Experts baffled by India’s lower coronavirus death rate: Harsh lockdown, younger population and ‘missing’ statistics all put forward as possible explanations for country bucking the trend
- India has reported only 934 deaths from 29,435 cases in a country of 1.3billion
- The country’s median age of 28 is well below that in the UK, US, Italy or Spain
- India imposed a nationwide lockdown when it had reported only 482 infections
- But India’s testing rate is low and experts fear a large tally of ‘missing’ deaths
- Here’s how to help people impacted by Covid-19
India’s low death rate from coronavirus is puzzling experts, who say the country’s young population is an advantage but warn the figures are likely to be incomplete.
Fears of an appalling death toll in a country of 1.3billion have not yet been realised, with only 934 deaths from 29,435 cases so far.
India imposed a drastic nationwide lockdown on March 30, when the country had confirmed only a few hundred cases – moving earlier than much of Europe.
India’s median age of 28 is well below that in the US (38), Britain (41), Spain (43) or Italy (45), an advantage against a virus which is most dangerous to the elderly.
However, India’s testing rate is small for the size of its population and experts fear there could be a large tally of ‘missing’ deaths among people who died at home.
A medical worker moves a patient from an ambulance to an emergency ward at a hospital in the Indian capital of New Delhi yesterday
This graph shows the daily number of coronavirus cases reported in India. Sunday’s figure was a new peak of 1,990, while yesterday’s figure was 1,396
This graph shows the daily number of deaths, which has remained below 100 a day so far – a low death rate which is puzzling experts
India’s fatality rate of 3.2 per cent – meaning around one in 31 confirmed patients has died – is well below that in Britain, Italy or Spain, although not Germany.
Indian-American doctor Siddhartha Mukherjee has described the low death rate as a ‘mystery’ and cautioned that India is carrying out too little testing.
Prime minister Narendra Modi says India is at ‘war’ with the virus and has urged his 1.3billion citizens to keep observing the lockdown.
‘We should not be trapped into over-confidence and nurse the belief that coronavirus has not reached our city, our village, our streets, our office, and so will not reach them,’ he said.
All domestic and international travel is banned, factories and offices are shut along with schools, and migrant workers have been moved to quarantine centres.
The country’s land borders with Bangladesh, Bhutan, Myanmar and Nepal have all been closed. The border with Pakistan is heavily controlled in any case.
Medical journal The Lancet says India’s measures are ‘already having the desired effect of flattening the epidemic curve’.
‘The lockdown has also given the government time to prepare for a possible surge in cases when the pandemic is forecasted to peak in the coming weeks,’ researchers say.
The measures were imposed when India had only 482 cases, only a week after Boris Johnson ordered Britons to stay at home when the UK already had 6,650.
India’s lockdown is currently due to expire on May 3, but could be extended further.
Some small shops have been allowed to open in residential areas with half their usual number of staff, but some regional authorities have resisted the move.
Municipal workers wearing protective gear wait to transport the bodies of suspected coronavirus victims for cremation outside a government hospital in Kolkata
India’s numbers are low enough to employ a successful ‘cluster containment’ strategy by detecting cases early and tracing that person’s contacts.
The southern state of Kerala has flattened the curve after publishing ‘route maps’ showing where an infected person had been.
Kerala has also built thousands of shelters for migrant workers and distributed millions of cooked meals, the World Economic Forum says, reducing the number of people moving around.
India’s most populous state of Uttar Pradesh, home to 200million people, has set up ten laboratories to test for Covid-19 since the first case was reported on March 3.
Meanwhile, the worst-hit state of Maharashtra – which includes Mumbai – has deployed drones and mass patrols to enforce the lockdown.
Experts have also highlighted India’s experience in tackling previous disease outbreaks including polio and HIV.
Dr Mike Ryan, the WHO’s top emergencies expert, said last month that India’s success in eliminating polio was an example of how it could deal with Covid-19.
‘India got rid of polio by breaking it down to the village level,’ he said.
‘All the way through the system, it broke down the problem, it went after the polio virus district by district by district by district. And India won.’
The World Health Organisation also praised India’s handling of the Nipah virus in 2018, especially its effective contact tracing after an outbreak in Kerala.
HIV charity Avert says India has made ‘good progress’ in containing the virus, with new infections reduced by half since 2001.
A study published in 2017 found that India had averted around a million child deaths from infectious diseases since 2005 after a series of government initiatives.
Health workers check the body temperature of police personnel at a police hospital during the lockdown in Amritsar
India’s young population may also provide a natural defence against the coronavirus, which is most menacing to older people.
Only six per cent of people in India are aged over 65 – compared to 18 per cent in Britain and 16 per cent in the United States.
Italy, which has suffered one of the world’s worst outbreaks, also has one of its oldest populations with a median age of 47, while India’s median age is only 28.
Covid-19 is especially dangerous to people with underlying conditions such as diabetes and high blood pressure which are more likely to develop in later life.
A less encouraging theory is that India’s death rate is deceptively low because many people are dying of Covid-19 without ever being confirmed as having the virus.
India has carried out only 716,733 tests in total, which is marginally fewer than Britain for a far larger population.
As a result, it is feared that many cases are being missed in a country where many people die at home in any case.
Speaking to BBC News, Dr Prabhat Jha of the University of Toronto said ‘missing deaths have to be considered’ as an explanation for India’s low death rate.
‘Since most deaths occur at home – and will be for the foreseeable future – in India, other systems are needed,’ Dr Jha said.
‘A lot of people get some medical attention over time, return and die at home in India,’ he said, including from diseases such as malaria and pneumonia.
Indian paramilitary soldiers from the Central Reserve Police Force manufacture personal protective gear at their camp in New Delhi
Many healthcare workers have complained of poor facilities at India’s overburdened hospitals and nursing homes.
Taking a tally from funeral homes would also be difficult when many people are cremated in the countryside.
On the other hand, some parts of India have reported falls in the total number of deaths from any cause – bucking a trend that some countries have seen.
In Indonesia’s capital of Jakarta, the number of funerals rose sharply in March, while some towns in Italy also saw a jump in recorded deaths.
But Mumbai, home to some 12million people, saw the number of deaths fall by about 21 per cent in March compared with the same month of 2019.
‘It’s very surprising for us,’ said Shruthi Reddy, chief executive officer of Anthyesti Funeral Services which operates in Kolkata and Bengaluru.
Indian doctors, officials and crematorium employees suspect a drop in the number of road and rail accidents is a major factor.
Accidents on India’s chaotic roads killed more than 151,400 people in 2018, according to official data.
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