Underestimation of the COVID-19 Burden

The number infected with SARS-CoV-2 in early May in India is estimated by a method utilising the unequivocal number available, namely deaths due to COVID-19. The estimated numbers are far in excess of reported numbers and indicate the systemic flaws in reporting deaths in India, augmenting the extent of underestimation. Additionally, there is the overestimation of the doubling time of infection. A realistic picture of the epidemic at the community level is presented, which informs us about the level of preparedness required to deal effectively with the epidemic.

The reported numbers of the SARS-CoV-2 infection have so far remained relatively low during the COVID-19 epidemic in India, despite high population density and consequent difficulties with physical distancing. The number of diagnostic polyamerase chain reaction (PCR) tests carried out has also remained low at ~864 per million population, as against several thousand per million population in many developed countries. The number diagnosed as infected is in a large part determined by the volume of testing.

The cumulative number of positive tests in India as on 5 May 2020 was only 46,476, a mere 3.9% of the 1,19,19,463 tested. In contrast, in the United States, the test positive rate was 16.3% until 5 May. The testing policies were different—the lower the yield, the less efficient the policy.