Muslims worst hit by Covid-19 mortality during first wave in India, new study shows

Muslims saw the steepest decline in life expectancy in the first year of the Covid-19 pandemic in India, indicating the highest rise in mortality risk among all social groups, a new research paper based on the National Family Health Survey has found.

Life expectancy of Muslims went down by 5.4 years between 2019 and 2020, more than four times the decline of 1.3 years seen among upper-caste Hindus.

The decline among other socially disadvantaged groups was also high: 4.1 years for Scheduled Tribes and 2.7 years for Scheduled Castes.

Life expectancy is the average number of years that a person is expected to live. When mortality rises among a group, life expectancy goes down.

The paper published on Friday in the science journal Science Advances compared life expectancy at birth among Indians in 2019 to that in 2020, using data from the National Family Health Survey, which it says is representative of about one-fourth of India’s population.

Overall, life expectancy at birth among Indians was 2.6 years lower and mortality was 17% higher in 2020 than the previous year, the research found.

This implies 11.9 lakh excess deaths in 2020, according to the research paper. Excess deaths is a metric used to analyse Covid-19 mortality by calculating the divergence between deaths reported due to all causes in a pandemic year and in normal years.

This estimate for excess deaths in India in 2020 is nearly eight times the official number of Covid-19 fatalities, and 1.5 times the excess deaths estimated by the World Health Organization during the year, the researchers said in their paper.

Using this metric, the study found that in India, mortality increased in almost all age groups between 2019 and 2020, but most prominently among the youngest and older age groups, mirroring the trend seen across the world.

However, contrary to the global trend, the life expectancy of women in India declined by one year more than that of men in 2020.

Why is this study important?

Aashish Gupta, a post-doctoral research fellow at Oxford University and one of co-authors of the research paper told Scroll that this is the first study to have examined mortality impacts of the Covid-19 pandemic in India by sex, social group, and age.

Gupta also said that using data from the National Family Health Survey’s fifth round, the study revealed patterns in Covid-19 mortality in India that could not be observed in other data sources like the Civil Registration System, a nationwide system of recording all births and deaths.

The Civil Registration System has been found to be lacking in coverage among women and other marginalised groups even during normal times, Gupta said. “Moreover, the system was disrupted between March and May 2020, during the first wave of the coronavirus pandemic, due to a severe lockdown in India,” he added.

Vulnerable groups faced greater mortality risk 

The study shows that excess mortality and a sharper decline in life expectancy prevailed across population groups that are vulnerable and marginalised in terms of sex, religion, caste and age.

For example, the study found an overall decline of 2.6 years in life expectancy between 2019 and 2020. But the loss among women was 3.1 years, that is one year more than the 2.1 years observed among men. This is in contrast to the global trend as in most countries, losses to life expectancy were greater for men than women, the study noted.

In normal years, women outlive men in India. But when the pandemic hit, the loss of life expectancy was larger among women due to gender-biased social conditions, Gupta told Scroll.

“We need to keep in mind that during the pandemic when everything is a pinch on your pocket, what gets prioritised in Indian households,” Gupta said. “When you are short of money and access to healthcare is limited, you would prioritise a male aged 40 to 60 years old who is probably the earning member of the family.”

Another factor Gupta pointed out was the underreporting of female deaths in official records like the Civil Registration System, which he said, was a shortcoming in the system even before the pandemic.

“If you look at serosurveys [which measure levels of antibodies against a virus], you will find the level of infection is similar among men and women, but the number of deaths is higher among men,” he said. “The National Family Health Survey shows that it is not that more men died, but that they are getting reported more because Covid death registration is a function of whether you are getting tested and counted as a death in a hospital.”

Like in the case of women, the study also found greater decline in life expectancy among disadvantaged caste and religious groups, as compared to privileged social groups in India.

Increased Covid-19 deaths among vulnerable groups showed that the inequality in access to healthcare widened during the pandemic.

This could explain why the decline in life expectancy among Scheduled Castes and Scheduled Tribes was sharper than in upper caste Hindus, Gupta said. “The fact remains that excess mortality was higher in these marginalised groups and that got underreported, so that itself shows that what is happening to these groups does not make it to the national conversation,” he added.

For Muslims specifically, Gupta pointed out that marginalisation had become more prominent in recent years. “In the beginning of 2020, for example, there were riots in Delhi, so the narrative of marginalisation intensified, and there were reports of Muslim-dominated areas being completely cut off from health care.”

Gupta said the Tablighi Jamaat congregation in Delhi was an example of marginalisation of Muslims during the pandemic.

The religious congregation took place in March 2020 in Delhi’s Nizamuddin area, days before a countrywide lockdown was imposed. After the Centre declared the congregation as a hotspot for Covid-19 infection, rumours and fake news gave the spread of the coronavirus a communal hue.

In terms of age, increased mortality was most prominent among the youngest and older age groups, the study found. Gupta said that this was consistent with underlying patterns as these age groups have higher mortality rates even in normal situations. But due to the stress on the healthcare system caused by the pandemic, immunisation programmes for children and old-age care might have been disrupted resulting in mortality rates going even higher.

‘Triumphalist narrative’ debunked

Gupta also told Scroll that the study’s finding on the undercounting of deaths due to Covid-19 in 2020 punches holes in the “triumphalist narrative” within the government about pandemic mortality being contained before the second wave of the pandemic hit in 2021.

He said that the mortality due to Covid-19 in the second wave got more noticed because it was an acute crisis that took place over a very short period. “But existing data has not been able to capture the extent of mortality in 2020,” he said.

As an example, Gupta pointed out that the World Health Organization data on Covid-19 mortality in India showed fewer deaths in April 2020 as compared to the same month in the previous year. This was because, Gupta said, the WHO took the Civil Registration System at face value, but the system itself was impacted because of a lockdown in the country.

This sort of undercounting of deaths allowed the government to say that the worst of the pandemic was over even as serosurveys that provide an estimate of levels of antibodies against a virus suggested otherwise, Gupta said.

“In March 2021, there was this triumphalist narrative that we have overcome Covid and nothing happened,” Gupta said. “Our study shows that if you had datasets like the National Family Health Survey that monitor mortality more accurately, we would not have such a triumphalist interpretation of the pandemic. We would have been better prepared before the delta [second] wave arrived.”