Cases, fatality rate or deaths per million, India in control of Covid: Niti Aayog expert

In an exclusive interview, Niti Aayog’s health and nutrition adviser Alok Kumar tells ThePrint that India has done way better than other countries with similar Covid numbers.

Niti Aayog’s health and nutrition adviser Alok Kumar | By special arrangement

New Delhi: The impact of Covid-19 in India has been relatively less severe, by whichever matrix one looks at it, said a health expert from the Narendra Modi government’s think-tank Niti Aayog.   

“If we look at cases per million, we are at just 151 cases per million as compared to over 5,000 cases per million for the US and Spain,” Alok Kumar, Adviser (Health and Nutrition), Niti Aayog told ThePrint in an exclusive interview.  

“Our case fatality rate (CFR) is around 2.8 per cent and has remained consistently low,” said Kumar, a 1993-batch IAS officer of the Uttar Pradesh cadre.  

As a way of comparison, Kumar cited the CFR in other countries.  “Germany is 5 per cent, it is 19 per cent in France, 6 per cent in the US and over 14 per cent in both Italy and the UK,” he added.  

CFR is the proportion of people who die from a disease among all individuals diagnosed with the disease. 

“If we look at death per million population, India has recorded four deaths per million whereas the numbers for the UK is 585, the US is 330, Germany is 104 and Brazil is 153,” he said, adding that “even allowing for our younger demography, our health system has been able to cope up with the pandemic reasonably well so far”.  

According to Kumar’s analysis, the cities most affected by Covid-19 contribute to over 65 per cent of the national caseload. “While it is true that some states share a higher caseload burden than others, there is a clear emerging pattern that dense urban populations are more susceptible to viral infection spread than others.”   

R0, CFR, death rate — which is the most accurate measure of checking the extent of the outbreak?  

“While all parameters are relevant in their own way catering to different monitorable criteria, death per million population is the most important number to keep in mind, because in this both the numerator and denominator are relatively less prone to measurement errors,” he said. 

While CFR reflects upon the success of our clinical efforts, lower R0 (R naught) reflects the success of our infection containment and mitigation strategy, he added. 

R0 is the measure of the average number of people who will contract a contagious disease from one person with that disease. 

Lessons for India

Kumar emphasised that India needs to be more strategic for planning health infrastructure.

“The National Health Policy (NHP), 2017, clearly articulates the need for enhanced government financing of health but it also requires us to look at the other elements of the health ecosystem,” he said. 

These issues include medical education and its quality, greater self-reliance in terms of medicines, medical devices and diagnostics and also streamlining regulatory pathways.

The NHP is a document published by the central government annually stating the country’s health objectives and goals for a well-defined period. 

“NITI Aayog has been advocating a whole-systems approach to health in India as brought out in its volume ‘Health System for a New India- Building Blocks: Potential Pathways to Reform’, which presents a series of options for consideration,” Kumar said.

The report released last year integrates viewpoints on the concerted efforts required for strengthening the existing fractured health system, to meet the challenges that lie ahead of the nation. 

Niti Aayog’s projections

The central government depends on the projections from NITI Aayog to plan its infrastructure. For instance, it began a 100-day programme to forecast emergency requirements that may arise in the next three months, depending on how much the coronavirus outbreak intensifies.

“Niti Aayog consulted a wide range of experts who included epidemiologists, statisticians, economists, inputs from other Ministries in Government of India and also feedback from the ground before arriving at our estimates for the projections of how Covid-19 will pan out in India,” Kumar said. “As you would appreciate, projections involving exponential function with great uncertainties in assumptions is a risky exercise in the best of times.”

“But I am happy to say that the projections proved to be robust in terms of the planning exercise to handle the Covid-19 response,” he added. “It is also important to note that all India aggregates hide regional disparities that are bound to occur in a country as vast and diverse as India.”

Best performers, globally 

The Niti Aayog expert also listed the other countries he believes have handled the pandemic well.   

“Lots of countries have applied innovative approaches to handling Covid-19 pandemic, but to my mind the following countries stand out in terms of their overall systemic response,” the IAS officer said. “While Taiwan used the lessons from previous outbreaks, extensive use of technology and compliance by the public, New Zealand focussed on elimination over containment, timely measures and science-driven communication with the public. 

“Fast and free testing, expansive tracing technology, and mandatory isolation of the most severe cases helped South Korea whereas Germany tackled outbreak well due to people’s participation, high numbers of testing and detection and suitable response in managing beds, doctors and nurses, material and medical equipment,” he added.