"Erroneous": Health Ministry on media reports highlighting excess mortality in 2020

New Delhi: The Ministry of Health and Family Welfare stated that the media reports highlighting excess mortality in 2020 from a study in the journal Science Advances are based on "untenable and unacceptable estimates" which are "erroneous" in nature.
The Ministry said that the study is erroneous and the methodology followed by the authors has critical flaws; the claims are inconsistent and unexplainable, adding that the study fails to acknowledge India's robust Civil Registration System (CRS), which recorded a substantial increase in death registrations (over 99 per cent) in 2020, not solely attributable to the COVID-19 pandemic.
"Some media reports have highlighted the findings from a paper published today in the academic journal Science Advances on life expectancy during the COVID-19 pandemic in India in 2020. These are based on untenable and unacceptable estimates," the Health Ministry said in a press release on Saturday.
While the authors claim to follow standard methodology for analysing the National Family Health Survey-5 (NFHS-5), there are critical flaws in the methodology, added the release.
The most important flaw is that the authors have taken a subset of households included in the NFHS survey between January and April 2021, compared mortality in these households in 2020 with 2019, and extrapolated the results to the entire country, the release added.
The NFHS sample is representative of the country only when it is considered as a whole. The 23 per cent of households included in this analysis from part of 14 states cannot be considered representative of the country.
The other critical flaw is related to possible selection and reporting biases in the included sample due to the time in which these data were collected, at the peak of the Covid-19 pandemic.
The paper erroneously argues for the need for such analyses, claiming that the vital registration system in low and middle-income countries, including India, is weak. This is far from being correct.
The Civil Registration System (CRS) in India is highly robust and captures over 99 per cent of deaths. This reporting has constantly increased, from 75 per cent in 2015 to over 99 per cent in 2020. Data from this system shows death registration has increased by 4.74 lakh in the year 2020 compared to 2019.
There was a similar increase of 4.86 lakh and 6.90 lakh in death registration in the years 2018 and 2019 over the respective previous years. Notably, all excess deaths in a year in the CRS are not attributable to the pandemic. The excess number is also due to an increasing trend of death registration in CRS (it was 92 per cent in 2019) and a larger population base in the succeeding year.
It is strongly asserted that an excess mortality of about 11.9 lakh deaths reported in the Science Advances paper in 2020 over the previous year is a gross and misleading overestimate. It is noteworthy that excess mortality during the pandemic means an increase in deaths due to all causes and cannot be equated with deaths that were directly caused by COVID-19.
The erroneous nature of the estimates published by the researchers is further corroborated by data from India's Sample Registration System (SRS). SRS covers around 84 lakhs population in 24 lakh households in 8842 sample units spread across 36 States or UTs in the country.
While the authors take great pains to show that results from NFHS analyses and Sample Registration Survey analyses for 2018 and 2019 are comparable, they completely fail to report that SRS data in 2020 shows very little, if any, excess mortality compared with 2019 data (Crude death rate 6.0/1000 in 2020, Crude death rate 6.0/1000 in 2019) and no reduction in life expectancy, the release said.
The paper reports results on age and sex, that are contrary to research and programme data on COVID-19 in India. The paper claims that excess mortality was greater in females and in younger age groups (particularly 0-19-year-old children).
Data on about 5.3 lakh recorded deaths due to COVID-19, as well as research data from cohorts and registries, consistently shows higher mortality due to COVID-19 in males than females (2:1) and in older age groups (several fold higher in > 60-year-olds than in 0-15-year-old children). These inconsistent and unexplainable results in the published paper further reduce any confidence in its claims.
The all-cause excess mortality in 2020 compared with the previous year in India is markedly less than the 11.9 lakh deaths reported in the Science Advances paper. The paper published today is methodologically flawed and shows results that are untenable and unacceptable, the release said.