How to assess the threat of Covid-19 in India? How much fear is justified and how much is overblown? How to think about future policies? Some thoughts below.
About 27,000 people die every day in India, including all causes of death combined (0.73% of the population annually). These can be classified into three categories:
(1) About 25%, or 6,750 deaths, are from communicable (infectious) diseases like TB, HIV/AIDS, Malaria, Flu, Diarrhoeal and other respiratory or parasitic diseases.
(2) About 50% of the deaths are from non-communicable diseases like cancer, diabetes, cardiovascular, digestive, respiratory, neuro-psychiatric, etc.
(3) About 25% of the deaths are from injuries, industrial and road accidents, suicides, and unclassified or ill-defined causes.
We are all mortal, so a certain number of daily deaths are a given, even if we all die happily in old age. But effective public health systems slash premature deaths from communicable diseases through universal vaccination, better hygiene, sanitation, education, etc. (that’s how India eliminated polio and smallpox; that’s how the average lifespan goes up). Communicable diseases also cause the most fear and panic because they can strike anyone randomly (though they often disproportionately strike the poor). The fear and panic are worse when, as with Covid-19, a disease is novel, is very infectious, has no cure or vaccine, and is abundant among the rich.
For a different perspective on the threat posed by Covid-19 in India, let’s compare it with our current communicable disease burden (so no silly comparisons with terrorist strikes or war deaths, as some are doing in the US; that’s a huge category error). Currently, Covid-19 is killing ~50 people daily in India—or let’s say 2X that, if not all deaths are being accurately assigned—so we have at most 100 Covid-19 deaths per day. Other communicable diseases in India kill 6,750 a day. Among these, TB alone kills over 1,000 people a day, mostly the poor.
Does this imply that Covid-19 should be a minor concern in India? No. Much depends on its growth trajectory. We know it spreads easily and has no cure or vaccine. New information about its infectiousness, mortality rate, and impact on the body is emerging daily. Left unchecked, what if Covid-19 grew to kill 25,000 a day in India? In New York and parts of Italy, the virus was killing more than all other causes of death combined, until a lockdown shrank the death toll. Given the virus’s novelty and its visible trail of havoc in other countries, I think the initial lockdown in India seemed necessary at the time (though it should’ve been better planned, as I’ve argued at length).
However, the disease isn’t progressing as fast in India (only 4.7% of symptomatic people are testing positive vs. 20% in the US). It is killing fewer infected people than the global average. With 20% of the global population, South Asia currently has only 2% of all Covid-19 cases. Is South Asia simply behind the curve due to its lockdowns, or do South Asians have some secret defenses against this coronavirus? The latter seems increasingly plausible, but not yet certain—the daily confirmed cases in India are still rising slowly, not declining, even after five weeks of lockdown (though its goal of distancing was only partially achieved owing to high human density or lack of awareness).
Though we’re still assessing its relative mildness in South Asia, what’s clear is that this virus is here to stay and won’t be stamped out. Since it spreads more easily than the flu, and has many more undiagnosed or asymptomatic carriers than confirmed cases, Covid-19 will continue spreading through the population. All we can do is reduce its rate of spread via lockdowns, physical distancing, masks, and hand sanitizers. What’s also clear is that a vaccine is at least a year away, and that lockdowns until then are not sustainable; the heavy economic toll they inflict disproportionately burdens the poor. The primary goal of a lockdown today is not to eradicate the virus but to ‘flatten the curve’ so new cases do not overwhelm the medical capacity, and to buy time to learn about the virus, raise medical capacity, and assess potential treatments and best practices. In the future, if a region’s healthcare system can cope with the projected new cases, a lockdown will be harder to justify—it’ll need to do much more than merely delay new infections—unless the Indian upper class, via the neoliberal state in its thrall, agrees to roll out ample welfare measures so the vulnerable participants in our economy can afford to stay at home (fat chance!).
So here is the painful decision looming before us: What higher level of Covid-19 disease burden can we tolerate while permitting the hard-hit workers in the informal economy to return to work? This trade-off will need to coexist with physical distancing, shielding the most vulnerable among us, and the ongoing scaling of medical capacity to handle the inevitable rise in Covid-19 cases. It’ll require locking down hotspots as well as regional lockdowns if cases rise too fast. The need of the hour is a nimble, data-led, scientific, and holistic measure of costs and benefits to arrive at a plan of action for minimizing collective suffering—and it will need to continue until there is a cure or a vaccine.
Well written Namit ! My friend Sulagna who is a Scientist at the National Institute of Cholera and Infectious Diseases works in close collaboration with the adjacent Covid treatment center in Calcutta. She seems to think that the cases are rising very slowly and surprisingly the virulence is nowhere close to what we are seeing here in the UK or in the US. It is quite interesting actually! I think the early lockdown in India has helped and possibly the viral load is not that high even in infected individuals. Also, we have a long history of battling infectious diseases so genetically we might have a better immunity compared to the West. Last but not least the searing heat of Indian summer is definitely helping.
Still, to be on the safe side I hope our Government plans for the ease of lockdown in phases and not all at once.
Posted by: Shreyasi Chatterjee | April 28, 2020 at 03:37 AM