The coronavirus outbreak that had brought India’s financial capital Mumbai to a standstill has contributed to a sharp increase in deaths in the city, The Indian Express reported on Tuesday. Data given by the city’s civic authority showed that the total number of deaths in Mumbai rose by nearly 37% compared to 2019.

Maharashtra, which has remained the worst-hit state, has 9,23,641 coronavirus cases. A rise of 423 deaths in the state on Monday pushed the toll due to the virus to 27,027. Of these, Mumbai accounts for 1,57,410 cases and 7,900 deaths. The state reported the fastest growth in coronavirus cases in August, registering over 3.7 lakh cases.

Between March 1 and July 31, Mumbai recorded a total 49,040 deaths as compared to 35,982 during the same period last year. Therefore, the city saw an increase of 13,058 total deaths.

Of these 13,058 deaths, as many as 6,395 people died of Covid-19, according to data by the Brihanmumbai Municipal Corporation till July 31. During these five months, an additional 6,663 people died of causes that are not yet clear. Experts and doctors have said several factors such as changes in the Centre’s guidelines on testing dead bodies for Covid-19 or the deaths of patients from outside Mumbai or non-Covid casualties may have contributed to this discrepancy.

Most of the deaths took place in May, when 14,085 people died, in comparison to 6,832 in 2019. This is the highest monthly fatality recorded in a decade by authorities for Mumbai. The figures may rise further as the death registration process is underway.

Meanwhile, 11,540 people died in June this year, as against 6,797 deaths in 2019. It is not clear why the deaths suddenly rose in May and June. The BMC’s data shows that the toll rose from April. The city recorded 7,243 deaths in April, 14,085 in May, 11,540 in June and 9,480 in July. But Mumbai’s total 6,692 deaths in March were lower than the 7,358 in 2019.

Civic officials said three factors the high number of deaths due to the coronavirus, fewer deaths on the tracks and in road accidents must be taken into account to understand this year’s toll. This means that even if Covid-19 fatalities are taken into account, the sharp rise is unusual as there were fewer fatalities due to accidents in 2020 as opposed to last year.

“It is possible there was rise in non-Covid deaths due to lack of health facilities during the pandemic,” Dr Mangala Gomare, BMC’s executive health officer, told the newspaper. “Our team has begun to study death registrations to assess causes.”

BMC Additional Municipal Commissioner Suresh Kakani said that more than 40% of the patients were hospitalised from outside Mumbai during the pandemic. “If any of those patients died, even that death is registered in our records,” he added. “That may explain the unusual rise in deaths,” he said. “Mumbai hospitals admit several Covid-19 patients from Thane, Navi Mumbai and Palghar. In the event of their death here, death certificate is issued from BMC.”

Health experts also said some coronavirus-related deaths may not have been recorded as the Indian Council of Medical Research’s guidelines stated in June not to test a corpse for the disease. An unidentified senior doctor working at the municipality-run KEM hospital in Mumbai said they had tested every body for the coronavirus in March and April, which was stopped after the change in rules. “Now we don’t test bodies even if the deceased had symptoms of Covid-19,” the doctor told the newspaper.