India has 3 million confirmed cases of COVID-19. That number is likely millions low, due to factors that are a problem in tracking the disease in developing nations. Experts say a lack of tests and sophisticated infrastructure to collect data on both confirmed cases and deaths make realistic counts impossible.

India’s confirmed cases put it third in the world behind that United States, which has just over 5.7 million and Brazil at just over 3.5 million. India lists deaths at 56,000, which is also below any realistic figure. Accurate data on deaths is also impossible to collect.

A microcosm of the trouble with COVID-19 data is New Delhi, which has 20 million of India’s 1.326 billion population. A local government study of 15,000 found that 29.1% of the city’s population had been infected. Health Minister Satyendra Jain said, “We found that 29.1 percent of the population of Delhi had antibodies, which means that they were infected and have been cured.” What about people who were infected but not counted? There is no way to know because the rate of testing in India is very low. So far, only 35 million people have been screened across the entire country.

Among India’s states, New Delhi is not even close to the lead based on confirmed cases or deaths. It confirmed cases count is only 158,604, which puts it in sixth place among all states. Its death count is an absurdly low 4,270 people. That figure is below Arizona’s 4,688 figure.

India’s COVID-19 death count per million people is sharply below that of any major nation in Europe or the United States.

A number of health experts have stated that India’s count is not just low, it is extremely low. Oommen C. Kurian of the Observer Research Foundation, a Delhi-based think tank, told the BBC, “Of course there is under-counting as we have weak health surveillance systems. But the question is about the scale of under-counting.”

The journal Science reports that deaths are underreported in India. One primary reason is that deaths attributed to COVID-19 usually are only counted if the person tested positive before he or she died. Such a small fraction of Indians have been tested that the death count has to be sharply higher.

Another reason India’s counts are low is that often data from private doctors and private hospitals are not counted at all. Brookings experts report that half of the hospitalizations in India are in private institutions.

What are India’s real confirmed case and death numbers? No one will ever know. A low testing rate and poor procedures for providing COVID-19 deaths mean the numbers are wildly low.

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