Covid-19 numbers should be seen in context

The media bombards us everyday with data on new Covid-19 cases. There are several trends in the reporting that are disturbing:

Headlines affirm that India’s total cases have “shot past” or “surged past” a particular threshold, or that India has gone past Spain and is now fifth in terms of countries with most confirmed cases (without mentioning that India’s cases per million and death rate per million place it in the 143rd and 120th ranks respectively).

One reputed outlet reported that Maharashtra’s confirmed cases had crossed those of Belgium and Qatar, without specifying why this is relevant (Maharashtra has 10 times the population of Belgium and 40 times that of Qatar).

There is also little perspective on what effect Covid-19 has on India’s overall death rate. India records approximately 9.5 million deaths a year, which translates to an average of about 26,000 deaths a day. In the 129 days since the first case was detected in India, there have been 6,946 deaths attributed to Covid-19, which translates to about 54 deaths a day.

In other words, Covid-19 seems to have pushed up India’s daily death rate by 0.21 per cent over a four-month period. Is this increase not within normal inter-annual fluctuations?

Of course, for the seven days from June 1- 7, the average daily number of deaths has been 257, and this needs to be brought down.

With few exceptions, media outlets and policymakers take States’ figures at face value. For example, Tamil Nadu has done 11.4 times as many tests per million as Telangana, and 4.2 times the number of confirmed cases per million. Yet, many States have more stringent quarantine requirements for passengers coming from Tamil Nadu than from Telangana.

Relevant metrics

There seems to exist a greater and greater tendency to editorialise news through the selective use of data. This begs the question — what relevant metrics should we concentrate on to assess our progress in battling the virus?

Due to this wide disparity in testing between Indian States, and indeed, between countries, comparison of the total confirmed cases is not very meaningful. The only real data we have are those on deaths. Both from the perspectives of deaths per million and excess deaths caused by Covid-19, India seems to have managed the situation reasonably well until now, although the next few weeks might strain the healthcare system in some cities. Other than this, the most important information that we are still lacking is the prevalence of Covid-19 in the general population. This would tell us the infection fatality rate (IFR), which is the number of deaths divided by the total number of infected, and give us an idea of how lethal the disease is.

Different studies from different parts of the world suggest that the disease is far more widespread than the confirmed case counts reveal. Early data from two studies conducted using rapid antibody tests in Santa Clara County and New York suggest that the total number of infected persons (the denominator) is much more than the number of confirmed cases. The Santa Clara County study suggests that the denominator could be 50-85 times higher. Both studies have been criticised on two grounds: the samples were not representative of the population; and the antibody tests used were not as reliable as they should be (they had a 5 per cent incidence of false positives).

A more detailed study carried out by two German virologists, Hendrik Streeck and Gunther Hartmann, in the first hotspot in that country, Gangfelt, is consistent with the US studies in that it estimates the incidence of infection in Germany to be over 10x higher than the confirmed figures. They conservatively conclude that the IFR of Covid-19 in Germany is 0.38 per cent (as opposed to 4.47 per cent based on confirmed cases alone), about 3-4 times more deadly than the flu, and far lower than the original estimate of 0.9 per cent published by Imperial College London.

Actual IFR

Padmanaban Venkatesan, a faculty member at Christian Medical College, Vellore, published a paper on April 17 based on severe acute respiratory illness (SARI) surveillance data of the Indian Council of Medical Research (ICMR), where he estimated the actual number of Covid-19 cases in India on April 2 to be 17,157, which was approximately 35 times the total confirmed cases on that day. Gautam Menon, a faculty member at Ashoka University who specialises in mathematical modelling, suggested that the total number of infected in India, as of May 30, could be approximately 10 million. Finally, the US Center for Disease Control (CDC) estimated on May 22, in its “best estimate”, that the IFR for Covid-19 in the US is about 0.26 per cent.

All these studies and estimates suggest that the disease is more infectious, but far less lethal than we had believed.

If the infection is indeed widely prevalent and therefore the IFR is much lower than previously feared, what implications does it have on how we should move forward?

India has a much younger population than the richer countries where Covid-19 has hit hard. There have been suggestions that the BCG vaccination may have enhanced the immunity of Indians against Covid-19. A recent study by European scientists confirmed an earlier finding from China, which suggested that persons with blood type A may be more susceptible to Covid-19 than others. India has approximately 21.5 per cent of its population with this blood type, which is about half the proportion in US, Spain and Italy.

Opening up

These hypotheses are consistent with the fact that only 3.6 per cent of the total confirmed cases in India have needed ICU support. A low IFR in India would mean that we could continue to cautiously open up the economy. We need to provide adequate personal protective equipment (PPE) for all frontline workers — healthcare staff, police, and others — followed by those who interact with the public, such as retail staff. Most importantly, we need to ensure that there are enough hospital beds if there were to be a surge in the number of patients needing such care. Preventing the hospital system from being overwhelmed is critical to managing the fatality rate in the country, and no effort should

be spared to ramp up the infrastructure.

The priority should be to restore economic activity. E-commerce should be opened up fully in all areas, including containment zones, because there is no safer way of doing business (in fact, it should never have been restricted). We will know the long-term impact of the lockdown on our MSME sector in the coming months, but thousands of units will remain shut, and the millions of jobs that have been lost will take a long while to return.

The hotel, restaurant and travel businesses need to slowly get back on their feet again. Many workers who returned from the metros to their villages may not want to come back, and they need to be offered better terms to return. We now need to learn to live Covid-19 until a vaccine or cure is found, because the alternative would be for us to be locked down for a further year and a half.

The writer is Chengwei Ventures Professor of Entrepreneurship at the China Europe International Business School

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