Sifting through Covid stats

Is the fight against the virus getting tougher? Do we have the infrastructure to handle a spike in the hinterlands? And what about testing facilities?

On the assumption today’s the first day out of lockdown, let me attempt to answer a question that must be at the back of many people’s minds: What’s the true picture of the spread of Covid-19? Over the last 65 days we’ve had a bewildering profusion of statistics often pointing in different directions. So a clear understanding may be difficult.

As of 9 am on Saturday, May 30, the health ministry’s website reports 173,763 cases of Covid-19, which is more than double that of China. Also, according to the Hindustan Times, the daily average of cases and deaths calculated on a weekly basis has grown every week for the last nine weeks. Today we have more Covid-19 deaths than China. Finally, according to Worldometer, India is ninth in terms of overall cases but has the fifth-largest number of active cases. Does all this suggest the fight against the virus is getting tougher?

The lockdown was intended to flatten the curve but that clearly hasn’t happened although it’s not growing as steeply as we feared. Now the government has produced mathematical models to claim up to 78,000 deaths and 2.9 million cases have been averted. But AIIMS Director Randeep Guleria says “mathematical modelling is a rough guess”. Similar modelling in America has gone horribly wrong.

Some projections suggest we’ll reach the peak in June/July, others say August/September. But the tens of millions of returning migrants could escalate the curve and bring the peak sooner. That’s because their positivity rate is said to be double or triple the national average. They could spark off a new surge in rural UP, Bihar, Orissa and Bengal.

Do we have the health care infrastructure to handle a spike in these hinterlands? How many of the thousands of corona hospitals and corona-care centres are in rural UP or rural Bihar? And what about testing facilities?

Meanwhile, the government insists India hasn’t entered community transmission. But with 173,763 cases, that’s hard to believe. Epidemiologists like T Jacob John claim it began as far back as March 18 when a young man travelled from Delhi to Chennai and tested positive on arrival but had no history of foreign travel or meeting someone who is positive. When I asked Dr Guleria, he said whilst we can claim we haven’t reached nationwide community transmission — because in large parts of the country, the number infected is very small — it’s hard to deny we’ve reached that stage in our multiple hotspots.  

If all this suggests things could get worse before they start getting better, we also have statistics that offer comfort and re-assurance. Lav Agarwal doesn’t miss an opportunity to broadcast them. Let’s consider some.

First, India has a recovery rate of 42.8 per cent. However, Italy with 33,229 deaths has a recovery rate of 65 per cent whilst Spain’s with 27,121 deaths is 69 per cent. So clearly a high recovery rate does not preclude a disturbingly large number of deaths. In which case how comforting is India’s recovery rate? No one asked Lav Agarwal but Jayaprakash Muliyil, a former principal of Christian Medical College, says, ultimately recovery rates will be roughly the same all over the world.

The other statistic Mr Agarwal loves to cite is the mortality rate. On Tuesday (May 26), he announced three versions. In percentage terms, it’s 2.87 (compared to a global average of 6.36), per lakh it’s 0.3 and per million it’s 3.08. You could add to this India’s low overall infectivity rate, which is 4.9 per cent compared to Spain’s 10.5 per cent and UK’s 11.7 per cent, and the fact only 6.4 per cent of our cases need hospitalisation and less than 0.5 per cent need ventilators compared to around 3 per cent globally, and ask does this suggest the virus is less virulent in India or do Indians, for whatever reason, have better immunity?

Health Minister Harsh Vardhan says “it’s not that virulent”. Dr Guleria told me the government has data which suggests the virus has mutated and its virulence has diminished but this needs confirmation. But on Thursday (May 28), the PM’s principal scientific advisor Prof. VijayRaghavan seemed to disagree.

Of course, if we’re to draw comfort from our low mortality rate, we need to ask how accurate is it? Several papers suggest Delhi’s municipal corporations are reporting more than twice as many corona-positive cremations and burials compared to the Covid-19 deaths acknowledged by the government. I’m sure that’s happening elsewhere too. And in rural India, it could be worse because I doubt if we have a reliable way of determining the cause of death. Still, if a lot of deaths had happened we’d have found out. In the age of social media, they’re difficult to hide. So even if the actual mortality rate is higher than the reported, it’s probably still comfortably low.

Now what should we make of all this? We haven’t flattened the curve but it’s not rising as steeply as feared. Also, the later the peak the easier for our health care system to cope. Finally, there are good reasons why our mortality rate could be amongst the world’s lowest, the most credible of which is 90 per cent of Indians are under the age of 60.

The problem is our minimal testing levels. As of Saturday, it’s only 2,619 per million compared to Spain’s 76,071 and Italy’s 62,102. Most importantly, we need mass serological surveillance to establish how far the virus has spread. At the moment we just don’t know. The ICMR is doing that in 69 out of 739 districts. But is that enough?