A population-representative serological study was conducted in all districts of the state of Tamil Nadu (population 72 million), India, in October-November 2020. State-level seroprevalence was 31.6%. However, this masks substantial variation across the state. Seroprevalence ranged from just 11.1% in The Nilgris to 51.0% in Perambalur district. Seroprevalence in urban areas (36.9%) was higher than in rural areas (26.9%). Females (30.8%) had similar seroprevalence to males (30.3%). However, working age populations (age 40-49: 31.6%) have significantly higher seroprevalence than the youth (age 18-29: 30.7%) or elderly (age 70+: 25.8%). Estimated seroprevalence implies that at least 22.6 million persons were infected by the end of November, roughly 36 times the number of confirmed cases. Estimated seroprevalence implies an infection fatality rate of 0.052%.

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We estimate excess deaths in India during the COVID pandemic using monthly deaths in the sample of privately-conducted, nationally-representative, large, panel data set. The data set includes roughly 174,000 households (1.2 million members) and spans January 2015 - June 2021. We estimate COVID is associated with 3.36 million (95% CI: 2.08-4.63 million) excess deaths, a 17.3% increase in the all-cause death rate, until April 2021. Excess deaths spike during the peaks of the 2 infection waves in India. The second wave is associated with significantly more excess deaths than the first. The age-pattern of deaths is skewed towards the elderly relative to baseline.

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