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In an Indian city, obituaries reveal missing coronavirus deaths and untold suffering

By JOANNA SLATER, NIHA MASIH AND SHAMS IRFAN | The Washington Post | Published: May 6, 2021

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NEW DELHI — It was halfway down page eight, one ripple in a sea of grief.

The obituary for Damyantiben Pithadiya, a 60-year-old mother of three, included a prayer for her to rest in peace. The memorial would be held by telephone "considering the current circumstances," it said.

Her death notice was one of more than 240 spread across seven pages in a local newspaper in the western Indian city of Rajkot one day in late April — a fourfold increase from early this year. Yet the rising tide of pandemic deaths — evident not only in obituaries but also at the city's crowded crematoriums — was not reflected in the official data. According to the authorities, the number of deaths from COVID-19 in the city and its surrounding district on that day was 12.

As India reels under a devastating surge of coronavirus cases, it is increasingly clear that the situation is even worse than statistics indicate. The country has shattered global records for daily infections, most recently on Thursday when it recorded 412,000 new cases in the prior 24 hours. It also reported nearly 4,000 deaths, India's deadliest day to date in the pandemic.

The actual toll is likely to be considerably higher. The Washington Post checked crematorium statistics in three cities in three Indian states and found a wide divergence from official tallies. In all of the cases, the statistics released by state authorities appeared to capture only a fraction of COVID-19 deaths.

Pithadiya was almost certainly one of those left uncounted. After she tested positive for the coronavirus and the oxygen level in her blood plummeted, her family drove her to the main hospital in Rajkot, a city on a large peninsula in the Arabian Sea. They waited outside in a line of ambulances and other vehicles for two hours. Her son Gaurav begged doctors to admit his mother or provide her with oxygen. She died in the car, he said.

The only paperwork Gaurav was given by the hospital was a small slip of paper that noted his mother's death but made no mention of COVID-19. Two weeks later, he has yet to receive a death certificate. If his mother "had received medical treatment, the result could have been different," said Gaurav, 35. She "took care of us for so many years, and I wasn't able to save her life."

With Indian hospitals overwhelmed and local governments stretched to their breaking points, experts say the official statistics cannot capture the real number of fatalities in a timely manner. Even in normal times, the mechanisms for reporting causes of death are not robust, experts say, particularly in rural areas, where people often die at home attended by family. In a surge of this magnitude, existing systems cannot keep up.

Yet there were also signs, even before the current wave of infections, that death counts in some parts of the country were artificially low. In certain places, coronavirus fatalities are being excluded from the pandemic death statistics, for instance, by not counting people with comorbidities in the official tally.

Now, experts warn that the true extent of the devastation might never be known, hampering the government's response. Understanding the scope of India's outbreak is crucial to controlling it, said Prabhat Jha, an epidemiologist at the University of Toronto. If authorities know where hot spots are, they can prioritize the distribution of a limited supply of vaccines and prepare for a third wave of infections that could arrive this fall, he said.

To grasp the number of fatalities in the current wave, Indian cities would have to release their data on all deaths, not just those from COVID-19, so epidemiologists could study the "excess" fatalities attributable to the pandemic, Jha said. In rural areas, where authorities are "swimming in the dark" when it comes to data on causes of death, Jha said, special surveys would need to be conducted.

A spokeswoman for India's Health Ministry did not respond to questions about the underreporting of COVID-19 deaths in the country.

In Bhopal, a large city in central India, crematorium records bear little resemblance to the official count. Mamtesh Sharma has worked for 20 years for the trust that runs the Bhadbhada crematorium in the city, one of several. "I don't know about the government's data but I am telling you what I see with my own eyes," said Sharma, 46.

He shared a ledger that he maintains of all the cremations that have taken place since April 11, with a separate column for those conducted according to COVID-19 protocols. The fewest number of daily cremations of COVID-19 victims was 34; the highest was 100, on April 24. Yet the official figures for such deaths in Bhopal never went above 10 for a single day in that period.

"I have never seen so many dead bodies in my life," Sharma said. "This second wave is killing people ruthlessly."

Avinash Lavania, a senior government official in Bhopal, did not respond to requests for comment on the discrepancy between the crematorium's data and the official statistics.

In Agra, the city famously home to the Taj Mahal, there is a similar mismatch. According to the official figures released by the Uttar Pradesh government, the coronavirus deaths in Agra have not exceeded 13 on any day since the start of April.

Chander Prakash Notnani, 41, has been the head priest for the past 15 years at the second-largest crematorium in the city. He said the crematorium has been receiving 100 bodies a day — unheard of before this year — and most of them are COVID-19 patients that are wrapped in special plastic bags.

"But when you read the newspapers the next morning, the official figures say only five people died of COVID-19 in the entire district," said Notnani. "We know it's a lie."

On Tuesday, a close friend of Notnani's died of COVID-19. He accompanied the family to a different crematorium — designated only for coronavirus victims — to conduct the final rites. He was given a token indicating he was 40th in line, with dozens of people behind him. The state bulletin for that day said the number of COVID-19 deaths in the district was three.

Navneet Sehgal, a senior official in the Uttar Pradesh government, said COVID-19 deaths in the state are entered in an online portal based on data provided by hospitals and personnel tasked with following up on positive cases. He denied that there was undercounting but said there could be a lag in updating the system, including because some of the staff members involved have been infected. "Information sometimes gets delayed, but it's not hidden," Sehgal said.

Early last month, newspaper editor Jayesh Thakrar watched in dread as the number of obituaries in the Rajkot edition of the daily Sandesh began to climb. In normal times, there would be no more than two pages of death notices in the 16-page paper, he said. But in April, that rose as high as nine, forcing the paper to expand to 20 pages to accommodate them.

"The tragedy is that they are hiding it," said Thakrar. Official statistics say that 220 people died of COVID-19 in the second half of April in Rajkot and its surrounding district. But figures provided by one of the city's seven coronavirus-only crematoriums indicated that it alone handled 673 COVID-19 deaths in that period.

In Gujarat, the state where Rajkot is located, the COVID death figures appear deeply flawed: Reporting by Sandesh indicates that only about 1 in 10 such fatalities in large cities are reflected in the official tally.

Doctors in the state say there has been an effort to keep death counts low. In Rajkot, COVID-19 deaths are counted only after they are vetted by a death audit committee at the main hospital, city officials confirmed.

The committee has excluded deaths of COVID-19 patients who had comorbidities, reducing official deaths by more than half in the first wave of the pandemic, according to two doctors with knowledge of the matter who spoke with The Post early this year on the condition of anonymity because they were not authorized to discuss it.

In the April surge, about 60 coronavirus patients died daily in the city's main hospital, one of the doctors said, but only 10 to 15 are declared to be COVID-19 deaths.

Two senior officials in Rajkot denied that there was deliberate undercounting of COVID-19 deaths.

Pithadiya, the mother of three, was not treated by a hospital and her case would not have been considered by the audit committee, the doctor said. Her son Gaurav, an accountant, spent harrowing hours at the hospital's morgue waiting for his mother's body. What he saw there shook him: More than 20 ambulances, each one carrying five dead bodies, leaving the hospital for crematoriums.

In the wee hours of the morning, after waiting four hours at the cremation ground, it was his mother's turn.

Now Gaurav is full of rage against the government of Prime Minister Narendra Modi, a politician whom he supported until recently. He said the current crisis made him feel ashamed to be an Indian citizen. Modi spent hundreds of millions of dollars building the world's tallest statue, but "we don't have oxygen," he said. "My mother could have been saved if there was oxygen."

The Washington Post's Maitree Muzumdar in Ahmedabad and Saurabh Sharma in Lucknow contributed to this report.