Family members of a person who died due to COVID-19 light the funeral pyre at a crematorium

India's COVID-19 infections could be 15 times higher than reported, says biostatistician

Bhramar Mukherjee, a professor of biostatistics at the University of Michigan, says India's "virus inferno" is "super-exponential," and that COVID-19 deaths and infections are underreported.

The World

A spiraling tragedy is unfolding in India, with nearly 400,000 new COVID-19 infections each day.

But those are just the reported cases.

By way of comparison, the US is now reporting close to 50,000 daily new infections.

Stories of deaths tangled in bureaucracy and breakdowns have become dismally common in India, where deaths on Wednesday officially surged past 200,000. But the true death toll may be much higher.

Related: India passes 200,000 COVID-19 deaths

India's daily deaths, which have nearly tripled in the past three weeks, also reflect a shattered and underfunded health care system. Hospitals are scrambling for more oxygen, beds, ventilators and ambulances, while families marshal their own resources in the absence of a functioning system.

Related: US loosens export restrictions to help India's 'full-blown' coronavirus crisis

Bhramar Mukherjee, a professor of biostatistics at the University of Michigan, has been modeling India's COVID-19 outbreak since March of 2010.

She joined The World's host Marco Werman to talk about what went wrong, and how the Indian government might respond now using data and statistics to inform policy decisions moving forward. 

Marco Werman: Professor Mukherjee, what is going on in India? Why is this spike happening? 

Bhramar Mukherjee: So it's really a confluence of factors: A lack of COVID-appropriate behavior, the avoidance of masks, large gatherings were happening. Political rallies, religious festivals and massive weddings were taking place. The public transportation reopened. So, it was really like a perfect storm. But then also, I think the new emerging variants, which were circulating silently throughout the country, has led to this virus inferno that is super-exponential, almost. It's really hard to watch this humanitarian crisis unfold.

So, we can only confirm the reported cases. Can you give us a sense of the real scale of what's going on in India?

The real scale of the pandemic is really beyond imagination. There is a mind-boggling number of people who are sick right now in India, the crematorium reports and the burial grounds, and people have taken satellite images of the fires that are being lit to come up with an estimate of death underreporting, as well. So, I think because of the surge, many deaths go undereported or medically unreported in India. Right now, we estimate that the total number to total death tally could be two to five times more, and the total number of infections could be 15 times more.

Fifteen times greater than what we understand right now? 


You wrote on Twitter that things are getting worse every day. That's what we're seeing. You've also written this is a national medical emergency. What is the government in New Delhi doing to tackle this crisis? 

So, what we have seen is a series of regional lockdowns, and I just don't think it's enough at this point. So many people are sick that health care capacities are completely overwhelmed. I just think that there's no way, except for massive regional lockdowns or regional lockdowns almost everywhere in India, possibly a national lockdown. 

So, why hasn't that happened? Why hasn't the government already taken these measures, or why haven't they put them in place?

So, you know, of course, I am not a policymaker. I can only provide data based on which people have to take these decisions. And we have been giving this projection ... We did this projection so that you don't have to see it; you can envision the future and act. And the government, of course, for a country like India, where lives and livelihoods are enormously tangled and there are so many daily wage earners, it's very hard to take a decision for lockdown. But right now, when so many people are dying, I think this debate about lives and livelihoods are completely futile because you just have to save lives. If you're not alive, you cannot go to work. And so many people are grieving. So many people are sick. To save lives: Lock down and accelerate vaccination. 

Related: Calls for fair global distribution of COVID-19 vaccines 

Governments everywhere, they aim to emphasize progress and not disaster. I do see this group of mental health professionals in India urging the media, though, not to be focusing so much on the funeral pyres, because honestly, they're depressing and that impacts an already fragile state of mental health for so many Indians. What occurs to you, professor, when you hear that?

So, I do think that we do need to take care of our mental health, but I do not think that just those images are contributing to the mental health decline. It's the immediate proximity to death and sickness. I personally have lost more friends in the last two weeks than in my entire life. So, even in my safely inoculated first-world bubble, my mental health is declining because of the immediate effect on my life, my family. So, I do think that the truth is always better than fiction. The world needs to know. I agree that dwelling on the negative things is not always a good thing. You have to run a country with cogent and clear public health actions and policy. And I'd love to see a briefing by the Indian government, which is guided by data, science and action plans, as opposed to these images. 

So, you mentioned earlier your own family, professor, and I have to ask you, because I'm seeing so many people online in the diaspora who have families in India. Obviously, there's enormous concern. How is this affecting you and your family? 

Everybody who has families and friends in India, every time we see a text or our phone buzzing or a +91, which is the country code for an India call coming [in], our hearts just sink. We tremble with fear that someone has fallen sick. So, yesterday I received a call from my own family that my father was running a fever. I spent the whole night trying to find a test for him. Tests are so difficult to get in India. The earliest test I could get was three days away, with the promised results of two to three days away. If he has COVID[-19], and I hope he doesn't, it would be six days from his symptom onset. And this is my own experience, so you cannot escape this virus. This is a global pandemic. We really need global collaboration because this is really destroying the morale of the country and many others. 

This interview has been edited and condensed for clarity. AP contributed to this report. 

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