Covid-19: Decoding the low death rate in India, writes Karan Thapar
I am not an expert but I am curious. I tend to focus inordinately on the peculiar, the inexplicable or just the odd. They always catch my attention. And at the moment I can’t stop thinking about the small number of deaths in India due to the coronavirus disease (Covid-19). As of Saturday evening, the health ministry website puts it at 480.
Now, worldometers.info has country comparative data from February 15 onwards. Let’s make that our starting point. What it reveals is very telling. On that date, the United States (US) had 12 infections, Italy and India three each and Spain none. There were no deaths. By Saturday evening (60 days later), 37,175 have died in the US, 22,745 in Italy and 20,043 in Spain. That’s way more than our 488.
So clearly the virus is killing very differently in India. The key question is what’s the explanation? However, before I turn to that, let me point out that this issue is not affected by the fact we’re testing nowhere near enough people. A bigger scale of testing will only reduce our case fatality rate. That would amount to good news of a slightly different sort.
Now could it be that Covid-19 deaths have been ascribed to co-morbidities such as tuberculosis, hypertension and cardiovascular diseases rather than the virus? Maybe but, remember, deaths cannot be hidden. The bodies have to be cremated or buried. More important, in our age of WhatsApp and Facebook, this cannot be done secretly. And if a lot of people are dying of a terrible disease, the widespread grief would be palpable. There’s no way we would not have sensed or witnessed it.
However, let me go one step further. Covid-19 kills by creating severe breathing problems. So if more people are dying of Covid-19 then we know of or admit, hospital outpatient clinics ought to be crowded with desperate patients. They’re not and so far there’s no indication of that happening either.
Let’s at this point sum up what seems clear. Even if the number of people we believe are infected is unbelievably small, the number who have died has to be close to accurate. This is why the explanation is both necessary and intriguing.
It could be the strain of the virus in India is less virulent than in Europe and the US. But the research done so far does not bear that out. It appears there’s no significant difference. It seems the answer must lie elsewhere.
First, our demography. We know that the elderly are most vulnerable and the young considerably less so. Now, 90% of the Indian population is under 60. The percentages for the US, Spain and Italy are 79%, 75% and 71% respectively. So has the fact we’re younger reduced the number killed by the virus? Possibly.
Second, our temperature. The Massachusetts Institute of Technology did a study in the last week of March which showed that as of that date, 94% of worldwide infections were in latitude bands where the maximum temperature was below 17 degrees Celsius. At the moment, we’re touching 40 degrees Celsius in North India. So has our temperature debilitated the virus? Perhaps.
Third, the tuberculosis vaccination BCG. It’s been given without break to Indian children since 1948. In Spain, it was discontinued in 1981. In Italy, it was terminated after 2001 but even when administered it was not given universally. And in the US, it hasn’t been given at all. So could this vaccine be saving us? I’m not sure. Germany and Australia also have low Covid-19 mortality but do not implement a universal BCG immunisation programme. This explanation seems least convincing.
Now, as I began, I’m not an expert. My answers are not definitive. In fact, they may well turn out to be wrong. But, remember, the answers are only an attempt to explain. The more important thing is the number who have died is strikingly small. Let’s focus on that this Sunday morning. It might be the ray of sunshine that could dispel the dark clouds surrounding us.