Are more people dying in India’s second Covid wave?
The most important target in dealing with any pandemic is to keep the number of people dying from the disease as low as possible. This has been repeatedly stressed by the government as the primary target of India’s handling of the coronavirus disease (Covid-19) outbreak.
As the country’s second Covid-19 wave continues to push daily case numbers up to record levels, daily deaths have also started increasing, though currently they remain below peak levels seen in the first wave.
What does this mean? Some say it shows that the second wave is not as dangerous as the first. But a deeper look at some crucial indicators for Covid-19 fatalities shows that India may be on the cusp of an alarming trend of deaths.
First, a ‘base’ CFR that can serve as a comparison point
Overall, of the 13,686,024 people infected across the country till Monday night, 171,108 people lost their lives to Covid-19. This places the country’s overall case fatality rate (CFR) at just a shade under 1.3%. However, in the initial months of the outbreak, a larger proportion of people were dying as doctors across the world took time to narrow down on effective treatments, and the health infrastructure was in the process of being strengthened. As a result, India’s CFR has steadily been improving – it was 3% till the end of June; it improved to 1.6% by the end of September. In the six months before the start of the second wave (from September 2020 to January 2021), only around 1.1% of cases resulted in deaths (there were 70.8 million cases and nearly 76,000 deaths). This 1.1% is a good comparison point. It is recent, and it is from a time when cases were declining.
So, are more people dying in the 2nd wave?
The 1.1% base CFR can be used as a yardstick to compare the death rate during India’s second wave.
In order to see if the second wave has had a lower death rate, HT plotted the seven-day average of deaths (with a 14-day lag) against the seven-day average of cases since October 1, 2020, at a ratio of 0.011:1 (as the CFR since October is 1.1%). Any deviation from the 1.1% CFR would be visible in such a chart – the target would be to keep the line representing daily deaths below the line for daily cases.
To be sure, all death calculations and CFRs used in this analysis have assumed a 14-day lag between cases being reported and deaths occurring. This is because a February 2020 study showed that the median time between someone testing positive for Covid and their death is around 13.8 days.
We see that the death trajectory is nearly identical to the case trajectory in the second wave for new cases occurring till the first week of March. But from there on, things take a turn for the worse: deaths are rising faster than cases. This gap, if anything, appears to be getting worse by the day.
After a long gap, the CFR has again started rising
For a period that lasted over four months – from the start of December till the end of March – the CFR for any week remained at 1% or below. The 1%-mark, incidentally, is significant because officials from the Union government have repeatedly stressed that their eventual goal is to bring the country’s CFR for Covid-19 to 1% or below, a number that is impressive for a country this size.
However, this trend did not last long. With the start of the second wave, CFR started to climb again. Accounting for the two-week lag in deaths, 1.1% of the people who got infected in the week ending March 8 ended up dying. In the two weeks that followed, the CFR was 1.2%. Then, 1.3% of the people who were infected in the week ending March 29 ended up dying.
If this trend of a CFR of 1.3% continues , it would mean that India is set to touch a record number of daily deaths. In the two corresponding weeks, there have been 548,698 (for week ending April 5) and 937,428 (for week ending April 12) cases. This would mean that 1,019 people may die every day across India in the coming week, and 1,741, in the week after. India’s death toll has never been this high – at the peak of the first wave, the seven-day average of daily deaths touched 1,169 for the week ending September 16.
Can any factor cause deaths to soar even further?
Simply put, yes. The number of active cases – those Covid-19 patients who have tested positive and are under treatment at a given point of time – in a region is crucial in determining the load that a health care system is bearing. The higher this number, the more hospitals and doctors get burdened and the more resources such as ventilators and hospital beds get stretched.
As of April 12, there are 1,264,430 active cases of Covid-19 in the country – the highest this number has ever been. This means that currently the health care system in the country is bearing a load of cases that it has never witnessed. An even more worrying trend is that this number is rising at the fastest rate ever recorded. On average, 67,951 active cases have been added to the national tally every day in the past week – the highest ever. This number has nearly doubled in a week (it was 35,214 a week ago).
This means that the health care system in the country is stretched the most since the start of the outbreak, and conditions are getting worse by the day. If this trend continues, it may result in an increase to the already rising CFR.