On Friday Wuhan in China revised its Covid-19 death toll upward by 50% to 3,869

And

city last week upped its toll by 3,778 after it began reporting deaths of people who were suspected of having Covid but weren’t tested

UK’s death count of over 15,400 could go up by thousands if nursing home deaths are found to be from Covid, according to multiple reports

With growing evidence that the virus not only damages the lungs but also the heart, kidneys and other organs, the Centers for Disease Control (CDC) in the US has issued an advisory saying that even cases where the infection is not confirmed by a test may now be counted

Crucial for countries to have reliable mortality data: Experts

As many countries begin to accept that undercounting of Covid-19 deaths is inevitable and that official mortality statistics could end up excluding many such deaths, public health experts here say this could be even truer in India. Even in non-Covid times, only about 22% of deaths are medically certified in India, while roughly 10 lakh deaths a year don’t even get registered. Thus, not only are Covid deaths likely to get undercounted, even deaths due to other causes with people not being able to access the health system during lockdown or due to the health system’s intense focus on Covid may not get fully counted.One of India's most respected epidemiologists, Dr Jayaprakash Muliyal , who was principal of Christian Medical College in Vellore, said unless a patient dies in hospital there is no way of knowing for certain if it was a Covid death. “Death reporting in India has always been a problem zone; more so while ascertaining the cause of death,” he said. “We have criteria for everything in India. Chennai eradicated malaria a few years back by classifying such deaths as fever deaths. In order to eliminate cholera, Kolkata decided to classify such cases as gastroenteritis,” Muliyal added.The apprehension that deaths could be understated through ‘reclassification’ has reason. There are reports from some states that hospitals are being pressured to keep the Covid toll down by attributing some deaths primarily to other causes, opening up a debate over whether a patient “died of Covid vs died with Covid”.West Bengal has set up an expert committee to ‘ascertain’ whether deaths of coronavirus positive patients are actually due to the virus. Mumbai’s municipal corporation has decided that all suspected Covid deaths will be subjected to an audit before being confirmed.Unless countries have reliable mortality data and there is a substantial jump in overall mortality as happened in Italy and the Netherlands, where the mortality data showed twice as many excess deaths as the official Covid count, it would be difficult to even estimate the extent of under-counting, point out experts.In India, the chief registrar of births and deaths estimated 70 lakh deaths in 2017, of which about 60 lakh were registered. Of those, only 14.1 lakh or 22% were medically certified. In many states, less than 10% of deaths were medically certified.Many co-morbidities, like heart disease, respiratory disease and diabetes, that make people vulnerable to Covid and increase chances of succumbing to the disease are also conditions that account for the highest proportion of deaths in India.As per the government’s report on disease burden trends in 2016, about 1.6 lakh died of cardiovascular diseases every month, over 64,000 from chronic respiratory illnesses, and several thousands from cancer and diabetes. Thus, without adequate testing and protocols on death certification, many deaths from Covid could be certified as being caused by the co-morbidities or in some cases vice versa. Dr Rama Baru from the Centre of Social Medicine and Community Health in JNU says, “How can you estimate Covid deaths without adequate testing facilities?