India has quickly risen to one of the nations most severely affected by the COVID-19 pandemic. However, given the consistently mixed messages from both the media and politicians alike regarding the true scale of the issues India faces, it is worth putting COVID-19 into perspective. Such are the aims of a recent article reported by the Observer Research Foundation (ORF), which has set the death toll of COVID-19 in India in the context of the numerous other diseases blighting the country.
Since the onset of the pandemic, global speculation with regards to the status of the virus in India has been bleak. As the ORF states, India is known as “the ‘cardiac capital’ and the ‘diabetes capital’ of the world, India was considered a fertile breeding ground for the pandemic. The Indian population was seemingly more susceptible to the impact of the Novel Coronavirus [which causes the disease COVID-19], due to a high number of people suffering from lung diseases, heart diseases, diabetes, and malnutrition-related conditions, amongst many other ailments.”
Indeed even experts within India were suggesting grim tidings moving forwards. Dr Jayaprakash Muliyil, former principal of the Christian Medical College in Vellore and chairman of the Scientific Advisory Committee of the National Institute of Epidemiology discussed the matter in a 37-minute interview with Karan Thapar for The Wire. During the interview, taking place in late June, he speculated that “India could see a total of 200,000 cases a day by August.” He went on to agree that a forecast made by Ramanan Laxminarayan, the director of the Washington-based Center for Disease Dynamics, that India could have 200 million cases by September is likely to be accurate.
Such vast numbers have yet to come to fruition, yet daily increases in cases remain high. Mixed messages have been a consistent trend among the backdrop of the pandemic. While scientists and public health figures have delivered severe warnings, the Centre continued to claim that community transmission — the state under which the spread of the virus has gone unchecked within communities to the point that contact tracing is no longer possible — was still not occurring in India. This denial of community transmission continued even following the announcement of a million cases within the country.
The ORF notes this, citing fears of densely populated areas fuelling the spread of COVID-19: “Adding to this fear was that the only known preventive measure for the spread of the coronavirus—the practice of physical distancing—was an almost impossible feat for India, considering that on an average every sixth Indian lives in slums with high population densities, poor environmental sanitation and overcrowded medical infrastructure.”
Some areas have proven this theory wrong. Dharavi, famed for being the setting of the international hit film and Academy Award-winner Slumdog Millionaire, is, by all rights, a perfect breeding ground for COVID-19 to spread. Population density is at an extremely high level, with single-room shacks comprising a large proportion of the housing in the area. However, through grassroots efforts and in-depth contact tracing and isolation procedures, the area went from one of the worst affected districts, to one showing significant reductions in case numbers.
The ORF article, while still stressing COVID-19 as a significant health concern, has attempted to place the disease in the context of diseases that claim the lives of many people in India every year, often significantly more than the current death toll of COVID-19. Even comparisons to other epidemics and pandemics underscore the relative low mortality rate of COVID. For example, the mortality rate for Middle Eastern respiratory syndrome (MERS) was around 34 percent. The rate was 9.7 percent for severe acute respiratory syndrome (SARS); 2.5 percent for Spanish flu, 1918; and 1.3 percent for H1N1 2009/10 (swine flu).
Despite the host of noncommunicable conditions such as heart disease, diabetes and obesity that are both prevalent among the Indian population, and key risks for comorbidity-related deaths due to COVID-19 — India still has a relatively low mortality rate.
The ORF notes that “[diarrhoea], one of the most prevalent communicable diseases, causes 1,422 deaths every day, whereas ischemic heart diseases and chronic respiratory diseases, such as asthma, together cause a shocking 6540 deaths on a daily basis.”
Compared to some of the most recent daily death counts for COVID-19, now exceeding 1,000 daily, these are substantial. However, greater problems do not mean that COVID-19 deaths are negligible. Deaths are rising, and the problem must be addressed, or else India faces another addition to its already formidable list of health concerns. The ORF summarises that despite the potential for a more optimistic outlook, this is not a call for complacency
“While these trends display a more optimistic scenario than many predicted, India must remain vigilant. The high burden of communicable diseases and malnutrition, and the relatively high child and maternal mortality rate – all of which will be amplified and exacerbated by COVID-19—coupled with an inadequate health system in India, pose a serious threat to the future of the country, which may lead to long-lasting shocks to the overall health of its people.”