Renowned virologist Dr Jacob John says as long as tests and results are all computerised, transparency is more or less assured, but the problem lies in coverage
Huge crowd seen at Marine Drive on Sunday. File pic
In view of a major article in The Lancet dated September 5 accusing India of lack of clarity and shortcomings in vital registration, testing practices and proper classification of COVID-19 deaths, mid-day speaks to renowned virologist Dr Jacob John about the concerns that the findings have brought to the fore. Dr John headed the ICMR Centre of Advanced Research in Virology and National HIV/AIDS Reference Centre at the Christian Medical College, Vellore, where he set up the country's first diagnostic virology laboratory to get answers to questions on data fudging and if it had any geo-political ramifications amidst the pandemic.
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Your interpretation of the study
The Lancet editors have always been interested in India's health issues, hence the report on India's COVID-19 situation is not surprising. There have always been shortcomings and lack of quality and coverage of data regarding vital events registration in the health management system, except for births. In the administrative system vital events of births and deaths are recorded but there is no cross-talk between these two systems — something that can easily be corrected if the government wants to. Deaths are recorded in the administrative system, but it is not interested in cause of death as long as it is neither homicide nor suicide. I feel the health ministries do not want clarity because it will tarnish the image of the healthcare system. The sudden interest in COVID-19 data therefore is understandable. In view of the long-standing flaws in the system, we cannot suddenly demand professionalism and transparency. Disease classification with evidence was never scrutinised by anybody.
Is India actually fudging the numbers? If so, why?
The states and UTs generate data while the GoI is just a bystander, so the question of fudging numbers does not arise. States have tried to alter criteria to look good, but the media has always acted as a watchdog. In case of COVID, the plus point is that the denominator is the total number of people tested positive. That is an underestimate of totals, not only in India, in all countries. But as far as lab-tested cases are concerned, they are followed up until the final outcome — recovery or death. Therefore, within that denominator, deaths reported are by and large reliable.
Is data fudging helping anybody?
No one was ever interested in the number of deaths with disease classification, and India does not have the required system to collect such data. Globally such an information system is called 'public health surveillance' but GoI does not want that and is happy with its cheap substitute called IDSP, just to collect some statistics, which are non-verified and non-verifiable.
Did initial confusion over testing and treatment protocol lead to alteration of figures?
As the pandemic progressed, testing in our country also became robust. As a result, a large number of positive cases was reported to the extent of almost thousands per day in India and approximate 25,000 in Maharashtra alone. Don't these high figures suggest transparency? As long as tests and results are all computerised, transparency is more or less assured. The problem lies in coverage. If 8 out of 10 infections are undetected, how do we know how many among the 80 per cent are undetected?
Are tier 2 and tier 3 cities the problem area in terms of detection?
The issues are different if we compare COVID and other diseases. Data of those tested and found positive for COVID-19 is transparent. I feel the deaths that go undetected are by definition non-COVID deaths. So the problem is systematic in nature.
With the mortality rate reducing, do you think it's the reflection of a transparent process?
'Has been reduced' is without evidence, but 'has apparently declined' is accurate. Leaders taking credit for positive turn of events and not accepting blame for the negative ones is the norm in India, partly because the government knows that the general public is gullible. A lot of people believe that India's response to COVID-19 has been exemplary, and low death rates reinforce that. Fudging cannot explain it. It is a phenomenon. This seems to be the case in many very poor (unhygienic) communities and India fits the bill. Healthcare has improved as doctors learned from experience and publications. Time also has an influence. As time moves on, mortality is tending to decline.
India's score is very poor, says Shaikh
Speaking to mid-day, Dr Wiqar Shaikh, senior allergy and asthma specialist said, "Currently India has more than 72.88 lakh positive cases, which is around 5,359 cases per million population. The US has 82.88 lakh positive cases, which translates to 24,997 cases per million population. The international portal has said that till date India has conducted approximately 82 million tests, which translates to 64,000 tests per million population. The highest number of tests in the world has been conducted in Israel (4.47 lakh tests per million), UK (4.21 lakh tests per million) and USA (3.70 lakh tests per million). India now stands in the 22nd position in the world in terms of tests per million population. This is a very poor score and corroborates the findings of The Lancet, raising concern regarding under-reporting of COVID-19 cases and deaths in the country."
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