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India’s low case fatality rate is good news but infections & deaths are still on the rise

In episode 539 of #CutTheClutter, Shekhar Gupta delves into Covid data on fatality rates in India and compares it to the rest of the world. There is some good & bad news here.

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New Delhi: While India has a very low case fatality rate for Covid-19 compared to Western countries, both the number of infections and deaths in the country are on the rise, said ThePrint’s Editor-in-Chief Shekhar Gupta in episode 539 of ‘Cut The Clutter’.

If the infections and deaths continue at the current pace, India may surpass Brazil on both counts by the end of August, Gupta said.

He noted that the total number of deaths in India may surpass Brazil by 25 August.

The test positivity rate (TPR) — the percentage of positive Covid tests — is also not coming down for India.

“In the past two weeks, the only time India’s TPR came below 10 per cent was on a day when India tested a record number of six and a half lakh cases,” said Gupta.

India has also not managed to flatten any curve — be it the number of cases, number of deaths, or test positivity rate.

Furthermore, several of India’s “headline figures”, such as Home Minister Amit Shah and Bollywood actor Amitabh Bachchan among others, have tested positive for the disease.


Also read: This is how India set up WHO’s drug Solidarity trial in less than a month, despite lockdown


Asia fares better than Western countries

However, in the midst of all this, the good news is that India’s fatality rate per million population is better than any major country in the world, outside of Asia.

Asia is an outlier in the coronavirus pandemic, particularly countries in South Asia.

If the per million death rates are compared, Asian countries are faring much better than the rest of the world.

“India at this point has 28 Covid deaths per million. It is marginally higher than Pakistan (27) because these are very similar populations,” Gupta said.

Bangladesh, which has a better health system, has 19 deaths per million. While for Japan and Nepal, the figure is eight and two, respectively.

In contrast, Brazil has seen some 443 deaths per million, while for Mexico it is 370. In Italy it is 582, and in UK the number is 672 deaths per millions.

These countries are much richer than Asian countries and have much better health systems, but their death rates are almost 20 times higher, if not more.

Hence, there is a difference between Asia and the rest of the world.

Covid-19 deaths per million population in Asia | Graphic: Shipra Kapoor | ThePrint

The case fatality rate (CFR) — the percentage of Covid-positive patients who did not survive — of India is also better than Western countries.

India’s CFR is 2.11 per cent and declining. For Pakistan and Bangladesh it is 2.13 per cent and 1.31 per cent, respectively.

Sri Lanka, which has the best public health system in the subcontinent, the CFR is 0.38 per cent.

While Japan, which has a much older population, has a higher CFR, close to 2.75 per cent.

In the West, Brazil’s CFR is 3.44 per cent, Mexico’s is 10.87 per cent, Italy has a CFR of 14.15 per cent, France 16.1 per cent, and UK’s is about 15.16 per cent.

This shows that things are different for Asia overall.

Covid-19 case fatality rate in Asia | Graphic: Shipra Kapoor | ThePrint

What is working for Asia, particularly for India

India has a much younger population — the mean age in India is 29.

“According to the 2011 census, only eight per cent of India’s population is above 60 years of age, which means 92 per cent is younger than 60. So, if 92 per cent of our population is contributing to 47 per cent of deaths — it shows you that the remaining eight per cent are contributing to 53 per cent of the dead,” Gupta said.

Asian countries are also poor, particularly in the subcontinent.

“They are much less urbanised and the virus loves density. So the more urbanised you are, the more concentrated the virus attack will be,” Gupta added.

This would explain why major cities in India like Delhi, Mumbai, Chennai and Kolkata are Covid-19 epicentres.

The virus also came to India a bit late and the early lockdown broke the momentum of the spread. This gave the system time to get ready.

Some treatments also now exist that can lower death risk, such as dexamethasone and remdesivir.

We have also learnt a lot more about how oxygen support is more vital than ventilators.

Moreover, studies show that there are pockets of the population that are not as susceptible to the virus as others.

According to Karl Friston, a British neuroscientist and statistician, upto 80 per cent of the population is not susceptible to the virus due to some “immunological dark matter”.

Immunological dark matter here refers to the part of the immune system that we know nothing about.


Also read: 15 days between diagnosis and death for Covid patients in India, fatality data shows


Is India hiding deaths?

According to Gupta, hiding deaths by a large factor is an impossibility in India since even in villages, deaths need to be registered.

Moreover, even if India was understating the death toll by half, this number will go up to 76,000.

At 76,000 India’s per million deaths would be 54, which is still much lower by far when compared to major countries affected by the pandemic.

In fact, even if nine out of 10 people dying in India were concealed, the deaths per million will be lower than all of Europe.

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