India reels from more than 300,000 daily infections and nearly 3,000 deaths for the past several days but experts say the true number of fatalities is several times higher from what is being reported by government officials.
India's devastating Covid-19 death rates, although strikingly high, may just be the tip of the iceberg.
With hospitals swamped by patients and oxygen in short supply in an already creaky health system, several major cities have been reporting far larger numbers of cremations and burials under coronavirus protocols than official death tolls show.
India's 323,144 new cases over the past 24 hours stood below a worldwide peak of 352,991 hit on Monday, while 2,771 new deaths on Tuesday took the toll to 197,894.
But many experts and media outlets say the true number of people dying from Covid-19 in India is being suppressed or undercounted by the government.
The actual numbers of caseloads and deaths "could be anything from 10 to 30 times higher," Vikas Bajpai of the Progressive Medicos and Scientists Forum told German broadcaster Deutsche Welle.
"Together with under-reporting of cases and the large test positivity ratios we are seeing across the country, the true scale of the pandemic may be far worse than the numbers would suggest," he said.
"The distressing scenes of patients dying in ambulances and bodies burning on pyres outside crematoriums and even on pavements across cities and towns clearly show that the tragedy is far greater," Anoop Saraya, a private doctor, told DW.
Even fewer confirmed infections are largely due to a drop in testing, experts say.
"This should not be taken as an indication of falling cases, rather a matter of missing out on too many positive cases," said health economist Rijo M John, of the Indian Institute of Management in the southern state of Kerala.
Essentially, none of those numbers are correct; all are vast undercounts.— John Burn-Murdoch (@jburnmurdoch) April 21, 2021
I collated local news reports (HT @muradbanaji) across seven districts, finding that overall, numbers of Covid victims who have been cremated are 10x larger than official Covid death counts in same areas. pic.twitter.com/y6sDZ1qgRX
'Massacre of data'
The latest surge, spurred by new variants of the coronavirus, has undermined PM Narendra Modi's claims of victory over the pandemic.
The country of nearly 1.4 billion people is facing shortages of space in intensive care wards.
Hospitals are experiencing oxygen shortages and many people are being forced to turn to makeshift facilities for mass burials and cremations.
Reliable data is at the heart of any government response to the pandemic, without which planning for hospital vacancies, oxygen and medicine becomes difficult, experts say.
But many parts of India are in "data denial," said Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan.
That's around 990,000 deaths due to Covid-19.
Sharing his projection with NDTV, Murad Banaji, a mathematics lecturer at Middlesex University said, "for every Covid-19 death counted, two more have been missed."
HUGELY UNDERCOUNTING DEATHS—India is either sloppy in miscounting #COVID19 deaths, or they are criminally covering up overwhelming deaths. All signs & reporting points either one or the other—“It’s a complete massacre of data”. Real deaths 2x-5x higher.🧵https://t.co/jC31QwTBfA pic.twitter.com/G2CMHICs20— Eric Feigl-Ding (@DrEricDing) April 25, 2021
Crematoriums contradict govt data
Gas and firewood furnaces at a crematorium in the western Indian state of Gujarat have been running so long without a break during the Covid-19 pandemic that metal parts have begun to melt.
Last week Sandesh, a Gujarati newspaper, counted 63 bodies leaving a single Covid-only hospital for burial in the state's largest city, Ahmedabad, on a day where government data showed 20 coronavirus deaths.
A worker at one of the large cremation grounds in Ahmedabad, Suresh Bhai, told Economic Times his bosses had instructed him not to write down the cause of death as Covid-19.
"Sickness, sickness, sickness," Suresh said. "That’s what we write."
Similarly in Gujarat's second largest city, Surat, Sailor's Kurukshetra crematorium and a second crematorium known as Umra have cremated more than 100 bodies a day under Covid protocols over the last week, far in excess of the city's official daily Covid death toll of around 25, according to interviews with workers.
Major cities in the populous northern state of Uttar Pradesh report similar disparities.
In Lucknow, data from the largest Covid-only crematorium, Baikunthdham, shows double the number of bodies arriving on six different days in April than government data on Covid deaths for the entire city.
The figures do not take into account a second Covid-only crematorium in the city, or burials in the Muslim community that makes up a quarter of the city's population.
READ MORE: India: the deadliest wave
#WATCH | Haryana CM Manohar Lal Khattar says, "Iss sankat (#COVID19) mein humko data ke saath nahi khelna hai. We should focus on seeing how people can recover. The dead won't resurrect with furore over it. There is no point in a debate over the number of deaths..." (26.04) pic.twitter.com/27Kh9k0r6c— ANI (@ANI) April 27, 2021
Haryana state Chief Minister and member of ruling Bharatiya Janata Party Manohar Lal Khattar denied data suppression allegations in his state, saying that the debate was "pointless" because it won't "resurrect" the dead.
"In the prevailing pandemic situation, we should not play with data. We should focus on how to ensure that people recover and get health facilities. The person who has died won't resurrect by a furore on death numbers. It is pointless to debate whether deaths are low or high," he said.
Other government officials say the mismatches in death tallies may be caused by over-caution.
A senior state health official told Reuters news agency that the increase in numbers of cremations had been due to bodies being cremated using Covid protocols "even if there is 0.1 percent probability of the person being positive".
"In many cases, patients come to hospital in an extremely critical condition and die before they are tested, and there are instances where patients are brought dead to hospital, and we do not know if they are positive or not," the official said.
Normal death rate in India translates to around 28,000 deaths/day. We are seeing around 2,500-2,800 Covid deaths/day. Such a small increase in daily deaths in the country would not lead to crematoria being overrun, as we have seen so far.— Ankur Bhardwaj (@Bhayankur) April 27, 2021
~ Dr Shahid Jameel, Ashoka University
Data collection limits
India's Integrated Disease Surveillance Program (IDSP) is responsible for collecting data on Covid. But specialists say that many positive cases may be missed due to the exclusion of suspected cases and asymptomatic cases.
"Somehow we have missed this whole spectrum of Covid-19 cases and that is why many people who may be positive are missed, especially in rural areas," Dileep Mavalankar, director of the Indian Institute of Public Health, told Scroll news website.
IDSP also relies entirely on data provided by testing laboratories and hospitals and therefore it cannot track deaths that occur outside these institutes.
Mavalankar said it is concerning that hospitalisation numbers are not included in the government's official data counts, therefore limiting information on hospital bed capacity.
"In some places, only 10 -15 percent of ICU beds are vacant. The cases will increase but if your hospital capacity is exceeded, then many people may die at home, which we will not be able to capture," he said.
READ MORE: Modi: India shaken by coronavirus 'storm'
UP CM Yogi Adityanath continues to maintain there's no shortage of Oxygen in the state. Hear this BJP worker's story who went from Modi Nagar to Meerut but failed to get his mother in law any treatment.— Shubhangi Misra (@shubhangi_misra) April 27, 2021
"CM's claims are hollow. Ashamed to be a BJP worker", he tells me pic.twitter.com/QShqETSOyJ
Unreliable death registration system
Fewer than a quarter of deaths in India are medically certified, particularly in rural areas, meaning the true Covid death rate in many of India's 24 other states may never be known.
"Because death registration is poor in India, the government will have little data to respond to the impact of Covid-19 on large sections of the population who live in rural areas," Jacob John, a renowned virologist told DW.
This fragile system coupled with an increasing anger at the government for allowing massive Hindu festival or Kumbh Mela and election rallies to take place, may suggest the situation is likely to get worse before it gets better.
"In the election rallies and the Kumbh Mela most people were not wearing face masks," journalist and social activist Awesh Tiwari told The Guardian.
"The government did not bother to halt those programmes and now we are paying the price."
Last night I was on a show on Channel 4 that seemed to have riled up many of them here. My apologies but as a journalist my job is to bear witness and not sugarcoat the truth. Our people did not deserve this devastation and heartbreak https://t.co/suLKZ7bpMS— Rana Ayyub (@RanaAyyub) April 26, 2021
Crackdown on criticism
Criticism is meanwhile mounting that PM Modi's federal government didn't prepare adequately to handle the crisis.
New Delhi has instead ordered Twitter to withhold dozens of tweets from being viewed in India, primarily those critical of India's handling of the pandemic.
On Sunday, Twitter confirmed it withheld dozens of tweets critical of the crisis after a legal demand from New Delhi.
"If (the content) is determined to be illegal in a particular jurisdiction, but not in violation of the Twitter rules, we may withhold access to the content in India only," the social media giant said in a statement.
Some tweets included comments, including from regional opposition lawmakers, about the overwhelmed healthcare system.
The IT ministry told AFP news agency it asked Twitter to remove 100 posts, adding that there was "the misuse of social media platforms by certain users to spread fake or misleading information and create panic about the Covid-19 situation in India".
Rana Ayyub, a Mumbai-based investigative journalist and one of the fiercest Modi critics, told Channel 4 that two of her tweets, citing numbers that health officials had given her showing data disparity, had been deleted.
"The Indian government is hellbent on hiding real numbers," she said.
"Nothing has gone right here...What I as a journalist am witnessing, as a citizen witnessing, it's nothing less than a carnage."