Coronavirus SARS-Cov2 (COVID-19)

[Atithee]

Yes, I know that. I was just reacting to the title of the numbers thread.

[jayakris]

Haha, yeah, it has been a year since some of you asked for an update-only thread (June 12th last year, I think). Whoa, none of us realized that it would be still going on after a whole year of that. Damn!

Anyway, we had +70.1K today, from about 1980K tests at a positivity that dropped further to 3.59% today. The 7-day case average came down by 4.3K to 85.8K... Great. So it is 30K less than last Sunday. Should we look for at least 15K less next Sunday, at 55K? ...

MAH shows no end to their death reconciliations. Added 2288 today; otherwise it was 1634 deaths.

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ICMR Update: 379,624,626 total tests... Sunday tests: 1,492,152... Lab count: 2642

[suresh]

Thanks Jay for maintaining the thread that gives daily state wise numbers for Covid19 cases for the past one year. I remember it starting off with us making random entries in this thread until Jay spun off a separate thread. To me this is the best resource for daily data for India on Covid19 today.

[suresh]

Telangana data is always suspect. If you remember, they did not share any data during the first wave -- maybe that is better. Telangana reported 15 deaths yesterday!

Excess deaths in Hyderabad are 10 times the official COVID-19 toll for Telangana

Figures corroborate Telangana High Court’s concerns with drastic undercounting of COVID deaths.

The number of “excess deaths” registered in the Greater Hyderabad Municipal Corporation (GHMC) ever since COVID-19 hit (from April 2020 to May 2021), is over 10 times the officially recorded figure of 3,275 deaths for the corresponding period in the entire State of Telangana. There were an estimated 32,752 “excess deaths” — 18,420 between April and December 2020 and 14,332 between January and May 2021.

Excess deaths in the GHMC were calculated based on the number of death certificates issued. The month-wise number for the last two years was accessed by The Hindu and compared with data for 2016 to 2019 that were obtained via an RTI. The 2021 figures were analysed till May 31.

Comparatively, the excess deaths’ multiple over the registered death toll in Kolkata and Chennai for 2021 was 4.5 and 3.3, in analyses published in The Hindu.

[arjun2761]

I believe excess deaths are higher in most parts of the world. A lot of the excess deaths are likely caused or impacted by Covid.

That said, the difference between the excess deaths and reported Covid deaths varies from country to country. Countries with poor healthcare infrastructure (e.g., most countries in Africa) likely have vast differences as do those whose governments that manipulate the data (such as China, Russia etc.). I suspect India is somewhere in the middle of the countries with respect to the undercount and mostly due to our poor healthcare infrastructure.

[suresh]

Under reporting of deaths always happens. However, Telangana's scale of under reporting is the issue.

[jai_in_canada]

Under reporting of deaths always happens. However, Telangana's scale of under reporting is the issue.

How can we be sure that ALL of the excess deaths were due to Covid-19? Apparently dengue fever, suicides and murders have been rampant in the past year, especially in agricultural communities, and which have not received coverage due to the "all Covid all the time" approach to news these days. The Hindu did not do an assessment of the "cause of death" in the death certificates, so we don't know for sure (not that that would be a very accurate indication anyway). The graphs indicate that the excess deaths coincided with the pandemic waves, so circumstantially we can reasonably deduce that most of those deaths must be due to Covid-19 - but it cannot be deemed conclusive.

Disclaimer: This is no way an attempt to defend that "genius" CM of TS. I am happy if their incompetence and/or lack of integrity are exposed. I'm just playing devil's advocate.

[jayakris]

I think we are all getting a good sense of what is going on. here is what I feel now, and what might be in line with the kind of news we hear of excess deaths (and the magnitude of real cases)

Basically, only half of India's actual cases have been found (because of lack of penetration of testing into some areas) - compared to what we would have found if we had the healthcare personnel/infrastructure penetration like in Europe or the USA. [I am not talking about the "infections" defined by sero-prevalence. Only talking about simply what would be found by good advanced-country testing regimes. Texas only finds 1/3rd of the cases shown by sero-prevalence. That means the sero-prevalence numbers have no relevance here, except to think of immune population]. If we compare apples to apples, India finds half of the case we could've humanly found (not 1/6th of all infections,where most of them cannot ever be humanly found - including by those who got it!)... I strongly believe that we do reach at least half of the population, and on that population that we test, nobody can blame India on our testing rate. Our positivity is still on par with, or better than, most of the developed world.

Then, secondly, the CFR we show (1.25%) is less than 2/3rd of what actually happens among the cases we officially test and find. This is because deaths are under-reported by hospitals and families. Doctors find all kinds of ways to write non-covid reasons, so even the state audit won't "reconcile" it later. The actual CFR in hospitalized cases is probably around 2.00% ...

But the CFR among the un-hospitalized village or poor-slum 50% of the cases (missed due to poor testing penetration mentioned above) may be as much as 5 percent. Here I simply use the initial death rates seen around the world even in hospitals in January last year before doctors figured out what to do.

If half of Indian cases are at 2% and the other half of unknown cases are at 5% deaths, then average CFR in India for ALL cases would be around 3.5 percent => that is about three times the CFR shown for hospitalized cases now.

So, multiply the Indian case numbers by 2, and death numbers by 2*3 = 6, and you will get the real India numbers. That is, India has had about 60M cases and about 2250K deaths so far.

That is the national picture. None of it is hidden by the state or lied about. Simply what is happening out there.

You can take the nation's average and find any state's true numbers based on the population. You will see that the reported excess deaths numbers (5 for West Bengal, for instance) do match. You can make some judgement adjustments up or down by 25% but pretty much that is the truth. You will find most states reporting only 1/6th of the deaths that may have actually happened. So when I see excess deaths data that show 10 times in Hyderabad, it won't shock me (sounds a little high, but not terribly high). No need to blame anybody. That is just how it is. For similar reasons, around the world the deaths numbers are probably 2 to 4 times too - no doubts about it. Only the Indian case gets discussed ad-nauseum. Like India is some super-advanced country that should be having perfect data on this. We don't. We are a really poor country that does much better than other poor countries like us have done.

[At the state level, there are some variations - but again not too much. The multiplier of 2 for cases is probably more like 1.25 in Kerala, 1.5 in Goa, and maybe 3+ in Madhya Pradesh. Hospital competence may make the CFR for hospitalized cases in Kerala close 1.00% but families and doctors managing to "write off" cases with non-covid reasons in the report, is as bad or worse in Kerala, so Kerala probably has 2 or 3 times as many deaths too.]

[jai_in_canada]

Basically, only half of India's actual cases have been found (because of lack of penetration of testing into some areas) - compared to what we would have found if we had the healthcare personnel/infrastructure penetration like in Europe or the USA. [I am not talking about the "infections" defined by sero-prevalence. Only talking about simply what would be found by good advanced-country testing regimes.

I don't think India has found 50% of the positive test cases due to limitations in its testing penetration compared to advanced countries. I think India has only found 25% of actual cases. Probably less. Here's my rationale.

Here are the rates of testing (total no. tests completed per million population) for a few different countries to compare to India since the start of pandemic reporting.

USA – 1,485,228
India – 271,478
France – 1,360,016
UK – 2,832,769
Italy – 1,136,264
Spain – 1,095,542
Germany – 740,889
Netherlands – 829,831
Canada – 936,498
Sweden – 1,007,882
Portugal – 1,213,798
Israel – 1,582,470

There is obviously a variation even among the so-called advanced country testing regimes, although as expected they exceed India's test penetration significantly.

However, depending on which one you take as the standard, the “missed” positive test cases in India would vary.

For example, compared to the US, India has only done 18% of tests > or said differently, if India had had the testing penetration of the US, it would have found 5 times as many cases i.e. 147,537,190.

Compared to the UK, India has only done 9% of test > or said differently, if India had had the testing penetration of the UK, it would have found 10 times as many cases i.e. 295,074,380.

So I feel that the estimation that India is only missing 50% of the positive test cases due to its testing penetration compared to advanced countries is being too optimistic.

Even if you take the average of the Top 10 most infected countries (which includes Brazil, Russia, Argentina, Turkey Colombia), the average testing rate to date is just over 1,000,000/million. India is just over 25% of that. So, I think what India is missing in positive case reporting due to limitations in its testing regime is more like 75%. In other words, if India had even had "average" testing penetration, it would have reported 3 times more cases i.e. a total closer to 120 million positive test results to date (instead of the 29.5 million as of Jun 13, 2021).
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Coming to deaths due to Covid-19, I think we might be missing much more than that but I am not sure how we can estimate that. People who tested positive and died at home and did not disclose the illness while obtaining the death certificate due to the stigma attached to the disease and deaths in hospitals that were mis-classified for whatever reason. For example, we had a family friend who had been in hospital for 7 weeks due to Covid-19 - actually due to complications due to Covid-19. His case would have been automatically reported as "Recovered" after 2 weeks. When he died, what would the doctors have put on the death certificate? Plus, he had lung cancer. So I think accurately estimating fatalities due to Covid-19 cases confirmed by testing is even more difficult, if not impossible.

[jai_in_canada]

^^^ For the above analysis, I assumed that TPR for India would have remained the same even if test penetration had been higher (on par with more advanced countries).

[jayakris]

^^^ For the above analysis, I assumed that TPR for India would have remained the same even if test penetration had been higher (on par with more advanced countries).

^^^ And that is a fatal assumption! It is simply NOT possible to get your numbers with our TPR. Not possible at all. I think you generally disregarded or under-estimated the importance of test positivity in these logical judgments. But TPR *is* what correlates to the deaths most, as even one of you (maybe you yourself?) had checked and posted here. That is because TPR does indicate at some level (not a liner connection) the population penetration of the testing regime too.

You used tests per million as the basis of the analysis, but that is not a correct assumption at all, in my opinion. More like, it cannot be - because I can't explain many countries' numbers based on that. The reason is that richer parts of the network tend to have much better social connectivity (related to activity and mobility of the population and where the friends and acquaintances of people live) and less social stratification. Larger circles that overlap, that is. But vast areas of poorer countries with villages do not have the same social mobility on large parts of the society, and vast groups of people even with an urban area are less connected to other strata of the society too. But lots of population are isolated into their own circles in places like Indonesia, India, Pakistan, Nigeria, etc, and maybe even Mexico (some of the large population countries). Population density is not the issue, but the social structure and activity circle sizes are the problem. The virus runs out of people faster in such structures and need another wave with some mutations to get there. It happens much less in USA, Europe, and most advanced countries. Partly the reason why Kerala has high numbers too. That is why the Indian peaks and drops have been sharper (especially the drops).

Depending on the type of the virus, countries like India will need several waves before we can say it has got to every part of the society. Then we can compare Tests per million, though it will still be fairly useless because every country will be in the 0.75 to 1.5 tests per person range!

If we had 4 times as many unreported "real" infections (not the epidemiologists definition, but what can be found), then we would have had 12 times as many deaths among those people. Because they WILL die at three times the CFR, without doctor care - and that is a conservative numbers I used too). That would mean at least 13 or 15 times the current death total. No, India has not had it. Nowhere even close.

Actually what I gave above as 6 times the reported death total is a high upper limit. Most research so far at state levels seem to point to around 4 to 5 times. Also note that newspaper reports will pick the worst cases and they would not write about all the cases where they found on quick calculation that say Salem had only 2 times the excess death (as an example). But even the worst biased (and localized) reports are not above 10 times. I saw academic research data that places like WB may be running at 4 to 5 times the deaths. And that is for a state that we always knew to possibly be unexcited to audit and give true numbers like Maharashtra does. I will not agree that Maharashtra has had even 3 times the deaths that they report.

[suresh]

@TNCoronaUpdate
#TamilNadu |14 June

• TN - 12,772
• Today's Deaths - 254 Yay!
• Today's Tests - 1,70,256
* TPR - 7.5%

• Coimbatore - 1,728
• Erode - 1,295
• Chennai - 828

Big States:

TN - 12772
KL - 7719 (TPR - 11.3%)
KA - 6835
AP - 4549
OR - 4339
WB - 3519

Total - 39733 (MH to come) -- this is the Monday low due to reduced testing on Sunday.

Expect a reduction of 10K from yesterday -- so it will be around 60-61K.

[suresh]

Tests per million will over count a little in the US -- don't know by how much. There are lots of people (athletes, students, university staff etc.) who are tested weekly. In India, we do not usually look for a second RTPCR negative test to declare a person free of covid. If you are okay after 2 weeks, you are considered officially free of covid. This is a factor of two reduction that we have with respect to the rest of the world. Most estimates for Indian deaths are 4-5 times the official count as Jay mentions. But Telangana (the state I grew up in) is special. It is not as if press is reporting only on bad states. The Hindu did similar analysis for WB and TN as per the link that I shared earlier about Telangana.

[depleter]

SO, the big states count is 47862. Looks like we will be below 60K.

[jai_in_canada]

You used tests per million as the basis of the analysis, but that is not a correct assumption at all, in my opinion.

So what IS the correct way to compare test penetration across countries? Cuz you were comparing India's testing regime to those of advanced countries. How were you doing that? (Just a hint would suffice, no need for a lecture )

Basically, only half of India's actual cases have been found (because of lack of penetration of testing into some areas) - compared to what we would have found if we had the healthcare personnel/infrastructure penetration like in Europe or the USA.

On what basis did you estimate that India has only found 50% of the cases because its testing regime was lower than those of advanced countries?

^^^ For the above analysis, I assumed that TPR for India would have remained the same even if test penetration had been higher (on par with more advanced countries).

^^^ And that is a fatal assumption! It is simply NOT possible to get your numbers with our TPR. Not possible at all. I think you generally disregarded or under-estimated the importance of test positivity in these logical judgments. But TPR *is* what correlates to the deaths most, as even one of you (maybe you yourself?) had checked and posted here. That is because TPR does indicate at some level (not a liner connection) the population penetration of the testing regime too.

I wasn't using that to estimate fatalities at all. I was using that as a constant to compare what India might have found if it had tested to the same extent as advanced countries, which you claimed would have reported TWICE as many positive cases. I am saying it would have reported THRICE as man. Besides, what does "It is simply NOT possible to get your numbers with our TPR. Not possible at all. I think you generally disregarded or under-estimated the importance of test positivity in these logical judgments. " mean?
Edit: Just to confirm, I used India's TPR (not some other country's) to project what the positive cases would have been more test penetration. Why is that "a fatal assumption"? (A bit dramatic wording, by whatever, it's just two blokes who know nothing about epidemiology. )