Of course it is far worse than it has been measured to be. People often do not seek out a doctor, especially in that part of the world. Many fear the ministrations of a doctor more than the disease, itself. Many victims are hidden away so as not to draw official attention to themselves and their neighbors and families.
Several years ago my son, DIL, myself and my husband got very sick after attending a banquet. We just thought it was food poisoning and when we had purged enough we’d be okay, which did happen. We never even thought of going to the doctor.
As it turned out over 50% of the people there got sick and the state got involved. When they interviewed us they were horrified and a little miffed that we hadn’t gone to the doctor.
What we all had was a norovirus that we got from the waiter who had just returned from working on a cruise ship.