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The COVID-19 pandemic has predominantly been a logistical crisis rather than a pure medical crisis wherein morbidity and mortality result mainly from lack of timely diagnosis and treatment, rather than failure of appropriate treatment. Health-care systems across the globe were inadequately prepared to handle the crisis, especially in LMICs such as India. Lewnard and colleagues found a gross disparity between the government statistics on COVID-19 mortality versus the excess all cause mortality they calculated on the basis of Chennai Civil Registration System (CRS) data. Although the Indian Government might have framed appropriate rules and regulations for testing, certifying, and so on, the implementation of such rules was extremely challenging during the pandemic. One needs to look closely at the local practice of how medical practitioners were filling death forms and certifying COVID-19 as the cause of death in the given government registry during this period.

The study concluded, the increased deaths in the second wave might have occurred not only due to the higher R0 and virulence of the delta strain (B.1.617.2) and laxity in COVID-19-appropriate behaviour (the public feeling that the game is over), but also due to the inadequate anticipation of the health systems and the logistical obstacles, this creates both for health-care facilities and individuals in need of care.