We agree with Drs. Mattiuzzi and Lippi that excess mortality during the pandemic is not exactly equivalent with mortality caused by SARS-CoV-2 infection.1 We noted that excess mortality may result from “Health system overload, delays in patients seeking unrelated healthcare … social changes such as lockdowns … other diseases, war, or environmental factors. Mortality deficits … may result from fewer injuries.”2
We found that the excess mortality during the COVID-19 pandemic in India, through August 31, 2021, was 198.7 per 100,000 population (range 146.1–263.8 per 100,000).2 For context, the Hopkins dataset we used reflected COVID-19 mortality of 203.1 per 100,000 population in the United States as of August 31, 2021.2 So, the excess mortality in India is comparable with the COVID-19 mortality in countries with more robust testing. The survey that Drs. Mattiuzzi and Lippi cited does not demonstrate that delays in seeking healthcare resulted in increased mortality of this magnitude.3 The survey respondents obviously had not died, and the survey did not ask whether anyone in the family had died as a result of delayed care.3
The most disruptive lockdowns in India occurred in Spring 2020.4 However, the bulk of the excess mortality in India occurred in Spring 2021, coincident with the delta-variant COVID-19 wave, and to a lesser degree in Fall 2020.2 Thus, we believe that the bulk of the excess mortality in India was in fact due to COVID-19 infection.
Leffler CT, Lykins VJD, Das S, Yang E, Konda S , 2022. Preliminary analysis of excess mortality in India during the COVID-19 pandemic. Am J Trop Med Hyg, https://doi.org/10.4269/ajtmh.21-0864.
Czeisler MÉ et al.2020. Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020. MMWR Morb Mortal Wkly Rep 69: 1250–1257.
Soni P , 2021. Effects of COVID-19 lockdown phases in India: an atmospheric perspective. Environ Dev Sustain 23: 12044–12055.