The big questions, and answers, on Covid-19, writes Karan Thapar
I’m prepared to bet the issues I’ve raised will keep popping up in our public discourse. If not the government, the media will raise them. When they do, it will help sort out meaningful information from mere detail and guffUpdated: Jul 12, 2020 05:37 IST
We’ve read so much about the coronavirus that our heads are reeling with the information we’ve taken in. A joke I received the other day puts it cleverly: “My phone has absorbed so much corona it no longer rings but coughs!” Yet there are still areas where we don’t have clear answers. This is often because experts cannot agree. But sometimes it’s because we’re obsessed with statistics that aren’t as significant as we’re told.
So that’s my subject today. I can’t pretend to have definitive answers. I’m neither a doctor nor an epidemiologist. But I’ve raised these issues with multiple experts and their opinions have given me a sense of how to guide us through this labyrinth.
First, are we testing enough? No one in government — politician, bureaucrat or doctor — will give you a straight answer. Independent experts, on the other hand, unequivocally say we’re not. But even they don’t agree on what’s enough. At the moment India is testing 8,191 per million compared to 122,651 for Spain, 169,945 for the United Kingdom (UK) and 96,836 for Italy. Given India’s population is 10 or 12 times bigger, this can’t be enough. What is? The best answer came from Soumya Swaminathan, the chief scientist of the World Health Organization. She says India needs to expand its testing till the positivity rate — not just national but in critical hotspots — falls below 5%. In other words, we need to do as many tests as it takes to reduce the rate to the required level.
Second, are we in community transmission? With 820,916 cases, and growing at 27,000 per day, it’s hard to believe we’re not. Independent experts say we are. But the head of the Indian Council of Medical Research (ICMR) disagrees: “India is not in community transmission”.
Last week, ICMR’s former head of epidemiology, Raman Gangakhedkar, gave me an answer that made a lot of sense. In specific areas, such as Delhi, Mumbai or Chennai, we cannot trace the source of the escalating infections. This is community transmission although he preferred to call it localised transmission. His reason was not unconvincing. It’s not happening all over the country. In fact, 80% of our cases are in just 49 districts. So, perhaps, localised transmission is more accurate even if it’s no different to community transmission. In either case, the strategy for handling the situation is the same.
Third, how significant is our mortality rate? At 16 per million, it’s decidedly better than the UK’s 658, Italy’s 578 and Spain’s 607. Consequently, the government claims we’re doing better than many other countries. But how accurately is our rate calculated? Do we really have a perfect idea of the total number of Covid-19 deaths? Certainly, the official number of cases could be a huge underestimate because the unreported ones aren’t counted. Even if the first problem is not common to all countries, the second undoubtedly is. So no one’s mortality rate is truly reflective of reality. Ours only less so.
A further issue arises when you compare our rate with that of other countries and claim we’re doing better. Mortality rates don’t take into account different age demographics. Ours is a youthful population — 90% are below 60. Italy has an older population. Only 70% are below 60.
Finally, the recovery rate. This is another statistic drilled into us. The government uses it to suggest we’re in control of the situation. However, experts say when we have a clear idea of both total deaths and total cases, everyone’s recovery rate will be the same and close to 99%. Harvard’s Ashish Jha and our own Raman Gangakhedkar agree. So if everyone’s recovery rate will end up the same, why do we make so much of ours?
Now I’m prepared to bet the four issues I’ve raised will keep popping up in our public discourse. If not the government, the media will raise them. When they do, remember what I’ve told you. It will help sort out meaningful information from mere detail and guff.
Karan Thapar is the author of Devil’s Advocate: The Untold Story
The views expressed are personal