India, the COVID capital of the world

A Government panel has said the number of cases will cross 10 million by February 2021. India saw an unprecedented rise in the number of cases in the months of August and September. This number has started to come down but not drastically. Is there a danger that India will leave the US behind and become the country with the highest number of cases? It is a distinct possibility

early eight months since the first COVID-19 case was reported in Kerala on January 30, the number of confirmed cases of novel coronavirus has crossed the 72 lakh mark. The fatalities have crossed one lakh ten thousand. At present India is at second spot globally behind the United States. But the number of fresh cases every day is more than seventy thousand. At this rate India will become the country with the highest number of cases globally in another two weeks, making it the worst coronavirus-hit nation. Since August there has been an exponential growth in the number of infected people in the country. In the last two and a half months, there have been more than fifty lakh positive cases in India. India’s COVID-19 tally had crossed the 20-lakh mark on August 7, 30 lakh on August 23, 40 lakh on September 5, 50 lakh on September 16 and 60 lakh on September 27. Globally, the total number of cases stands at 37.6 million and the number of deaths is 1.8 million. It means that every 6th COVID case is in India and every 10th death is happening here. (see Graphics)
Why is this happening? Are people getting tired and throwing caution to the winds or numbers are going up because there is more aggressive testing now. At the last count, according to the Indian Council of Medical Research (ICMR) more than eight crore people have been tested by now. Then the question that comes to mind is why it was not done earlier. In June and early July, we were talking about record spike in the number of cases when it used to be little over fifteen thousand. That number sounds minuscule if we compare it with numbers that we have now. There are a lot of questions that beg answer but are hardly forthcoming.

Is there a problem in comparison?

There are many arguments and counter-arguments being offered. While some blame the government for its faulty policies and handling of the pandemic, there are others who argue for looking at things rationally. While there are experts who hold central government of taking decision of lockdown in a haste, they argue that even if the decision was taken that period should have been used to strengthen the health infrastructure and prepare the country to deal with the situation better. But others argue that while we discuss the numbers we must keep the size of the Indian population in mind. We should just not look at the overall numbers but look at the number of positive cases and fatalities per million. They compare this with the United States which has a population of about 36 crores but the number of cases and fatalities per million is much higher. India, the world’s second-most populous nation has the lowest number of deaths per 100 confirmed cases — the observed case-fatality ratio — among the top 20 worst-affected nations at 1.5 per cent, according to a Johns Hopkins University tally. In comparison, the United States, the most infected country, has a death rate of 2.8 per cent. India’s number of deaths per 100,000 population is 7.73, compared with 64.74 in the United States. Though the low fatality rate in India has baffled many experts and have even doubted the data that has been coming both in terms of positive cases and fatalities, there are many explanations being given for that.
Dr Randeep Guleria, Director, AIIMS says, “We have been able to keep the curve rise slow, but I do agree that we have not been able to get it to move aggressively down. That’s related to our population density, diversity of our country and socioeconomic challenges in our country.”

Younger population and possible immunity

One of the key reasons being given is the younger population of the country. Older people suffering from conditions such as diabetes and heart disease have become a particular target of the pandemic but India has a young population with a median age of 28.4, according to the UN World Population Prospects report. In comparison, France –which has reported almost 700,000 cases and more than 32,000 deaths for a death rate of 4.7 per cent — has a median age of 42.3. Virologist T Jacob John says ‘it is possible that other viral diseases such as dengue fever, which is endemic in India, may have given the population some antibody protection against the coronavirus’. Others say it is also plausible that exposure to other milder coronaviruses could give some cross-immunity. But all experts say more research is needed into this line of defence.

Complacency can hit hard

Experts have been warning of complacency once the process of unlocking began. Dr Mathew Varghese of St Stephens Hospital says, ‘A major share of the problem would be addressed if people simply followed basic COVID appropriate behaviours’. He says it is important to wear masks properly and maintain social distancing at all times. He adds, “The government should have worked on strengthening the health infrastructure in the country. Not doing that has also led to the death of a number of healthcare workers.” There are other health experts who echo his view. Dr SP Kalantri, a hospital director in the village of Sevagram in country’s worst-hit Maharashtra state, said that people in his village had stopped wearing masks, maintaining distance or washing their hands regularly. He added that the sick were still being brought in to his hospital.
“If we are able to have good behaviour in terms of physical distancing and masks, maybe by early next year we should be able to come to a new normal. COVID-19 will not finish but it will be under reasonable control with travel and other things becoming much more easier and people relatively safer,” said Guleria.

Festival season, pollution and winters

After a relatively clean air because of lockdown and even after that because of people mostly staying indoors and working from home, poor air quality has again hit the national capital. It has already entered into ‘poor’ category. Experts are warning that it could lead to a big surge in COVID-19 cases. AIIMS Director, Dr Randeep Guleria has cautioned people and said that coronavirus cases could witness a surge if there were to be even a slight increase in PM 2.5 levels. He said, “Since there is a rise in air pollution, there is data to state through certain modelling studies from China and Italy (Europe) which show that in areas where there is even a little bit of increase in PM 2.5 levels, it leads to a surge of at least 8-9 per cent in coronavirus cases”.
He also warned that winter will make the health crisis worse as it is the season of respiratory viruses. Guleria asserted that during winter, people tend to stay indoors, and hence there could be more crowding leading to a spike in the infection. The biggest worry for health experts at the moment is the festive season approaching. Though state governments have issued Standard Operating Procedure (SOPs) and guidelines, the fear is that people will not maintain physical distancing, there will be overcrowding at the places of worship and it could lead to a huge spike in cases. They cite the example of Kerala, where after the festival of Onam there was a spike of four hundred per cent in the number of cases. These three factors are a cocktail of worries and that has led NITI Aayog to ask Delhi government to prepare for 15,000 cases per day in coming weeks.
The profound impact of the pandemic is still unravelling across the country and some are warning that as Corona cases begin surging once again, as being feared, the situation may become worse than as it is now. The central government must work together with states to ensure that innovative methods are adopted and keep the fresh infections in check. The safeguards need to be implemented strictly and an awareness campaign must be undertaken.