“IF YOU TORTURE THE DATA long enough, it will confess to anything,” said Ronald H. Coase, the noble laureate British economist. But regimes know that if you massage the data long enough, it will hide the most evident truths.

When there is disease and death making news all around, and every day newspapers and television bring us horror stories, as also half-baked lies that claim that the coronavirus does not matter or is a hoax, why does mathematics matter?

Why should you pay attention to data collection of deaths in India? Why is it important to know in how many cases we knew how people died even before coronavirus ever came to our country? How do we know how many have died of the deadly virus? Who is in charge of counting? Who kept the figures last year? Who was counting them during the last decade?

Also, why is it important to know basic mathematics to understand how many people have died till date of coronavirus? Isn’t it simply a head count of those who have stopped breathing and who we have either buried or cremated? What is mathematics doing in this national mortuary of the virus-killed?

Well, all of this was simply to get you to persist with this piece where you may have to deal with Grade V maths that you did in school, and that our government doesn’t want you to try again. If you do not do this much, you will not know how many have died of the virus.

When a person dies in India, it does not necessarily follow that a doctor is called and he pronounces the person dead. An average citizen may believe that someone somewhere in the vast government structure must be counting every death, but in reality this does not happen. Many deaths are not counted, as per the admission by the government. Of those which are counted, not in every case a doctor had declared the fact of the death. In many, there is no medical certification of the cause of death.

So, when you are told that X number of people died of disease Y in India in a certain year, it means that only those whose deaths were registered were scanned, and out of those in those cases in which the medical certification of the cause of death (MCCD) was available, X number did die of disease Y. Among the deaths that were counted and where medical certification of the cause of death (MCCD) was not available, how many died of disease Y, we will have no idea. Also, of those deaths which were never counted to begin with, how many had contracted disease Y, we have no idea.

So you get three kinds of figures: (a) the total number of people who die in a year; (b) the total number of registered deaths; and, (c) out of that figure ‘b’, the total number of deaths in which medical certification of cause of death is available.

In India, data about births and deaths is collected via Civil Registration System (CRS) while data about the cause of deaths is collected via MCCD Report, both collated by the Registrar General of India.

In 2009, of the total deaths in India, only 66.9% were registered, a figure that has increased to 86.0 in 2018. This is an achievement made over decades of efforts, and it still leaves 14% of the dead outside the radar of basic data. Of these 86% deaths that were registered in 2018, only in case of 21.1% of the deaths do we know the cause. In 2017, this number was 22%.

Even within this data, there are hugely skewed statistics. For example, as per the MCCD report for 2018, of the 14,56,023 total medically certified deaths in 2018, males 9,00,075 outnumbered females (5,55,948) by a large factor — a ratio of 61.8 % to 38.2%. (reflecting a sex ratio of female deaths to male deaths at 618 per thousand). Similarly, as per the CRS Report 2018 (page xiv), out of the total registered deaths, the share of male and female are 59.6% and 40.4% respectively.

Since the CRS 2018 report blandly states that “there is no significant difference in percentage share of male and female medically certified deaths to their respective totals as far as eight leading causes are concerned,” there can only be one assumption: We simply count less women even among the sections of society we cover under this data collection exercise.

Also, it can be safely assumed in India that the deprived marginalised sections of society form the larger chunk of those left out.

So when we say X number of people died of disease Y, you can assume that the data is truer for males and for people materially, educationally, socially better endowed than those left out. So the prevalence of disease could often be far more among the sections left out.

Something has to be done to make this data a little closer to reality, otherwise it will be a meaningless statistic upon which no understanding or policy could be based. The experts have no other way except to deduce that since the medical certification of cause of death was known only in 21.1% deaths (MCCD Report) of the 86% (CRS 2018 Report) that were registered, only 18.15% (0.86*0.211) of the deaths actually went through the MCCD sieve.

A major share of the blame should go to our inability to ensure that deaths pass through an institutional framework. The CRS 2018 Report states (page xiv) that the share of Institutional deaths in total registered deaths is a mere 33.8%.

But even this bad data is skewed.

The MCCD Report 2018 bluntly states (3.6; page 24) that the institutions covered under the MCCD “are mostly located in urban areas” and “consequently, the number of deaths reported therein may lack the representative character at the State level.”

The skew in the data will be easier to understand with an example of a state and a union territory that our readers know well.

In Punjab, notes the MCCD Report 2018 (Statement 2.3; page 10), a total of 1,515 medical institutions have inpatient facilities, but of these only 472 are covered under MCCD, of which only 264 medical institutions reported MCCD data as per the National List for Tabulation. The CRS Report 2018, on page 20 (Statement 2.8), states that “no training programmes on Civil Registration System were organized in 15 States/UT’s during the year 2018” including in Punjab.

In Chandigarh, of the 35 medical institutions with inpatient facilities, only 13 were covered under MCCD, and of them, only 5 reported MCCD data as per the National List for Tabulation.(MCCD Report 2018; Statement 2.3; page 10)

How much can you actually learn about how many people died of what causes in our country from a data for which the sole sources could be CRS Report 2018 and MCCD Report 2018?

On Page 27, the CRS 2018 Report states specifically in respect of Punjab that “There is a shortage of Staff at every level in the State and associated departments are facing difficulty in managing various affairs of registration of births and deaths.”

And still, the official morning bulletins issued by the state and central governments confidently proclaim every morning at 8 am exact as to how many people died in the entire country of a particular disease in the last 24 hours!

India has been making massive efforts to implement the MCCD since the 1970s, and every annual report issued by the Registrar General of India, this year under the signatures of Vivek Joshi, solemnly states (Chapter 1, page 3) that while the “Conference on Improvement of Vital Statistics held in 1961 had recommended the introduction of the scheme of MCCD… and its progressive implementation…in all major medical teaching institutions and other hospitals in different States/UTs, owing to the lack of adequate medical facilities and consequent difficulty in obtaining medically certified cause of death in several parts of the country; it has been introduced in phases since early seventies.”

This is the fate of a scheme that has all the statutory backing under sections 10(2), 10(3), 17(1) (b) and 23(3) of the Registration of Births & Deaths (RBD) Act, 1969.

It takes a long time for a well-oiled machine to collate data for deaths, as evidenced by the fact that the MCCD 2018 Report could be finalised only in July 2020, but with some strange level of confidence, we announce to the world the latest Covid-19 mortality data exactly at 8 am every morning.

What is wrong with that?

Hemant Deepak Shewade and Giridara Gopal Parameswaran, both trained as community physicians, in their much talked about article in The Hindu of August 10, 2020, argued: “The COVID-19 deaths compiled by States predominantly include deaths occurring in COVID-19-designated facilities among reported COVID-19 cases. Hence, suspected COVID-19 deaths occurring at home or during transit or in non-COVID hospitals may not be reported. Outside designated COVID-19 facilities, there could be many instances of suspected COVID-19 being the cause of death (testing not done or results not available); this may not be captured. This is possible in the context of a prevailing systemic under-registration of deaths and the poor coverage of MCCD. This may be more pronounced in rural and semi-urban areas where there is poor access to health facilities and/or qualified medical doctors. Hence, we need to adjust for the prevailing under-registration of deaths and poor coverage of MCCD to arrive at the correct estimate of COVID-19 deaths.”

There is no other way to account for deaths left outside the radar and the disappointing MCCD coverage than to multiply it by a factor calculated as the inverse of 18.15% (total MCCD accounted deaths among total deaths based on the 2018 CRS and 2018 MCCD reports). This factor, as any one with a fifth grade school understanding of mathematics will be able to deduce, comes to 5.5096, or 5.51.

So when, on the morning of September 2, 2020, Wednesday, the Government of India’s Ministry of Health announced that a total of 65,288 people have till date died of Covid-19, then, keeping in view the data sets generated by the Government of India through CRS 2018 and MCCD 2018, you can actually glimpse the conservative scenario of Covid-19 deaths only and only by multiplying the 8 am toll figure with an adjustment factor of 5.51, which, on the morning of September 2, 2020, at 8 am, yields the number of fatalities at 365,494.

The difference between 66,333 dead people and 365,494 corpses is the difference induced by our unwillingness to understand data even when all it requires is an extremely basic understanding of mathematics that most journalists possess, but then it is also a measure of the apathy we have developed, a willingness to inure ourselves of the deaths of other people.

Just a reminder: you will have very little inclination to pull out a calculator and do any maths when you or a loved one contracts the virus. The time to do so is now.

And to remind you once again that while you now understand the national data for deaths, the scenario for Punjab might give you goose bumps. Punjab registered total number of deaths in 2016, 2017 and 2018, respectively, as 213578, 210398 and 213234, while the number of medically certified deaths during these years, respectively, was 32337, 33127 and 36448, accounting for 15.1%, 15.7% and 17.1% (Statement 2.4 page 12 of MCCD Report). It falls at rank 23 among 35 states and union territories on the MCCD performance scale (Chart 2.7; page 13; MCCD Report).

Now, try calculating the adjustment factor with which you will have to multiply the Covid-19 toll of 1,512 as on the morning of September 2, 2020 at 8 am!

We advise you not to be alone when you do the calculation. It can be a very scary scenario to envisage, particularly when you know that this is a conservative estimate, fully derived from official data sets, and that the world’s leading health experts have much more doomsday estimates and predictions to make.

We are citizens of a country in which the Government of India tells us that “about 1.3% of the total registered deaths during 2018 received medical attention from qualified allopathic professional and practitioner of other system and 35.7% of deceased did not receive any medical attention at the time of death.” In such a pre-coronavirus scenario, you should have a healthy dose of scepticism about the hour to hour figures and cause of death dished out by the government.

So, please wear a mask, properly, and maintain social distance, strictly, but never lose sight of your politics, not even momentarily, or someone will come along and torture the data, or massage it so well that the god of death will smile in your face.

Haath Ki Safai zaruri bhee hai, iss se bachna bhee hai, varna koyee haath saaf kar jayega.