra, Karnataka, Tamil Nadu, Delhi and Uttar Pradesh – accounted for 57% of all officially recorded deaths. In all states, except four (West Bengal, Odisha, Andhra Pradesh and Tripura and the Union Territory of Ladakh), the official toll at least doubled during this time.

In a few states, the toll rose by nearly four times. On June 10, 2021, with 6,148 deaths, India reported the highest single-day toll from Covid-19 in the world.

But scholars and reporters who counted cremation and burial figures or bodies brought into hospital mortuaries in both cities and villages offer compelling reasons to believe that the actual number of deaths was probably significantly higher.

I wrote in the first article of this series that in the industrial city of Surat in Gujarat, since the gas and firewood furnaces at a crematorium were operating 24x7 without a break, the metal of the furnaces had begun to melt.

Reality vs official figures

On April 14, 2021, 140 persons who were Covid-19 patients were cremated in just one crematorium in Surat, Caravan reported. But the Gujarat government reported 41 deaths for that day for the entire state: of these, 25 people were listed as dying in Surat. “On an average, every day we are getting around 150 deaths,” a manager of the crematorium told a reporter of Caravan. The employee said there was a distinct pattern of official under-reporting of deaths.

On April 11, 2021, he said, 190 deaths were handled by the crematorium – and those were “just the Covid-19 deaths”. But officially, Gujarat reported the death toll for that day for Surat at just 18, and for the entire state at 54. Likewise, on April 14, 2021, there were 275 cremations following Covid-19 protocols in Surat but the official tally for the whole of Gujarat was only 74 Covid-19 deaths.

A cremation worker who had been familiar with the workings of the facility since 1987 and involved with its daily functioning since 2005 told Reuters that he had never seen such a rush of bodies – not even during the outbreak of the bubonic plague in 1994 and floods in 2006.

At around the same time, journalists from the leading Gujarati newspaper Sandesh who had stationed themselves for 17 hours outside one government Covid-19 hospital in Ahmedabad on April 12, 2021, counted at least 63 bodies being brought to the morgue that day. But the state government’s Covid-19 death figures for that day for the city was just 20.

“The government is definitely hiding the real figures from the public,” an Ahmedabad-based television journalist told Scroll.in. “If Sandesh counted 63 bodies coming out of just one Covid hospital in Ahmedabad, and there are many Covid hospitals in the city, then how can there be just 20 Covid deaths?”

The story was not very different in Jamnagar, a small district town in the same state. The state government reported zero Covid-19 deaths in Jamnagar on April 13, 2021, and just one death on April 11, 2021. But a digital news portal Khabar Gujarat said around 100 people in Jamnagar died of the virus within 48 hours between April 10 and April 11, 2021. On April 13, there were 54 deaths in the city. Journalists with the portal said they got the death figures from the two cremation grounds in the city.

The Gujarati newspaper Divya Bhaskar reported that between March 1 and May 10, 2021, Gujarat legally registered 1.23 lakh deaths. In the corresponding period in 2020, there were around 58,000 registered deaths. The Hindu calculated that any comparisons with the 2020 figures could be misleading because the lockdown may have prevented or delayed many death registrations. They calculated instead the baseline from previous years for the same period of the year at 82,500.

“The 1.23 lakh registered deaths in Gujarat between March 1, 2021, and May 10, 2021, were thus 50% higher than expected from baseline estimates,” the paper said. “Moreover, the current Covid-19 wave may have caused delays in registration – the scale of the mortality surge could be even greater.”

But in this period, the official Covid-19 toll was 4,200, which means that the “excess deaths” are ten times higher, the paper said. The report warned that some of these excess deaths could also “reflect overwhelmed health-care facilities or worsening economic conditions”.

Excess deaths are deaths caused by Covid-19 together with non-Covid deaths due to the lockdown, over-burden health facilities, shortage of oxygen and medicines.

Similar reports of massive under-counting of deaths came in from many other parts of the country. In Kanpur, the local media reported that on April 22, 2021, though 476 bodies were cremated across the city’s crematoriums, government records showed just three deaths for that day.

In Bhopal, crematoriums recorded that in the month of April, the last rites of 2,557 people were performed according to the Covid-19 protocols. However, the official data for the entire district put coronavirus deaths at 104, the New Indian Express reported.

In June, the Bihar government itself raised its Covid-19 death figures to 9,429, from its earlier figures of under 5,500. This was after both the Opposition in Bihar and journalists had been alleging that the government was falsifying death figures to cover up its failure in handling the pandemic.

The Wire had also reported how numbers put together by crematoriums and municipal corporations proved that the number of deaths in the state was far higher than being officially reported. In Patna, for instance, crematoriums saw 452.4% more Covid-19 deaths than previously officially reported between April 1, 2021, and May 20, 2021.

The Hindu similarly used data from Kolkata’s municipal corporation to calculate that the number of excess deaths in 2021 compared to previous years was “as high as 4.5 times the official recorded figure of 1,371 Covid related deaths”.

In April and May 2021, these were “6.87 times the officially recorded figure of 1,198 deaths”. In Chennai and Mumbai, the paper found a rise in deaths of 20% in 2020 over previous years. But excess mortality in the second wave was four times the reported figure in Chennai.

Madhya Pradesh officially reported 4,461 Covid deaths between January 1, 2021, and May 31, 2021. The excess deaths found in this period were 42 times the reported Covid-19 toll. Part of this was again attributable to severe ruptures to regular health services.

Deaths undercounted

The figures for Covid-19 mortality tend to neglect or overlook deaths caused by policy choices made to deal with the pandemic. In India, rarely estimated are the extent of sickness and death resulting from the closure of OPDs and the diversion of beds and health personnel from other ailments, including hypertension, diabetes, cancer, HIV, TB, unsafe deliveries and almost every other disorder.

Even less visible are the mental health consequences of job losses and isolation borne out of extended lockdown and of mass hunger. A window into one kind of non-Covid deaths – caused by mental health consequences – was provided by a report of the National Crimes Records Bureau in October 2021 on “Accidental Deaths and Suicides in India” for 2020. Road accidents and related deaths fell in the pandemic year, but by contrast, the number of deaths by suicides rose by 10% from 2019, taking the total figure to an all-time high of 153,052, the Hindustan Times reported.

Instructively, daily wage earners made up the largest proportion of people who died by suicide in the country in 2020, at 24.6% of the total. Their share in total deaths by suicide in the country has doubled from 12% in 2014 to 24.6% in 2020. This should not be surprising because they bore the hardest brunt of India’s punishing lockdown with among the smallest relief packages in the world.

Murad Banaji, a mathematician at Middlesex University, London, Aashish Gupta, a PhD Candidate in Demography and Sociology at the University of Pennsylvania, and Leena Kumarappan, an independent researcher, scanned the Hindi press for reports of suspected Covid-19 deaths from the first three weeks of May 2021 in villages in Uttar Pradesh, Haryana, Bihar, Madhya Pradesh, Jharkhand and Rajasthan.

Together, the reports noted 1,297 deaths from villages with an estimated combined population of around 480,000. They calculated that around 0.27% of this population died of suspected Covid-19. The median value was of 0.31%. This meant that in a village of 5,000 people, there were around 15 deaths in about 15 days, roughly one death a day.

In normal times, using crude death rates from 2018, around 174 deaths would have occurred in all of these villages taken together in this period. Since 1,297 deaths occurred instead, there were around 1,123 excess deaths in these villages. This means that deaths in the second Covid wave were more than seven times higher than in normal times.

“It is little wonder that many of the reporters who visited the villages describe panic, confusion, and sometimes a feeling of abandonment,” the authors note.

They calculated that there were 2.3 excess deaths per thousand population. In some villages, one in every 200 villagers died within the span of a month or less. But the researchers found, based on the media reports, that not even 10% of the deaths mentioned were officially recorded as Covid-19 deaths.

They found that “only a small minority of those who died were ever tested for the disease. Some reports are explicit that none of the deceased was tested, while in others this is strongly implied”.

The authors concluded that rural India saw much higher death levels than had been officially reported. “The low death figures reflect poor testing and recording rather than some natural ‘protection’ from severe disease in rural India. It is likely that the great majority of rural Covid-19 deaths in many parts of India have gone unrecorded.”

Milind Sohoni, who teaches at IIT Bombay, looked closely at the official data on Covid-19 deaths per million in the states of India, comparing these also with global levels. In the affluent nations in the West, from the United States to Belgium, there were roughly 1,500-2,200 deaths per million population, he wrote in the Indian Express. In India, the official data shows wide divergence: 100 deaths per million in Uttar Pradesh and 150 deaths per million in Gujarat to 530 deaths per million in Karnataka and 1,980 deaths per million in Goa.

This is counter-intuitive, as Uttar Pradesh has 37 doctors per one lakh people, Gujarat has 101, while the states with higher deaths per million, Karnataka and Goa have 153 and 260 doctors per one lakh people. This divergence is probably explainable, Sohoni surmised, at least in part by the under-reporting of deaths, more so, the cause of death.

The Census office reported in 2018 that in Goa, 100% death certificates reported the cause of death. In Uttar Pradesh, this was only 6%, Sohini wrote. By scaling each state’s death toll by this factor, he calculated that we could get more comparable deaths per million figures for all states – other than Gujarat – of 1,500 to 2,000.

‘Data denial’

Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, lamented that many parts of India were in “data denial”. “Everything is so muddy,” she said to Reuters. “It feels like nobody understands the situation very clearly, and that is very irksome.” But what explains this massive under-reporting of Covid deaths across many parts of the country?”

Amulya Nidhi, national co-convener of the Jan Swasthya Abhiyan suggested: “Those who tested positive were counted as Covid patients and their deaths counted as Covid deaths. Thousands of people across the state who died in villages with Covid symptoms have gone untraced.”

In addition, thousands more had died from the lack of access to routine health services including cancer treatments and dialysis, he said. “What is to be gained from hiding this data? Making it public can help plan for the next wave.” His advice was ignored by the Central and most state governments.

A report in The Indian Express examined reasons for extensive under-reporting of Covid-19 infections, fatality rate and the total number of deaths, especially in rural India. These are the result first of a weak data collection system. The Registration Act was promulgated in 1886, providing for birth and death registration throughout British India on a voluntary basis. In 1969, the Registration of Birth and Death Act was enacted.

Although death registrations have risen to 92%, the levels of registration are uneven between states. The Hindu reported: states like Bihar and Jharkhand have levels of registration of deaths of 51.6% and 58.8%. Moreover, even in 2019, only a fifth of registered deaths in the country contain a medical certification of the cause of death. In most cases, the cause of death is reported simply as “old age” or “unknown”.

In some states, the medical certification of deaths is a lot lower. For instance, it is 9% in Madhya Pradesh, 7% in Uttar Pradesh, 6% in Jharkhand and 5% in Bihar. In these states, therefore, over 90% of the time we do not have a definitive cause of death. Even in Kerala, a well-administered state, medical certification of death by a doctor is only 12%.

Some lapses leading to under-reporting that the Hindu Business Line identified are:

1. Some of the Covid-19 positive cases and deaths under home quarantine or of those waiting outside hospitals were not being considered
2. No information was collected and maintained of a patient from the stage of testing positive till the outcome of infection
3. There were cases that were negative in RT-PCR tests but diagnosed as positive in CT-scan or chest X-ray. These cases are not included in official statistics.

For the huge rural population, testing facilities are scarce and people do not want to test for fear of being hospitalised. Especially in rural areas, health officers ascribe deaths due to Covid-19 to comorbidities, partly due to poor testing facilities or to give the illusion that they handled the pandemic efficiently.

Manipulated data

There is reason to believe that the absence of robust death reporting is not just the outcome of institutional infirmities, but actual official design to shroud the full extent of the pandemic. India has two major data systems, the Civil Registration System and Sample Registration System, which collect death data for all population and sample population, respectively, but both systems do not publish this data in real-time.

There are only annual reports published only after two or three years. If these were published instead on a weekly or monthly basis, this would have supplied scientific estimates of excess deaths and Covid deaths. Likewise, the Indian Council for Medical Research has, since the outbreak of the pandemic in 2020, collected hospital-based data, but once again this is not released to the public, Hindu Business Line reported.

Some experts go further to maintain that there is clear manipulation and dishonesty by state authorities about Covid testing and death statistics in India.

In an interview with Karan Thapar for The Wire, Rijo M John, a health economist at Rajagiri College of Social Sciences in Kochi, describes several examples of state governments in Uttar Pradesh and Bihar manipulating tests and presenting dishonest outcomes. He said that Bihar and Uttar Pradesh increased tests in areas where case levels were low and conducted low testing in areas where cases were increasing.

This, he said, was to present to the Indian public (and global observers) a low test-positivity rate to make the state look good. John gave several examples of this. In Lucknow, which has 13.4% of Uttar Pradesh Covid cases, only 4.9% of tests were done, while in Bijnor, with 0.7% of cases, 10.2% of tests were done.

Likewise, in Patna, with 19.3% of cases, only 3.6% of tests were done, while in Aurangabad, with 2.9% of cases, 12.4% of tests were done.

Inadequate testing

On occasion, states also made highly inflated and, in fact, incredible claims about the number of tests they have done. Bihar has 66 labs but claims to have done 2.94 crore tests up to date. This amounts to 4.5 lakh tests per lab. John said if you assume that the labs worked six days a week and eight hours a day this comes to 1,200 tests per lab per day. In turn, that amounts to 150 tests per hour and 2.5 tests per minute. But in fact, an antigen test, the quickest test available, takes at least 30 minutes.

Chahat Rana and Shahid Tantray from Caravan also studied carefully the reasons for undercounting. First, officials confirmed that they were collecting mortality data only from hospitals, and not from crematoriums. A team of experts conducted rapid audits on these hospital deaths, to determine if Covid-19 was the primary cause of death. But the deaths of people with comorbidities were not counted as Covid-19 deaths, even if they test positive for Covid-19. Also, “those who test negative but have symptoms indicative of Covid-19 are not counted”, Dr Ashish Naik, who works with the Surat municipal corporation confirmed to Caravan.

This flagrantly violates guidelines of the Indian Council of Medical Research that for patients who test positive and die, Covid-19 should be recorded as an antecedent cause of death. Conditions such as acute respiratory distress syndrome or an acute cardiac injury should be recorded only as the immediate cause of death.

The guidelines add that if a confirmed Covid-19 casualty has comorbidities, these should not be recorded as underlying causes of death. There is sound scientific reasoning for this instruction, which is that while comorbidities might cause complications, they do not cause in most of these cases in of themselves cause death.

In addition, the Indian Council of Medical Research requires that if a patient has clinical symptoms of Covid-19 but tested negative for the disease, “clinically diagnosed Covid-19” should be added as an antecedent cause of death. And in case the patient died while the test results were pending, then the words “suspected Covid-19” should be entered as the antecedent cause of death.

A major reason for high unreported deaths in rural India, particularly in poorer North Indian states were that “most of the deceased were not tested, and many did not receive medical attention…Some of the deaths were likely preventable. It seems that inadequate public health messaging led to generally poor awareness about the pandemic in rural areas”, Caravan reported.

Dipankar Ghose, a reporter for the Indian Express, painted a vivid picture of how Covid deaths evade the official record in a rural district in Uttar Pradesh, Rae Bareilly. He wrote about a pall of fear that enveloped a village that he visited, Sultanpur Khera.

A makeshift wooden barrier was erected by villagers at the entry to the village, where 18 people had died in the period of one month. Residents testified that the village has never seen 18 deaths in a month before his visit. “In a village of our size, maybe one or two [deaths in a month,” one person told Ghose. “There are many months when there are none. When someone dies, everyone knows because everyone comes together.” .

Another villager, a bank employee, had carefully compiled details of all the 18 dead, and 17 of them had displayed flu-like symptoms. Official records show only two Covid deaths from the village in April 2021.

After the mass deaths, the district administration swung into action on May 2, 2021. They cordoned off the village and undertook mass testing. But people did not know who had tested positive. In a week there was another death, of a man who sold masks and cloth products. A neighbour reported, “I tried calling ambulances but could not get through. Nobody comes here to the village anyway. Before we had any chance to think, he was dead.”

Experts believe that a major reason why the second wave was so disastrous was the failure of timely death tracking and public reporting. Why is accurate death data in real-time so critical?

Nandita Saikia, an Assistant Professor in Population Studies at Jawaharlal Nehru University and Krishan Kumar, a PhD candidate in Population Studies at the same institution, explained in Indian Express that “Precise knowledge on premature deaths due to Covid or other causes will facilitate proper intervention at the local level. This could prevent avoidable deaths. The information could be a crucial input for budget allocation, implementation of health services, and creating behavioural changes among people.”

It would also enable researchers to investigate the Covid-19 pattern clinically as well as from a social science perspective.

Further, “reconciliation of mortality figures would allow a more systematic study of our current health infrastructure, [hu]manpower and capabilities and the human costs of not having them in place”, she wrote.

Data journalist S Rukmini also underlines a moral responsibility of the living to the dead – that an independent and scientific inquiry into the actual numbers of Covid deaths, and comparing this with the death statistics presented by the government is something we owe to the dead. Honesty and transparency about the total deaths “should be our way of paying respect to the ‘millions’ who have died and also the best response to the catastrophe India has suffered” over the course of the pandemic, she told Karan Thapar in an interview with The Wire.

Appeal to Modi

In April 2021, more than 200 scientists and medical researchers, made a public appeal to Modi, for “rapid and systematic data collection and release so that data-driven mitigation measures can be implemented”. They cautioned that India’s inability to adequately manage the spread of the infection had resulted largely from its epidemiological data being either not systematically collected or denied to the scientific community.

They asked for “the systematic collection and timely release” of data on testing for better predictions of the spread of the infection, data on clinical outcomes of hospitalised patients to improve treatment strategies, and data on the immune responses to the inoculation campaign in India to validate the vaccines’ efficacy.

They said that the Indian Council of Medical Research had a database of testing data on all 1.83 crore people who had tested positive until then, but this remained inaccessible even to researchers in government agencies, let alone outside these. One of the signatories, Gagandeep Kang, a senior clinical microbiologist at the Christian Medical College, Vellore, said to The Telegraph, “We cannot do public health without data, we need multiple pairs of eyes looking at data, we need experts from academic institutions to be looking at data.”

Infectious disease modeller Gautam Menon from the Institute of Mathematical Sciences, Chennai said, “The ICMR is sitting on a mountain of data that it either isn’t analysing itself or allowing others to analyse.”

Needless to say, this appeal too was ignored by the prime minister and his government.

Excess deaths

What then was the extent of death under-counting? The University of Washington Institute of Health Metrics and Evaluation estimates that India’s actual death toll is around three times what is reported by government bodies. Underreporting Covid deaths is found to be a global phenomenon: for the planet, it is estimated that actual coronavirus deaths exceeded reported deaths by 113%.

The major reasons for this are said to be a lack of testing in deaths that occurred outside of hospitals, especially in countries with a poor public health services, and also weak reporting systems. Still, India’s unreported Covid deaths are estimated to be much higher than the global average.

The National Health Mission’s Health Management Information System, which aggregates data from around 200,000 health facilities across the country, registered every month in 2019 on an average 200,000-220,000 deaths in the country. But in April 2021, this rose to over 310,000 deaths, the highest in recent recorded history.

In May, the number of deaths shot up further to 511,000. This was more than double the usual monthly deaths of any recent month, a 175% increase compared to May 2020 and a 150% increase over May 2019. The biggest increases were in deaths from “fever” and “respiratory diseases”.

Dr Yogesh Jain, a public health physician in rural Chhattisgarh, and founding member of the Jan Swasthya Sahyog, told IndiaSpend, “In the absence of other information, these deaths should all be considered as Covid-19 deaths, particularly in a month like May where we will not expect deaths from malaria or similar vector-borne diseases that present with a fever.”

Another leading public health expert T Sundararaman added that this database does miss out on a lot of deaths in private hospitals, but it offers robust insights into the situation of rural patients because the database captures not just deaths in public facilities, but also deaths at the village level collected by the wide network of auxiliary nurse-midwives.

This data reveals that in May 2021 alone, there were over 300,000 more deaths than in normal months (May 2019), which is 2.5 times the official Covid-19 death toll of 120,072 in May 2021. It is significant that the data also shows a rise of as much as 82% in maternal deaths in May 2021, over maternal deaths reported in May 2019, a reminder of the fatal consequences of diverting all the limited public health infrastructure and personnel to Covid-19 care.

Data journalist Rukmini said in an interview for The Wire with Karan Thapar that she believes the most reliable estimate of total Covid-19 deaths since the start of the pandemic in March 2020 is 25 lakh. This is more than five times the official tally of Covid deaths which was on July 10, 2020, pitched at 407,145. She also is convinced that the most robust estimate of Covid deaths during the second wave, between February-March 2021 and May-June 2021 is probably 15 lakh.

Some researchers in the US and the European Union have estimated that under-reporting of infections may be to the extent of 90%, which means only one case out of 10 is reported. A New York Times report used serosurveys and infection fatality rates to estimate the number of infections and deaths.

Serosurveys give an indication of the difference between the reported cases and actual possible cases. The newspaper calculated the number of probable covid deaths – according to it, the best-case scenario was that if the number of infections was 15 times higher than the number of reported cases, then there would have been 40.42 crore infections by May 2021. Taking the infection fatality rate as 0.15%, the deaths would be 600,000, about twice the current reported total of 3,00,000 as of May 24.

However, the report said that a more likely scenario was of the infection rate being 20 times higher than what is reported, bringing it to 53.9 crore cases. With the infection fatality rate at 0.3%, total Covid deaths until then would have been 16 lakh deaths, 5.3 times the currently reported total of 300,000 as of May 24, 2021.

But in the worst-case scenario, the total number of infections could have been 70.07 crore (26 times the reported cases), and with an infection fatality rate of 0.6%, the total number of deaths would be 42 lakh deaths.

Murad Banaji and Aashish Gupta used data that was publicly accessible on all-cause mortality from civil registration systems of 12 Indian states (which made up 60% of the country’s population) to assess the scale of excess deaths in India during the Covid-19 pandemic.

According to their still preliminary findings, for the 12 states, they found a 28% increase in deaths during the period from April 2020 to May 2021 as compared to the nearest pre-pandemic year, 2019. Extending this ratio to all of India, this implied 28 lakh-29 lakh excess deaths.

More limited data from June 2021 raised national estimates of excess deaths during April 2020-June 2021 further to 38 lakh. With more optimistic or pessimistic assumptions, excess deaths during this period could credibly lie between 28 lakh and 52 lakh. They conclude that pandemic mortality could have been as much as around 8-10 times than the figure officially recorded as Covid-19 deaths.

In their words, the data reveals that “India is among the countries most severely impacted by the pandemic. It is likely that in absolute terms India has seen the highest number of pandemic excess deaths of any country in the world”.

Spanish flu experience

Chinmay Tumbe, who teaches at the Indian Institute of Management, Ahmedabad, told the Indian Express how deaths over a century ago in the global flu pandemic were spectacularly undercounted. The Sanitary Commissioner of India estimated in 1919 that six million people had died in India during the 1918 pandemic.

But census officials in 1921 found entire villages depopulated, and the colonial government pushed up the pandemic death toll estimate to over 1 crore. Later scholars calculated that the deaths may have been even much higher.

Tumbe himself added estimates for the princely states and argued that the Indian subcontinent saw 2 crore deaths during the flu pandemic a century ago. This was three times the official figure, the death of around 6% of the total population, one of the greatest demographic shocks ever recorded in history.

The colonial government had introduced a death registration system in India in the 1860s in the wake of a cholera pandemic, Tumbe wrote. It seems reasonable to expect that in independent India a century after the flu pandemic, the country’s death data would be far more robust and credible.

But as we have seen, for a variety of reasons, both systemic and deliberate, we sadly cannot trust the data of Covid-19 deaths that the government publishes.

Punjab’s sanitary commissioner wrote at that time:

“The hospitals were choked so it was impossible to remove the dead quickly enough to make room for the dying…. the burning ghats (cremation site) were literally swamped with corpses, the depleted medical service was incapable of dealing with more than a minute fraction of the sickness requiring attention.”

We might recall how Hindi writer Suryakant Tripathi, popularly known by his pseudonym Nirala, spoke of the river Ganga as “swollen with dead bodies” when India was swept by the second wave of the influenza pandemic in 1918. In the pandemic, his family “disappeared in the blink of an eye”. Tumbe recalls this and other oral histories from that period describing corpses being thrown off cliffs or in jungles.

When in the summer of 2021, during another second wave of another global pandemic, the Ganga once again swelled with rotting, half-eaten dead human bodies, it was a sobering reminder that even with independence, electoral democracy and science, how little still has changed.

Read the other parts of the “Tsunami of suffering” series here.

The author is a Richard von Weizsacker Fellow, Chairperson of the Centre for Equity Studies and convenes the Karwan e Mohabbat, a people’s campaign to fight hate crime with solidarity and atonement.