India is in denial about the covid crisis”, “India staring at coronavirus disaster”, “The callousness of India’s covid-19 response”—these were the typical headlines in the Western press just a few months ago. Alleged epidemiological experts were confidently predicting millions of deaths by August 2020. Yet, today the headlines are “India: Has the covid pandemic started to burn itself out?” and “The mystery of India’s plummeting covid-19 cases.” There is global wonderment at how India has managed to dramatically lower the spread of infection and case fatality rates.
Cinema halls have now been allowed to open at full capacity. Even the local trains in Mumbai have started running. In Delhi, more than half the beds in the covid wings of hospitals are empty.
To understand the scale of India’s achievement, compare some numbers. According to World Health Organisation data, as on 4 February, India, with a population of 1.4 billion, has had a cumulative 154,596 covid deaths, and 110 in the preceding 24 hours. In comparison, the United States, with a population of 330 million, has seen 439,830 deaths and 1,866 the day before. To put it rather simplistically, if the US had a population the size of India, it would have suffered 1,865,945 deaths, or 12 times the number of fatalities that India has seen. For the United Kingdom (108,103 deaths), that number would have been 15 times, or 1.6 million—nearly 2.5% of the country’s population.
Last September, India was confirming nearly 100,000 new cases a day. Today, that figure is between 9,000 and 11,000. India has not only flattened the curve, but hammered it down. The case fatality rate has dropped from a peak of 3.4% on 16 June (the world rate on that day was 5.4%) to 1.4% on 1 February (the world rate was 2.2%). In fact, India’s case fatality rate has been consistently below the world rate, which rose to 7.2% at the end of April (data from Ourworldindata.org).
What could be the reasons for India’s success that has the world’s scientists and media scratching their heads?
First and foremost, swift government action. Like me, many Indians were disturbed when Prime Minister Narendra Modi slammed a complete national lockdown—the biggest on earth—at four hours’ notice. But it has worked. Much went wrong in the beginning: the migrant crisis, a confused bureaucracy issuing contradictory or ambiguous diktats at the rate of a dozen per day, a few states trying to fudge data. But like it almost always happens, India and its people sorted things out. Citizens wore masks and maintained social distancing. Testing volumes kept rising. Awareness spread like wildfire, not least through cautionary messages that replaced ring tunes on phones. The production of personal protective equipment (PPEs) went from zero to the second-highest in the world within two months. And our doctors and health workers were truly heroic.
Two, the country’s age profile may also have played a positive role. More than half our population is below 25, so more resilient to the virus, and only 4.8% above 65, people who are most at risk.
The third possible reason is the most interesting: the fact that we are not a squeaky clean country like the developed world. A study by the Dr Rajendra Prasad Government Medical College, Kangra (bit.ly/3oNwWeH), has found that per capita covid deaths are lower in countries where people are exposed to a diverse range of microbes and bacteria. Another coronavirus study (bit.ly/36EbRgc) has found that low- and lower-middle-income countries with less access to health care facilities, hygiene and sanitation actually have lower numbers of covid deaths per capita. Scientists looked at publicly available data for 106 countries on parameters like demography, prevalence of communicable and non-communicable diseases, sanitation, etc, and concluded that “improved hygiene and higher incidence of autoimmune disorders correlated positively with covid-19 mortality and were among the most plausible factors to explain covid-19 mortality as compared to the GDP of the nations.”
If these two studies are correct, we may have survived the pandemic better because we grew up amid filth and pollution, drank contaminated water, contracted or were exposed to viral flus or malaria or typhoid, all of which gave us greater basic immunity.
Indeed, a study of 28,000 Delhi denizens last fortnight found that 56% of residents already have covid antibodies, suggesting prior exposure to coronavirus, and the figures were higher in more crowded areas. Another study shows that 57% of Mumbai slum-dwellers and 16% of people living in other areas have antibodies. These people caught the virus, had no or mild symptoms, and have achieved at least temporary immunity as a result, without even realizing that they got infected. Thus, India could well be getting closer to herd immunity.
However, complacency must not set in. The virus may mutate, a second wave may come, as has happened in some countries. This war against the covid pandemic is hardly over, but till now, to the amazement of the world, India has done far better than many had expected, given the country’s size and many inherent problems. If we can vaccinate 300 million by the end of August, which is the government’s target, we will be much safer. But it’s not yet time to give up that mask and crowd the buses. – Mint