As number of COVID-19 deaths increase in India, Death Rate decreases
Sai Krishna Muthyanolla
July 6, 2020
The number of deaths due to COVID-19 and the corresponding death rate, known as the Case Fatality Ratio (CFR), has wide variations across states. In some states, despite a phenomenal increase in the number of new cases, the CFR is well below 1.5%.
India recorded its first COVID-19 case on 30 January 2020, and the first recorded death due to this infection  was reported on 12 March 2020. The initial spread of COVID-19 in India was slow compared to the United States, western European countries and few of the Asian countries, largely on account of the lockdown. It was during the mid-May that the number of cases started to increase, after the lockdown restrictions were starting to be relaxed and the movement of people began. Currently, India ranks fourth among the countries with the highest number of cases.
In an earlier story on Factly, we observed that while the number of cases are increasing around the world, the number of daily deaths due to COVID-19 are decreasing. The data also shows that the case fatality rate (CFR) in India is least among the top six countries that are worst affected by COVID-19. Global trends also point out that the fatality rates in USA & Iran, which are experiencing a second wave of new COVID-19 cases are also lower than earlier.
In this story, we take a deeper look at the COVID-19 deaths in India and the CFR at state-level among other data.
Slight increase in the number of COVID-19 deaths
The first COVID-19 death in India was confirmed in Karnataka on 12 March 2020. The number of deaths recorded in day were in single digits for the rest of the month in March. The first double digit number of deaths was recorded on 02 April 2020, when 15 were reported. The number of daily deaths has been on an increasing trend ever since, though the death rate has slowed down.
There have been inconsistencies in the deaths being recorded under COVID-19, with subsequent corrections by various states. A well-known instance was on 17 June 2020, when both Maharashtra and Delhi reconciled COVID-19 death numbers resulting in the single day death figure of more than 2 thousand. This was a one-off instance.
In order to mitigate the impact of these extremities and inconsistencies of reporting, we have taken a 7-day moving average for the purpose of analysis. Further, the timeline being considered is from 01 April 2020, so we have substantial data. The source of information is the data released by the Ministry of Health & Family Welfare (MoHFW), Government of India.
The average number of COVID-19 deaths in India were being reported in double digits in the beginning of April 2020. The numbers have gradually increased over the remainder of the month, with daily average of deaths crossing 100 during the first week of May. By the end of May 2020, the number of reported daily deaths were just below 200.
The month of June 2020 saw a considerable increase in the number of reported daily deaths. The one-day spike on 17  June, as indicated earlier, had an influence on the average. Despite this anomaly, the number of deaths being reported was in the 300-400 range for the rest of June.
However, since the beginning of July, a higher number of daily deaths are being reported, as the number of positive cases is also rising. As of 8 AM on 05 July 2020, a total of 613 deaths were reported (not average) in the previous 24 hours.  The 7-day moving average has also increased to around 453.
While Deaths increase, Death Rate shows a decreasing trend
Although there is an increase in the number of deaths reported over the past few days, the fatality rate is witnessing a decreasing trend.  Case Fatality Rate (CFR) is the number of deaths divided number of positive cases identified.
The paradox of increasing number of deaths but a decreasing CFR can be attributed to a greater  proportionate increase in the number of new COVID-19 cases compared to the number of deaths.
During the month of June 2020, the fatality rates have increased from 2.8% to a peak of around 3.3% (on 17 June when 2000 + deaths were reported). However, it has shown a subsequent decreasing trend with the CFR going back to around 2.8% by 05 July 2020. This is considerably lower than other countries with high number of COVID-19 positive case, as highlighted in an earlier story.
Maharashtra has the highest number of COVID-19 Deaths
As of 05 July 2020, a total of 19,268 COVID-19 deaths were reported as per the information provided by MoHFW.  Out of these, the highest number of deaths were reported in Maharashtra with 8,671 deaths followed by Delhi which has reported 3004 COVID-19 related deaths so far. Gujarat with 1,925 and Tamil Nadu with 1,450 deaths are the other two states which have recorded more than One thousand deaths.
While most of the North-Eastern states have recorded a smaller number of COVID-19 related deaths, Chhattisgarh & Kerala are among the bigger states which have reported fewer deaths with 6 and 25 respectively.
Gujarat has the highest CFR
While India’s CFR is 2.8%, it is not even across the States. Gujarat has the highest CFR which is nearly double the national average CFR with 5.45%.  Maharashtra and Madhya Pradesh complete the top-3 states with the highest CFR with 4.33% and 4.09% respectively.
The other states which have a higher CFR than the national average are West Bengal, Delhi & Uttar Pradesh with 3.47%, 3.09% & 2.91% respectively.  Meanwhile Tamil Nadu which has the 4 highest number of deaths, has a CFR of 1.36%. Of the other bigger states, Andhra Pradesh, Telangana & Chhattisgarh have a CFR of less than 1.5%.
Is there an under-reporting of COVID-19 deaths?
Each of the states is at a different stage of COVID-19 infection. Maharashtra has been the most severely affected state in terms of the numbers. Even from the perspective of CFR, it was at a point of time in a descending trajectory, which off late is again on the rise. Meanwhile, Kerala with lower death rates is experiencing a second wave of COVID-19 infections while the CFR is maintaining at less than 1%.
On the other hand, though states like Karnataka & Telangana have reported a phenomenal increase in the number of cases in the last four weeks, the CFR has decreased substantially to around 1.5% which is almost half the national average.
However, despite these mixed trends at a state-level, there are apprehensions regarding the inconsistencies in the reporting of COVID-19 deaths. Rukmini S, writing for ‘India Spend’ reiterates the need for proper functioning of ‘Death Audit Committees’ with independent members from outside the government. She also writes about proper recording of COVID-19 deaths using the ICD-10 codes.
In the next story, we look at the fatality trends in few select states along with their correlation with the tests conducted and the number of positive cases.