Doctors in India certified more Covid-19 deaths than the country’s official pandemic toll during 2020, according to death registration records that health experts say support suggestions that Indian authorities undercounted Covid-19 fatalities.

The Registrar-General of India’s 2020 report on medical certification of the cause of death (MCCD) has attributed 160,618 deaths as “due to Covid-19” during 2020 compared with the 148,994 Covid-19 deaths recorded by the Union health ministry till December 31, 2020.

Among India’s 8 million registered deaths during 2020 in states that turned in MCCD reports, around 1.8 million (or 22.5 per cent) were medically certified by doctors and attributed to specific causes — cancers, circulatory, respiratory or endocrine disorders, or injuries, among others, and the new addition: Covid-19.

The increase in the country’s proportion of deaths attributed to specific causes has been sluggish over the years — rising from 20 per cent in 2012 to 22.5 per cent in 2020.

The 160,618 deaths attributed to Covid-19 by the MCCD 2020 report account for nearly 9 per cent of the 1.8 million medically certified deaths that were attributed to causes during the year.

This is the same proportion of excess deaths in India during 2020 as estimated by two independent studies. One of them was released in January this year and was led by Prabhat Jha, director of the Centre for Global Health Research at the University of Toronto, and the other was released earlier this month by the World Health Organisation.

Several studies, including those by Jha and the WHO, have over the past year yielded estimates for India’s excess deaths during 2020 and 2021 that range from 3.2 million to 4.9 million.

Excess deaths during the Covid-19 pandemic are defined as the increase in deaths, directly or indirectly, because of Covid-19 — or the extra deaths that would not have occurred in the absence of Covid-19.

“The percentage excess just of Covid-19 deaths (in the MCCD 2020 report) is consistent with the WHO excess estimates and our estimates for 2020. And the absolute total of Covid-19 deaths — (over) 160,000 — exceeds the official Covid-19 deaths,” Jha said.

The health ministry has raised questions about each of those excess-death studies.

While the 160,618 deaths attributed to Covid-19 in 2020 by the MCCD report exceed the officially confirmed 149,000 pandemic deaths in 2020, Jha said, the MCCD itself “vastly underreports” with only 1.8 million deaths certified and attributed to a cause.

“In sum, yet another GOI (government of India) source shows official Covid-19 deaths vastly underreported in 2020 (prior to killer delta wave of 2021),” Jha tweeted on Sunday.

The RGI’s Civil Registration System (CRS) 2020 report too shows nine per cent excess deaths during 2020 compared with the average of 2018 and 2019, Jha said.

Jha and other experts say the Centre’s CRS 2021 data, which is yet to be released, will yield greater insights into how Covid-19 has impacted mortality in India.