NEW DELHI (Reuters) – India’s COVID-19 deaths relative to infections hit a record high in June after cases peaked in early May, an analysis of government data shows, amid pressure on authorities to accurately report deaths from a second wave of the virus.

A big rise in infections in April and May, driven largely by the more infectious and dangerous Delta variant, brought India’s health system to its knees.

India has officially reported 403,281 deaths out of 29.75 million people who have contracted the virus.

While the country of 1.35 billion people has reported fewer deaths than the United States and Brazil some experts believe its actual case and fatality numbers are several times higher.

Based on data reported by state authorities and collated by the federal health ministry, the COVID-19 case fatality rate (CFR) jumped to about 3% in June from 1.26% in October, the first full month after the peak of its first wave of infections.

India’s overall reported CFR is 1.31%, one of the lowest in the world, which the government has highlighted as a sign of the effectiveness of its pandemic response.

For interactive graphic: (tmsnrt.rs/3dKc5pI)

“We knew in the early part of the second wave that the pandemic was mostly in northern India and the reporting there was not as good as other states,” said Chandrakant Lahariya, an epidemiologist and public health expert in New Delhi.

By contrast, the more developed southern states better reported data when they got hit later, he said, adding that more deaths are being recorded now following a public outcry over undercounting.

The populous and poor northern state of Bihar, for example, raised its death count by about 4,000 on a single day in early June after a court ordered an audit.

India’s worst affected state of Maharashtra also raised its COVID-19 death toll sharply higher after the discovery of thousands of unreported cases.

The health ministry did not immediately respond to a request for comment.

DEADLY DELTA

While reported infections have fallen fast since the May peak, deaths are not going down at the same rate, worrying some experts as lockdowns have been eased in many parts of the country.

“The Delta variant is both the most contagious variant and among the most dangerous variants in terms of infection fatality rates,” said Christophe Z Guilmoto, a demographer at the French Institute of Research for Development in New Delhi, who has studied COVID-19 mortality in India.

“It did play an increasing role at the end of India’s second wave, and this may explain why the daily count of deaths in India isn’t coming down as fast as we expected/hoped.”

To keep deaths low in any future wave, authorities will have to place restrictions early, when the rate of positive COVID-19 results rises, said Rajib Dasgupta, head of the Centre of Social Medicine & Community Health at Jawaharlal Nehru University.

He said authorities would also have to ramp up clinical care capabilities together with case forecasting models, genomic surveillance data and molecular epidemiologic analyses.

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India’s COVID-19 Case Fatality Rate tmsnrt.rs/3qMw10q

India’s COVID-19 Case Fatality Rate (Interactive) tmsnrt.rs/3dKc5pI

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