A continuing fight

India is far from the pandemic peak

India now has over 1.8 million confirmed cases of Covid-19. Of those more than 580,000 are active. The highest number of new cases daily in the world is in India, even more than in the United States — in spite of its relatively low and inaccurate testing mechanisms. July saw the cases in India treble — they were under 600,000 at the end of June. It is worth noting that the dismal mathematics of a pandemic make even some good news sound bad. For example, the fact is that the number of cases per million in India is fewer than 1,400, a fraction of what it is in countries like Brazil or the US. Even if the differential testing ratio is ignored — Brazil and India have both tested at similarly low rates — a low number of cases per million also suggests the pandemic has considerable room to expand. There is every reason to fear, for example, that August will see an expansion of the pandemic into states and Union Territories that have not so far succumbed in great measure. Even though things have improved in some areas, the spread would lead to a further doubling, or even tripling, of the numbers. Preventing this spread must remain the priority for both the Union and state governments for the foreseeable future.

There are some reasons why a certain degree of overconfidence has crept in. For one, the death rate per million remains very low in India — under 30 — as compared to three-digit figures in many European countries. While that is an achievement, it might be dangerous to extrapolate from that. Death rates might be understated because of misreporting — and death statistics in India had been problematic even when there was no pandemic. India also has a fairly favourable age distribution of the population, which means it is more appropriate to compare the mortality rates for specific subgroups — the elderly, those with co-morbidities — than the aggregate rates. Finally, the experience in Europe and in Wuhan has revealed the effort in the pandemic must be to keep the number of severe cases as low as possible, because once that number passes a threshold determined by the capacity of the healthcare system, the death rate climbs steeply as hospitals turn into battlefields. This has not yet happened in India, but it is worth noting that given India’s generally under-provisioned healthcare system, such a threshold will be lower in this country than in Europe, China, or even Brazil.

Thus, neither government nor people can afford to relax. August will continue to be a battle, and India is far from hitting the possible peak of the pandemic, which has a great deal of space still to spread if it is permitted to. Later in the year, complexities will arise with the return of the regular influenza season, which will lead to misdiagnoses and panics. Thus, effort must continue to be focused on the public health crisis. This was always going to be a long haul effort, with no real end till an effective vaccine is broadly available. In spite of some encouraging news, that day still remains some distance away.