In the light of the panic that has been created by the COVID-19 Crisis, it may be an idea to step back and examine the issue dispassionately.
Before we discuss COVID-19, let us look at the main causes of death in India. The chart, from https://www.worldlifeexpectancy.com/ shows the main causes of death in India. The number one cause of death is Coronary Heart Disease (16.44%), followed Lung Disease (10.19%), Stroke (7.89%), Influenza & Pneumonia ((7.37%) and Tuberculosis (5.35%).
According to the website https://countrymeters.info/en/India for the Year 2019, India’s total population in 2019 was 138,72,97,452 persons and the total deaths were 1,01,52,060.
The total number of deaths in India from natural causes was approximately 23 lakhs, and from disease and other causes as 88 lakhs. The death of 2,100 persons from COVID-19 would be approximately 0.024% of total deaths.
Nothing, however, can detract from the seriousness of the Pandemic nor its potential to decimate large numbers of the vulnerable population.
In India, we may doubt the Government figures for the number of infections and despair at the lack of adequate testing, but a single indisputable fact is the low mortality rate from COVID-19 in India.
The institutional recording of death in India is extremely robust and the Death Certificate a critical document to the family of the deceased. So, even if the cause of death may be questioned, the number of deaths cannot be under reported. The total deaths according to reports from cities where the data is available show that the total number of deaths is less that it was in the corresponding month last year.
There are theories as the why the Indian mortality rate from the disease is so low, given the potential disaster with overcrowded slums in all major cities.
The low mortality has been ascribed to the universal use of the BCG Vaccine, although scientists disagree on its actual impact in building immunity.
Indians, from birth are exposed to a number of virus and bacterial strains. These include TB, Chicken Pox, Malaria, Measles, Amoebiasis, and many more. Yet we survive, as our bodies develop immunity to all these invaders. The Indian body, due to our environment and circumstance, have developed a greater capacity for developing herd immunity.
Some scientists believe the indiscriminate use of drugs like Chloroquine, Hydroxychloroquine and antibiotics like Erythromycin, etc. in India by ‘quacks’ and doctors who took the easy solution, has contributed to the high immunity in the country. Others feel that the hot weather contributes to the low infection rate.
The H1N1 virus commonly known as Swine Flu, and started as a Pandemic in 2009, still exist in the country. According to The National Centre for Disease Control (NCDC), in 2009, 28,798 persons were infected with H1N1 and 1218 patients died.
The statistics show that a majority of the COVID-19 deaths are from Co-Morbidities like hypertension, diabetes, cardiovascular disease, respiratory ailments, etc.
Some facts to consider:
The situation in India re our Medical infrastructure is well known. Researchers from The Center For Disease Dynamics, Economics & Policy (CDDEP) estimated that India has approximately 19 lakh hospital beds, 95,000 ICU beds, and 48,000 ventilators. Most of the beds and ventilators in India are concentrated in seven states – Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%).
The strategy worldwide for control of the virus spread is RT-PCR tests. Initial studies indicate that there is a 30% chance of the result being a ‘FALSE NEGATIVE’. This means that although the test result is negative, you may still be infected and wandering free. Researchers believe that a majority of the errors come occur during the collection of the sample rather than the lab. However, it must also be understood that no test is perfect. It must also be understood that the test only indicates if the person is infected, and not how infectious the person is. As yet, scientists have been unable to identify the precise mechanism of the COVID-19 virus in the human body and how it spreads. Without this, a vaccine is difficult.
Due to the easy availability of X-ray machines, hospitals have been using them as an indicator of infection. However, standard studies worldwide show that CT CHEST has greater sensitivity to COVID-19 and can be a primary tool for detection.
In the face of the worldwide spread of the pandemic, the quick action of imposing a complete a complete 21 day lockdown from the 25th of March, preceded by the Janata Curfew on Sunday the 22nd of March, was a necessary and timely intervention by the Government to break and halt the COVID-19 transmission cycle. The comparatively low infection and mortality in the country can be attributed to this decisive action.
We are now toward the end of the 3rd lockdown cycle. The human tragedy that has unfolded in urban India in the wake of the lockdowns, with millions of migrant workers, most of whom live on daily wages and have no savings, is heart breaking.
Despite State Government efforts to look after they basic need for food and shelter, most migrants would rather return to their homes.
Millions of them have walked, and continue to walk, for thousands of kilometres to their villages, often carrying children, with little food or water.
A continuation of the restrictions on movement would worsen this human tragedy. In a survey of migrants that have returned to their villages in the Self-Reliant villages of Chitrakoot, data shows that 60% of the migrants have no wish to return to the cities.
The Government is working on multiple interventions to ensure that the rural economy starts. Farming and allied activities have already been allowed. However, unless we re-start the economy as a whole, there will be no market for the produce, much of which would need value addition at the village and district level to give employment to the returned migrants.
Statistics show that approximately 85% of COVID-19 cases have mild symptoms, 12% moderate and 3% severe.
The Government of India has stated that patients with mild symptoms do not need hospitalisation or testing, but has States have different policies to deal with their patients. Governments worldwide believe that home isolation for persons with mild and moderate symptoms is the best practice for its management.
Given these facts, developing Herd Immunity may be the ideal strategy for India, as we have developed it for other viral infections. While Herd Immunity is being developed, we could follow basic personal hygienic precautions like washing hands with soap, hand sanitisers, face masks or face covering with gamchas and the like, disinfecting public areas and social distancing.
Also, designated COVID-19 Hospitals in cities and district headquarters, can be the Containment Zones where patients could be rigorously isolated and treated, with the RT-PCR Test only used for testing patients with moderate or severe symptoms.
– Vasant Pandit