Preliminary Analysis of Excess Mortality in India During the Covid-19 Pandemic (Update September 26, 2021)

Background As both testing for SARS Cov-2 and death registrations are incomplete or not yet available in many countries, the full impact of the Covid-19 pandemic is currently unknown in many world regions. Methods We studied the Covid-19 and all-cause mortality in 18 Indian states (combined population of 1.26 billion) with available all-cause mortality data during the pandemic for the entire state or for large cities: Gujarat, Karnataka, Kerala, Maharashtra, Tamil Nadu, West Bengal, Delhi, Madhya Pradesh, Andhra Pradesh, Telangana, Assam, Bihar, Odisha, Haryana, Rajasthan, Himachal Pradesh, Punjab, and Uttar Pradesh. Excess mortality was calculated by comparison with available data from years 2015-2019. The known Covid-19 deaths reported by the Johns Hopkins University Center for Systems Science and Engineering for a state were assumed to be accurate, unless excess mortality data suggested a higher toll during the pandemic. Data from Uttar Pradesh were not included in the final model due to anomalies. Results In several regions, fewer deaths were registered in 2020 than expected. The excess mortality in Mumbai (in Maharashtra) in 2020 was 137.0 / 100K. Areas in Tamil Nadu, Kolkata (in West Bengal), Delhi, Madhya Pradesh, Karnataka, Haryana, and Andhra Pradesh saw spikes in mortality in the spring of 2021. Conclusions The pandemic-related mortality through June 30, 2021 in 17 Indian states was estimated to be 132.9 to 194.4 per 100,000 population. If these rates apply to India as a whole, then between 1.80 to 2.63 million people may have perished in India as a result of the Covid-19 pandemic by June 30, 2021. This per-capita mortality rate is similar to that in the United States and many other regions.