The media talks about the mystery behind the India coronavirus death rate and that the country is going against the world's trend of mass-infection. Death rates in major Indian cities are also lower than in other global hotspots. One way to inspect the mortality is to monitor how many days does it take for the number to double. India, this number is nine days. The country recorded 825 deaths from Covid-19 on April 25, double that of April 16.

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India has a surprisingly low death rate for a populous country

Experts acknowledge this as good news. The time that the number of deaths in New York doubles during the same period of the disease is two or three days, according to the BBC. Many public health experts and doctors say the widespread lockdown \employed over the past month could have helped reduce the India coronavirus death rate.

The medical journal Lancet also said that the lockdown had been effective in flattening the curve. Others believe that the young population has helped India reduce the death rate because the elderly are exposed to a higher risk of death when infected.

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Has the lockdown policy paid off?

There is also an argument that the less virulent strain in India, combined with the hot weather has slowed the spread of disease. Neither of these statements is evidence. In fact, the doctors treating the critical Covid-19 patients said that the virus in India is just as virulent as anywhere else in the world.

So is India coronavirus death rate an exception?

Are there any un-recorded deaths?

Indian-American doctor, Siddhartha Mukherjee told the BBC that neither he or the world knew the answer. “This is a mystery and I think part of this mystery is that we didn't perform enough tests. If we test more, we will know the answer. ”, he said. Mukherjee was referring to the process of testing people with Covid-19 and antibody testing to find out who has been infected and cured.

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False test results is a prominent cause

Whether India "miscounts" the number of deaths?

Most countries affected by the epidemic miscalculates the number of deaths. The New York Times, after studying death data for 12 countries in March, estimated that at least 40,000 more people died during the pandemic than official figures. This number includes deaths from infection as well as other causes.

The Financial Times, when analyzing the overall death rate during a pandemic in 14 countries, found that the real figure could be as 60% higher than the official report. However, the two studies did not look into Indian data.

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Indian hospitals recorded only a fraction of deaths

Dr. Prabhat Jha of the University of Toronto, head of India's Million Death Study, believes that in order to fight epidemics, unrecorded deaths must be considered. "Because most deaths in India occur at home and in the future, other systems are required," Jha told the BBC.

About 80% of India coronavirus death rate happened at home, which may include deaths from other illnesses such as malaria and pneumonia. Cases of maternal deaths or deaths from coronary diseases and accidents are often recorded in hospitals. "Many people come to the hospital several times, come back and die at home in India," Dr. Jha said.

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Other factors should be considered

Clearly, hospital deaths alone will not be able to tell the exact number of deaths related to Covid-19. Calculating this figure from funerals, cremations, and cemeteries is also difficult. Many Indians are cremated outdoors in large fields of the countryside. Funeral services only serve a small group.

At the same time, there are still no reports of an increase in India coronavirus death rate in hospitals. If this happens, someone will certainly report, K ​​Srinath Reddy, president of the Indian Public Health Foundation, told the BBC. Mr. Reddy also believes it is unlikely that the number of home deaths increases over an extended period of time without being noticed.

Nothing is certain

Without an effective public health monitoring system, experts say mobile phones can be utilized to detect whether the number of flu-related deaths has increased abnormally. More than 850 million Indians use mobile phones and encouraging them to call a toll-free line to report any unusual deaths in their village is possible.

Authorities can then track the number of deaths by visiting and investigating the cases. Counting the death figure is always inaccurate in India.

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Indian doctors are still running against the clock

About 10 million people die in India every year. The Million Death Study shows the number of deaths recorded is far less than the actual number. The Indian government reported only 100,000 premature deaths from HIV in 2005. This is only about a quarter what the World Health Organization (WHO) estimated.

In contrast, other disease-related deaths recorded were higher. The number of deaths due to malaria in the Indian government published was 5 times as high as the WHO figures. And according to the Indian government, only 22% of deaths here have a medical certificate.

So how to determine a Covid-19 death?

Some Indian doctors say that many have died of Covid-19-like symptoms without being tested or treated. The problem of misdiagnosis in a country where doctors often misdiagnose should also be considered. Jean-Louis Vincent, a professor at Erasme University Hospital in Belgium, told the BBC that India was among the countries that falsely recorded the actual number of deaths due to Covid-19.

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Hospital deaths alone are not accurate

He also stated that slight signs of infection could be seen before one died. But without testing, we can’t know for sure whether it’s related to Covid-19 or not. “That's why the mortality rates due to Spanish flu in 1918 vary in many places, ”Vincent said. Dr. Vincent is not sure whether the number of deaths presents a full picture of the disease. Experts also say most governments refused to report actual deaths to avoid making people scared. However, no one could deliberately conceal the number, especially when it’s too great, Dr. Jha said. 

The number of infections is greatly affected by laboratory deviations. Therefore,  counting the dead is far more reliable. “But it is important to make sure all deaths or a random sample are verified, ” he added.

India coronavirus death rate may be miscalculated and the country fails to locate Covid-19 infected cases. Though it is undeniable that the country has low mortality, it is still too early to decide whether India has negated the epidemic.