How big could India's true COVID toll be?

The latest national seroprevalence study in India ended in January, before the current wave, and estimated roughly 26 infections per reported case. This scenario uses a slightly lower figure, in addition to a higher infection fatality rate of 0.3 percent — in line with what has been estimated in the United States at the end of 2020. In this scenario, the estimated number of deaths in India is more than five times the official reported count. “As with most countries, total infections and deaths are undercounted in India,” said Dr. Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy. “The best way to arrive at the most likely scenario would be based on triangulation of data from different sources, which would indicate roughly 500 to 600 million infections.”