Under-reporting does hurt the COVID fight -Bhramar Mukherjee and others
Without good data, accurate projections are impossible, making it difficult to gauge the true state of the pandemic
India, now home to the world’s worst ongoing coronavirus pandemic, is currently reporting nearly a million new cases and 10,000 deaths every three days, according to data released by the Ministry of Health and Family Welfare. The true extent of the second wave now ravaging India is likely much worse than official numbers suggest.
Is it a problem noted only in India? Not capturing all COVID-19 cases and COVID-19-related deaths is not unique to India. Research on the behavioural dynamics of COVID-19 from a group at the Massachusetts Institute of Technology estimates the global under-reporting factor for cumulative cases around 7 and for deaths 1.4 as of December, 2020. Researchers further note that these factors vary substantially across nations. In India, this problem seems to be particularly acute during the second wave based on empirical evidence and epidemiological models.
Why is it hard to capture all COVID-19 infections and related deaths? There could be several reasons why we cannot capture all COVID-19 infections such as silent asymptomatic infections, barriers to testing due to cost and travel time, reluctance to get tested due to COVID-19 associated stigma, limited availability of tests, obtaining a false negative test (remember that diagnostic tests are not perfect) and alike. Deaths related to COVID-19 that are missed often consist of deaths that happened outside health-care facilities at home, and post-COVID-19 deaths where the cause of death is listed as a pre-existing comorbidity such as heart disease or kidney failure. India also has a poor and delayed infrastructure for reporting of deaths and certifying the cause of death in general, particularly in the rural areas. In a 2017 estimate, one out of five deaths was medically reported.
How do we estimate this under-reporting from epidemiologic models? For modelling growth of an epidemic, what we observe are deaths, cases or hospitalisations. However, what really defines an epidemic is not exactly the growth of these observed quantities but the infections, which in turn become these outcomes (deaths, cases, hospitalisations) with some delay, and not all infections get converted to these observed quantities. What proportion of people die from an infection is a very important quantity as it allows us to know how dangerous a disease is. Another important quantity is how many infections a health system identifies, that is, how many of these will actually end up being reported as cases. A high number of infections being caught by the health system shows a successful surveillance strategy.
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The Hindu, 4 May, 2021, https://www.thehindu.com/opinion/lead/under-reporting-does-hurt-the-covid-fight/article34474676.ece?homepage=true