data journalist Rukmini S. has reported. Her analysis is based on all-cause mortality data collected from the Civil Registration System (CRS), according to which says deaths in the state were three-times higher than the average of past years.

Her report, published in Scroll.in, says that while the state reported 4,461 COVID-19 deaths between January 1 and May 31, 2021, the excess deaths in this period were 42-times the reported death toll due to the disease. However, Rukmini warned that it isn’t possible to attribute all the excess deaths to COVID-19.

The reporting mirrors findings from other states and cities – that official figures are missing many COVID-19 deaths and underscore claims that India has been significantly undercounting the true toll of its COVID-19 epidemic.

According to the report, Madhya Pradesh reported a death count in April and May 2021 that was nearly three-times more than the average in previous years. Apart from urban centres like Indore and Bhopal, even rural districts like Chhindwara reported a big increase in registered deaths in May 2021.

Estimates of the true COVID-19 death toll based on deaths registered with the CRS are more accurate than those based on crude reports of burials and cremations. These estimates compare deaths registered during the pandemic with the corresponding period in pervious years.

As experts, including Rukmini, wrote in The Wire Science wrote in May, official figures miss three types of COVID-19 deaths: those who test positive for COVID-19, but whose deaths were registered as “non-COVID-19” or were not registered at all; people who died of COVID-19 but were never tested; or government’s intentionally suppressed deaths of COVID-19 positive people to reduce the death toll.

“In 2018, the last year for which estimates are available, the Office of the Registrar General and Census Commissioner of India estimated that 86% of all deaths were reported to civil registration authorities,” the report said. In the same year, Madhya Pradesh registered fewer than 80% of all deaths in the state, according to Scroll. 

“Despite being an underestimate, the CRS provides the only reliable estimate of all-cause mortality in the country.”

The report adds that in April 2018 and 2019, there were 28,000 deaths on average in Madhya Pradesh, climbing to 31,000 in May. In April 2020, the deaths reported dropped slightly – because the lockdown also pulled down the number of deaths due to road accidents, etc. The number then increased slightly in May 2020 to 34,000. “For the rest of the year, deaths remained slightly elevated over the 2018-19 average,” the report said.

“However, from March 2021, Madhya Pradesh began to see a large spike in total deaths. The divergence between deaths reported this year and in normal years grew further in April 2021, but it is in May 2021 that the gap truly expanded to worrying levels.”

In May 2021, Madhya Pradesh reported 1.6 lakh deaths – nearly five-times the average in pre-pandemic years. The deaths reported between January 1 to May 31 this year is also twice that of the 2018-2019 average.

It is difficult to say how many of these were ‘missed’ COVID-19 deaths. When the second wave was peaking in April and May 2021, the healthcare system was overwhelmed and services were disrupted. This could have resulted in more deaths, even among those who did not have COVID-19.

“There is massive under-reporting of COVID-19 deaths across MP,” Amulya Nidhi, an Indore-based health activist and national co-convener of the Jan Swasthya Abhiyan, told Scroll. The undercounting is because the deaths of people who had COVID-19 but did not have a positive report were not included in official figures.

This has been a problem across the country, as the Madras high court observed on Friday. While the WHO and the Indian Council of Medical Research have issued guidelines on how COVID-19 deaths need to be classified, officials on the ground often ignore them. In many states, deaths of COVID-19 patients who had comorbidities are not included in the official toll. A positive RT-PCR test is also necessary in some states. 

The Madras high court observed that if all deaths are not properly recorded, the mismatch in figures – between the official record and reality – would hinder efforts to understand the true scale of the epidemic and prevent families from availing compensatory government schemes.

In a series of articles published last month, The Hindu showed that the death tolls in Gujarat, Kolkata and Chennai were also underreported. In Gujarat, the actual toll due to COVID-19 was 10-times the official figure.Earlier this week, Bihar acknowledged that it had been undercounting deaths and ‘reconciled’ its official data. The exercise led to a sharp rise in the state’s death toll, adding as many as 3,951 deaths and pushing up India’s total tally up by a record-breaking jump as well. The state government said the total number of COVID-19 fatalities in the state was now 9,429, up from under 5,500.

Undercounting COVID-19 deaths is not restricted to India, but it is of particular concern in the country. The Union health ministry has thus far reported more than 3.67 lakh deaths due to COVID-19, but experts have said the true figure may be four-times higher. Together with the number of cases India reported over the course of its second COVID-19 wave, the country is likely to have topped COVID-19 charts on more than one count.