The mortality burden from COVID in low-income settings: evidence from verbal autopsies in India

Measuring the mortality burden of SARS-CoV-2 in lower-income countries is difficult because death registries are incomplete and lack cause of death. As a result, it is difficult to determine if deaths during the COVID pandemic were directly caused by SARS-CoV-2 or another ailment. We address this problem in India, which had the second-highest number of officially reported cases. We completed WHO-compliant verbal autopsy (VA) surveys on roughly 20,000 deaths drawn from a population-representative sample of people who died between 2018 and 2021. These surveys identify the cause of death for deceased persons via surveys of their next of kin. We find that deaths attributable to SARS-CoV-2 spike in June 2020, just after India’s lockdown, and in May 2021, after its second wave. During those spikes the virus is responsible for 23.3% and 35.8% of all deaths, respectively. Cardiovascular deaths also spike during the start of the pandemic. We find that the death rate rises by 81% during the pandemic, SARS-CoV-2 is directly responsible for 33% of those excess deaths, and cardiovascular disease for 23% of those deaths.