medRxiv preprint doi: https://doi.org/10.1101/2021.08.22.21262432; this version posted August 25, 2021. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license . All-cause excess mortality in the State of Gujarat, In- dia, during the COVID-19 pandemic (March 2020-April 2021) Rolando J. Acosta1, Biraj Patnaik2, Caroline Buckee3;4, Satchit Balsari∗5;6, Ayesha Mahmud∗7 1Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115 2National Foundation for India, New Delhi 110 003, India 3Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115 4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115 5Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA 6Fran¸cois-Xavier Bagnoud Center for Health and Human Rights, Harvard T. H. Chan School of Public Health, Boston, MA 02115 7Department of Demography, University of California, Berkeley, CA 94720 ∗
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[email protected] Abstract Official COVID-19 mortality statistics are strongly influenced by the local diag- nostic capacity, strength of the healthcare system, and the recording and reporting capacities on causes of death. This can result in significant undercounting of COVID- 19 attributable deaths, making it challenging to understand the total mortality burden of the pandemic. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mor- tality shock of the COVID-19 pandemic.