For the past two months, staff at Ahmedabad’s Ganj Shahid Kabrastan for Sunni Muslims have been shocked and overwhelmed by the near-constant stream of funerals at the burial ground every day.

There were as many as 199 burials at the large graveyard in April – a number three times higher than the 66 burials that took place in April 2019. The next month, the situation seemed to spin out of control: Ganj Shahid had 376 burials in just the first 25 days of May. In the same month last year, there had been just 61 burials.

Is the Covid-19 pandemic the reason behind this surge in deaths in Ahmedabad? The city is Gujarat’s biggest hotspot for the novel coronavirus, with 11,163 cases and 773 deaths reported so far, and a staggering mortality rate of 6.9%.

Rizwan Kadri, the head of Ahmedabad’s Sunni Waqf Board which manages the city’s burial grounds, points out that only 147 of the 575 burials at Ganj Shahid in April and May have been confirmed Covid-19 deaths.

“But we have been seeing a huge increase in the number of deaths at almost all of our kabrastans,” said Kadri.

Take Musa Suhag Kabrastan, for instance. It is Ahmedabad’s largest Sunni burial ground, where 71 people were buried in April 2019 and 66 in May 2019. This year, however, the graveyard has accommodated 142 burials in April and as many as 300 in the first 27 days of May. Of these, only 31 were confirmed coronavirus deaths.

At Chartoda Kabrastan, there were 55 burials in April 2019 and 117 this year; 52 burials in May 2019, and 193 in the first 15 days of May 2020.

Outside of the Muslim community, too, deaths in Ahmedabad seem to be on the rise.

On Wednesday, Gujarati newspaper Divya Bhaskar reported that the Antim Dham crematorium in Thaltej, Ahmedabad, has had at least 350 cremations in May so far – much higher than the average number of 180 cremations it has per month.

What explains these unusually high numbers?

Highway funerals?

Bhavin Joshi, the additional medical officer of health at the Ahmedabad Municipal Corporation, acknowledged that there has been an increase in the general number of deaths in the city in the past two months. “But it must be maybe a 10% or 12% increase from six months ago. The numbers have not doubled or tripled,” he said, without offering any data to back this claim.

“In general deaths do increase when temperatures rise in summer,” Joshi added.

When pointed out the available data that showed a staggering rise in burials and cremations in certain places, he said: “Maybe because of the lockdown, people are choosing cremation or burial grounds that are closer to the highway, like the Thaltej cremation ground.”

According to Kadri, however, none of the three major kabrastans seeing an increase in burials are close to the highway. “Six weeks ago, officials from the municipal corporation’s health department had come to us to ask us about the number of burials we were doing in our kabrastans and what those numbers were last year at this time,” said Kadri. “We gave them the numbers but there has been no response after that, while the deaths have only been increasing.”

Kadri and others attribute the higher mortality to the lack of adequate testing for coronavirus as well as the reduced healthcare access during the lockdown.

“It is possible that coronavirus has caused deaths among many more people who were not tested, or who were asymptomatic,” said Kadri. “It is also possible that because of the lockdown, many sick people were not able to go to doctors when they needed to.”

Said Sabir Kabli, a former legislator from Ahmedabad’s Jamalpur area, where the local kabrastan had been burying up to 10 people a day at the end of April: “We can’t say the reason but it is clear that deaths have increased in large numbers since coronavirus began.”

No testing for the dead

Gujarat’s high mortality rate for coronavirus has led to considerable criticism of the state’s poor health infrastructure and low testing rates. On Friday, an Ahmedabad Mirror report highlighted a number of cases in which suspected Covid-19 patients were not provided with timely medical care and were tested after they had already lost their lives.

Kadri, however, points to another aspect of the city’s Covid-19 problem: many suspected cases of coronavirus, he claims, are not being tested at all, even after death.

“When people die, hospitals have been telling families to do the burial without a Covid test. But if the families say that the person had Covid symptoms, we treat it as a suspected case and do the burial according to Covid norms.”

Kadri is referring to the standard operating procedures issued by state governments for the safe disposal of Covid-positive dead bodies. Typically, these norms involve disinfecting the body and placing it in a body bag, allowing no more than 20 people into the crematorium or burial ground and ensuring that people handling the body wear protective gear like masks, gloves and hazmat suits.

In the case of Muslim burials, graves for Covid-positive persons have to be dug nine or ten feet deep, instead of the usual four feet. Burial grounds have been calling for excavators, locally called JCBs, to do this digging. Since these graves are too deep for family members to climb into, a businessman in Ahmedabad has devised a unique cloth stretcher with straps to help lower the body into the grave for Covid-19 burials.

“I came up with the idea in March, because I was disturbed when I saw how the body of a woman from my neighbourhood was thrown ten feet into her grave after she died of corona,” said Mohammed Sharif Kakuwala, the owner of Ahmedabad’s famous Astodia Bhajiawale snack shop.

Kakuwala now gets these stretches mass-manufactured by a tailor and gives them for free to kabrastans across the city. He uses this as a metric for the massive increase in deaths in the past two months.

“My stretchers are used only for Covid and suspected Covid deaths, and I have handed out more than 600 of them so far,” said Kakuwala. “And these are only for Muslim deaths in Ahmedabad.”

A demonstration of the cloth stretcher devised by Mohammed Sharif Kakuwala for Covid-19 burials. Photo courtesy: Mohammed Kakuwala

The need for tracking deaths

State governments also typically have standard operating procedures to determine what is classified as a Covid-19 death.

Delhi government, for instance, decided on May 17 that Covid-19 testing would not be done on dead bodies, and that persons dying of co-morbidities like heart disease, hypertension or diabetes, where Covid-19 is not the primary cause of death, would not be considered coronavirus deaths.

Bhavin Joshi did not respond to questions about standard operating procedures for Covid-19 in the city, and other health department officials were not available for comment.

But reports of a clear surge in death rates are not unique to Ahmedabad or Gujarat.

In early May, Indian Express reported a sharp surge in the number of deaths in Malegaon, Maharashtra – 580 deaths in April, which is 48% more than the 390 deaths reported in March, and almost double the number of deaths in the same month last year, when 277 people had died.

In Madhya Pradesh, Indore also reported a significant surge in burials at Muslim graveyards in April, although crematoriums in the city did not report such increases in deaths. Many of the burials were for people who had not been tested for Covid-19 but had been listed as deaths due to heart attacks, hypertension or diabetes.

India already has a poor record of tracking deaths – only around 70% of deaths are registered, and barely 22% have a medical certificate. Even among those, cases, the cause of death indicated on medical certificates is often not specific, confusing the mode of death with the cause of the death. According to experts like Dr Prabhat Jha, one of the leading authorities on mortality in India, this could make it harder to understand the true extent of Covid-19 death rates in the country.

Data from burial grounds and crematoriums in Ahmedabad and other parts of the country underscore this need for better death reporting systems.