As the world grapples with COVID-19 pandemic, one of the more intriguing stories revolves around India’s fight against the virus. Why does India have so few cases and such low mortality rates? Is India an outlier or is this a classic case of poor surveillance; for COVID RT-PCR test kits are in short supply, and under-reporting of cases is but natural. Beware of the gathering storm!
There are differences in how the public health authorities in the West are fighting the pandemic and how the crisis team in India is handling this emergency. In the West, the approach is focused on ramping up the development of a vaccine (a Marshall Plan or a Manhattan Project type mission to discover the vaccine), on social distancing, and obsessed with universal testing however ambitious this goal maybe. The holy grail, being to achieve complete coverage of the population.
In India there is less talk of the vaccine and an underlying acceptance that the virus is here to stay, and that a vaccine may never be discovered. Similarly on testing, the approach is nuanced; 100 per cent coverage is impractical and uneconomic. Testing is critical but do it strategically, rush this scarce resource prudently to potential hot spots, identify clusters and seal them off. ‘Cluster containment strategy’, is India’s mantra. And all of this centred in an overarching policy of a complete lockdown: to a scale, the world has never seen, a staggering 1.3 billion people forced to stay home.
There are grave doubts on whether the worst is over. India is still a puzzle (when is it not?) and the fear of a rampaging virus that may yet devastate its population.
But is India winning the war against the virus?
Some argue that the epidemic may have struck India later than other countries and the crisis is only unfolding. Others claim India may have inherent protective characteristics to fight COVID-19 and researchers suggest factors like low percentage of the elderly in the population, the high temperatures and humidity in India, widespread BCG vaccination for tuberculosis, and resistance to malaria through extensive use of Hydroxychloroquine. None of these are conclusive and it would make sense to spotlight the country’s data points and compare them to the rest of the world.
India has been on lockdown for more than a month and there cannot be a better time to evaluate. Speculative theories are at best notional and questions to be asked are, have transmissions gone up, has there been a spike in total deaths and in the case of the latter there are challenges in weeding out non-COVID related deaths. Also records may not have been updated besides by shutting down travel and factories, it has eliminated deaths that are transport-linked as well as on account of air pollution.
What are India’s data points?
First, while the number of cases have kept surging (over 37,000 and climbing), the rate of increase is linear and not exponential. This is a huge marker and a major achievement. If the positivity rate in India is around 4.5 per cent (from a peak of 7.9 to a low of 2.4), in the US it has been 19.8 per cent, in France 41.8 per cent.
Similarly India’s R0 (a measure of how many people each person will infect) is showing a healthy decline. It had peaked to a max of 4, then hovered to 1.7 and dipped to 1.36. When the R0 goes below 1 (RO< 1), one can theoretically claim the end of the pandemic. The state of Goa has been declared virus free and Kerala is on a similar trajectory. It is also interesting to note that the fatalities in India are largely on account of comorbities (pre-existing conditions)-more than 80 per cent.
Next, what has India done during lockdown to ramp up dedicated COVID-19 centres, hospital beds and ventilators? Short answer: Impressive but nowhere near ideal. Exact figures have been put out but suffice here to say the uptick is impressive (33 times what facilities it had pre-lockdown).
In short India has not been sitting on its haunches, the country has been on the move and preparing for conditions that can change dramatically. Especially when the lockdown is eased. When the Tablighi Jamaat (TJ) event took place there was a sharp rise, R0 surged to 7.9, and over 4,291 positive cases were linked to TJ members in 23 states of the country and over 40,000 were consequently quarantined at various facilities. Worryingly, hundreds remain still untraceable.
Extreme caution needs to be exercised therefore to draw conclusive trends. There are grave doubts on whether the worst is over. India is still a puzzle (when is it not?) and the fear of a rampaging virus that may yet devastate its population and lay waste its land is needed to keep at bay complacency.
T. S. Eliot’s ‘April is the cruellest month, breeding Lilacs out of the dead land’... from his poem ‘The Waste Land’ needs recitation in these trying times.
— Ravi Menon is a Dubai-based writer and thinker, working on a series of essays on India and on a public service initiative called India Talks.