90% of those killed by Covid in India are older than 40, 69% are men
Twice as many men have died of the coronavirus disease (Covid-19) as women in India, with men accounting for 69% of all fatalities, according to health ministry data accessed by HT that offers the most granular view to date of how the pandemic is affecting people across age and gender in the country. And more than 90% of the people who died, both men and women, were above 40 years of age.
More than half the 56,292 Covid-19 deaths across states by August 22 were in the 50 -70 age group, with Covid-19 deaths being the highest in the 61-70 year age group among both genders.
Less than one in three persons who died of Covid-19 was a woman. By August 22, women accounted for 17,315 of the total Covid-19 toll of 56,292. The pandemic had killed 38,973 men by the third week of August, shows the data, which categorises four deaths as “to be updated” and “others.”
The unreleased data on deaths appears reaffirm what scientists have observed about the global fatality trends of the disease — it is disproportionally fatal for men, and for those who are older.
Deaths among women are roughly a third of all Covid fatalities, with the only anomaly being that of death rates being almost the same in girls and boys aged 20 years and below. Girls accounted for 49% of the 599 Covid-19 deaths in the 11-20 age group.
Children under 10 years are the least likely to die of Covid-19.
There were 301 Covid-19 deaths among people over the age of 90 years, who account for 0.5% of the total deaths. This is much lower than the global average, where people 85 years old and above account for 3.4% deaths, according to World Health Organization data till June.
“The risk of dying from coronavirus disease is also linked to underlying health conditions such as cardiovascular disease, diabetes, hypertension and kidney disease, and the capacity of health-care systems. India’s test, track and treat strategy has focused on diagnosis, surveillance and treatment while simultaneously strengthening health systems and supply chains, which, along with the invaluable hard work of Covid warriors, has helped bring down the case fatality rate to 1.7%,” said Union health minister Dr Harsh Vardhan.
The global Covid fatality rate is 3.3%.
Worldwide, age remains is a strong predictor of the risk of death from Covid-19, which hits people in their mid-fifties, sixties and seventies the hardest.
Death among young adults usually occurs within 24 hours of hospitalisation. “Older adults die of pneumonia and other Covid-19 related complications, but sudden, unexpected death is more common in young adults in their 20s and 30s, whose condition dips very quickly after admission. In such cases, the cause of death is usually cardiovascular, with abnormal clotting in brain, lungs and heart leading to cardiac arrest,” said Dr Shiv K Sarin, director, Institute of Liver and Biliary Sciences, New Delhi, where India’s first plasma bank has been set up for convalescent therapy to treat Covid-19 .
Unlike in Europe, where the majority of deaths took place among older people living in care or assisted-living homes, deaths among people over 80 are relatively fewer in India. A major reason is that life expectancy is lower 69.1 years in India, compared to 83.2 years in Italy, 80.9 years in Germany, and 78.4 years in the US.
“Indians develop chronic diseases at a younger age, which raises their risk of severe disease and death from Covid-19. Men also have higher levels of the ACE2 (angiotensin-converting enzyme 2), which is a protein the virus attaches to enter and infect human cells. ACE2 is found not only in lungs, but also the heart, kidneys and tissues lining blood vessels, and in the testes, which partially explain why men are more vulnerable to severe disease,” said Dr Yatin Mehta, chairman of the Institute of Critical Care and Anaesthesiology, Medanta - The Medicity.
Sars-CoV-2 causes infection by using its crown-like spike protein, which gives the virus its name (corona is Latin for crown) to bind to ACE2 receptors on the surface of human cells, from where it invades the air sacs in the lungs, leading to respiratory collapse.
Men’s immune response to new coronavirus infection differs from that of women, which led to more severe disease often being observed in men, said a team of US researchers led by Akiko Iwasaki from the Yale University School of Medicine. The study, published in the journal Nature last week, found men had higher levels of inflammation-causing proteins called cytokines and chemokines in their blood while women had a stronger T cells response. T cells, which are a part of the body’s longer-lasting immune response, seek and destroy infected cells to stop virus from replicating inside the body. Cytokines are proteins that regulate immune response. Covid-19 is marked by a hyper immune response called a cytokine storm, which can lead to death.
The study found that infection worsened in men with weak T-cell response while women who had more severe disease had increased amounts of inflammatory cytokines.
“Data categorising risk across age and gender helps people make informed choices about their own disease risk and take measures to protect themselves. Many people are still not using the social vaccine (use of masks, hand hygiene and social distancing) and not taking precautions,” said Dr Sarin.