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COVID-19 cases much higher than official figures?

142157361 - bengaluru / bangalore, india - march 4 2020: a hospital ward for testing covid-19 or coronavirus setup in bangalore, india. the infectious disease has over 93,000 confirmed cases worldwide, with india has reporting 28 confirmed coronavirus cases. COVID-19 case count concept. Image credit: Ajay Bhaskar / 123rf. Critical COVID-19 concept. COVID-19 tests concept.
A hospital ward for testing COVID-19 in Bengaluru. Image credit: Ajay Bhaskar / 123rf

A study of Karnataka households suggests India’s true number of COVID-19 cases during the pandemic may be markedly higher than the official tally.

The research, published in the Journal of the American Medical Association, collected data from a representative sample of households spanning twenty districts of the southern state, SciDev reports. The research indicated that Karnataka alone may have had 31.5 million COVID-19 cases during the pandemic – a figure almost 95 times its official tally.

For India as a whole, the official caseload stands at 10.95 million of which just over 137,000 are active versus almost 10.7 million recoveries. The findings from Karnataka also indicate that the level of COVID-19 exposure is almost the same among urban and rural populations, attributing this to the rural areas’ reliance on agriculture – a sector which is exempt from restrictions. According to the research, 44.1 percent of those in rural Karnataka and 53.8 percent in its urban areas tested positive for COVID-19 antibodies by the end of August 2020. 

The research, explained study author and professor at the University of Chicago’s Law School and Pritzker School of Medicine, Anup Malani, quoted by SciDev, “has a more precise estimate of the spread of COVID-19.” Malani outlined that concurrent testing using the RT-PCR test was utilised in the research, with those surveyed tested to see if they were currently infected as well as if they may have contracted COVID-19 previously. 

“This pairing allows the study to both report current levels of immunity and forecast future immunity because most of today’s infected population will, in a few weeks, join tomorrow’s immune population,” Malani said. Similarly, subsequent research in Tamil Nadu found that the number of cases in the state during the pandemic may be 36 times higher than the official numbers. 

The notion of underreporting of COVID-19 cases is far from a new phenomenon. As my colleague Nicholas Parry reported for Health Issues India in October of last year, a serological survey conducted by the Indian Council of Medical Research (ICMR) found that the number of people who may have contracted COVID-19 could be ten times the official figures. Nor is underreporting a phenomenon isolated to COVID-19, being associated with conditions ranging from tuberculosis to snakebites to mental health issues and suicide.

The importance of the latest research conducted in Karnataka, according to Malani, is that “if COVID-19 is much more widely spread, it tells us two things. Assuming death statistics are correct, the infection fatality rate is lower. On the other hand, India’s efforts to control [the] spread of the virus were less successful than many other countries. We need to investigate how India can do better in the next pandemic, especially if it is more dangerous to Indians than COVID-19.”

India recently arrested global headlines for its declining number of fresh daily cases and its recoveries vastly outweigh its active cases: 137,342, to 10,656,845, according to the Union Health Ministry this morning. 

As noted by Health Issues India yesterday, “declining case numbers are manifest in the country’s health system, where the burden has eased. In Delhi, for example, critical care unit beds equipped with ventilators recorded occupancy figures of almost ninety percent in November. Occupancy rates have since dropped to sixteen percent at the time of writing.” 

Experts have attributed a so-called “human barricade” to the drop and expressed optimism that India is past the worst of its outbreak. “India suffered through a lot and because it suffered through a lot, it’s reached the other shore now,” said Ramanan Laxminarayan, an epidemiologist at the Center for Disease Dynamics, Economics and Policy, quoted by NDTV.

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