A doctor inspects a patient suffering from COVID-19 inside a classroom turned COVID-19 care facility on the outskirts of Mumbai, May 24, 2021. Photo: Reuters/Francis Mascarenhas
During both of India’s COVID-19 outbreaks, the government hasn’t published sex-disaggregated data on deaths due to the disease since May 2020. The government released some partial data before this period, but it was at a time when India’s COVID-19 cases were lower than those in the US and Europe.
In fact, government officials have also published similar demographic data for COVID-19 cases in inconsistent fashion, especially after September 2020.
As a result of this failure, among the countries most affected by COVID-19, India only fares better than Russia, which has never published any such data.
Russia, India, Brazil and Turkey together accounted for 51% of COVID-19 cases and 66% of deaths with unknown sex worldwide at the time of writing.
Without sex-disaggregated data, we can’t calculate COVID-19 the case fatality rate (CFR) across sexes. The CFR is an important metric to assess the pandemic’s impact on different demographic groups, especially among women in India.
A study published in the Journal of Global Health Science in June 2020 used data from covid19india.org to find that women in India had a higher CFR than men despite there having been fewer reported cases among women – 3.3% v. 2.9%.
In most other countries, the CFR among men was higher. A database called ‘The Sex, Gender and COVID-19 Project‘, which tracks official sex-disaggregated data on COVID-19 in more than 190 countries, also reported similar trends worldwide.
The data from covid19india.org, which is crowdsourced, is useful but has been susceptible to being undermined by gaps in India’s and Indian states’ official bulletins.
“Since our study’s publication, there has been no national statistics available that allows us to compute case fatality ratio by age and/or sex,” S.V. Subramanian, a professor of population health and geography at Harvard University and a coauthor of the study, told The Wire Science. “This is unfortunate as this statistic presents information about ‘risk’ of fatality, which is critical for people and policymakers to understand.”
‘The Sex, Gender and COVID-19 Project’ used official data to calculate the CFR for men and women in India. However, at the time this data was available, India only had 4,065 COVID-19 cases and just over a hundred deaths.
While India has since released sex-disaggregated data for COVID-19 cases, it hasn’t done so for deaths. According to the International Center for Research on Women, a non-profit working to advance women’s rights and a partner on the project, this hampers calculations.
For now, Haryana is the only state to have reported sex-disaggregated data for both cases and deaths at the sub-national level, according to the project.
“If we wish to get serious about the pandemic, then there is a responsibility on the part of the government to present data on such demographic breakdowns and preferably at a geographically granular level,” Subramanian said.
The Union health ministry didn’t respond to several requests for comment.
The CFR analysis in the June 2020 study were surprising since behavioural risk factors, like relatively higher mobility, smoking and other lifestyle choices, place men at greater risk of health complications and death due to COVID-19.
“It does not make sense,” Anita Raj, a professor at the department of medicine and education studies and director of the Center on Gender Equity and Health, University of California San Diego, said. “I am inclined to believe this is not due to a unique physiological phenomenon in the context of India but rather something that must be social in terms of either the capture or the management of infection.”
For example, according to Raj, women are more likely to be hospitalised only when they have become quite sick. She also said women are more generally expected to perform informal care-giving inside households, including attending to sick household members, and may not be able to shield themselves as well as others.
The lack of sex-disaggregated makes it difficult to elucidate the reasons for the higher CFR among women in India, and if this continues to be the case this year as well.
“I don’t think there would be significantly higher mortality [among women], but if that is the case, there could be some physiological phenomenon that is occurring in India that we need to understand better,” Raj said. “That is only possible with more data.”
Fazil Khan is a student at the Columbia Journalism School.