The word ‘only’ is highly problematic, but it is a word that is now used quite commonly to underplay the effect of COVID.

‘The fatality rate in India is ONLY 1.x%, while worldwide it is 4%”, is a statement we often hear.

But is the statement correct?
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We can argue that even 1% is an extremely large number given the population of the country, but before we get to that is the fundamental question- is the fatality rate in India really lower than elsewhere?
And if so, why?
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The easiest way to calculate the fatality rate is by dividing number of deaths with number of people who have tested positive. Using this formula, the fatality rate in India is 1.69% against a global average of 3.36%. It does certainly seem as though India is doing better.
But,
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..this is not the correct way to calculate the fatality rate, because people do not die immediately after testing positive. The correct formula is-
Fatalilty rate = (total number of deaths) / (total number of deaths + total number of people recovered)
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This data is not easily available in India, because in case of asymptomatic or mildly symptomatic patients, the person is deemed recovered two weeks after testing positive, even in the absence of a negative COVID test.
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Therefore, assuming the fatality rate remains stable over time, the formula that can be used is-
Fatality rate = (total number of deaths) / (total number of people who had tested positive 4 weeks back)*
* assumption that it takes an average of 4 weeks to succumb to the virus
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Applying this formula, the fatality rate in India, goes up to 3.17%, against a global average of 4.44%. Though the fatality rate in India is still lower than the global rate, it is no longer much lower as it was earlier.
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Is 3% insignificant? Certainly not.
More importantly, if despite a younger population, the fatality rate in India remains as high as 3%, we cannot dismiss the virus as benign as some people try to claim it is.
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However, sero-surveys show that a quarter of the population has been exposed to the virus and developed antibodies against it. If the fatality rate is calculated using those estimates, it certainly falls to an extremely low percentage.
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There are, however, two arguments that work against it- the possibility of contamination by exposure to a different pathogen, and the underreporting and undercounting of deaths in the country.
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While we are not sure about the accuracy of the kits used in the sero-survey, and whether a previous exposure to a very different pathogen may not produce similar responses. Since we have no data, we can, perhaps, set this objection aside for now.
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The second objection is more important. The deaths due to COVID are certainly underreported and under counted.
In the ideal scenario, unless a person dies in an accident, any death that occurs after a person tests positive should be counted as a COVID related death.
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This, however, is not the case. If a person has co-morbidities and succumbs to any of them, that is given as the only reason for death. This leads to a gross undercouting.
Three approaches have been put forward for estimating deaths.
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(1) compare with funerals that are conducted with COVID protocols.
There is clearly huge underreporting.
+ https://twitter.com/PriyankaPulla/status/1284093864853139456?s=20

(2) extrapolating from data on medical reasons given on death certificates to total number of deaths
+ https://twitter.com/giridar100/status/1292752229007425536?s=20

(3) comparing absolute numbers of deaths this year, to deaths in previous years.
+ https://twitter.com/DrSamira_Asma/status/1303595054334980096?s=20

Each of these can be debated, but it is clear that it is much higher than the actual number reported. Correcting for the accurate mortality figures will certainly counter the increased number of people presumed to be exposed to the virus.
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It is, therefore, best to go with the fatality rate calculated using the official data- roughly 3% of the population that has got infected, and it certainly cannot be dismissed with the word ‘only’.
We can ignore only at our peril. https://link.medium.com/0d03BvcaE9