There is a significant amount of discussion across India whether the government should continue with the national lockdown, the degree and scale of the lockdown. Following the imperative to save lives, the timely decision to implement the lockdown certainly stemmed the transmission rate in India. The unthinking obtuseness of a few has led to rapid proliferation in specific hot spots.
In this article, I am aiming to draw conclusions about the continuation of the lockdown in India based on comparison of the transmission rate and the mortality rate of the patients who have acquired the SARS-CoV2 virus in their bodies. The rates being compared are those of the 8 nations that have had the highest proliferation and mortality. The highly impacted country transmission and mortality rates were compared with the Global and India average rates to draw conclusions.
The methodology used has been the same as that mentioned in the previous article. The source data for countries such as USA, UK, Italy, Spain, France, Germany, Iran, China has been analysed. The figures were analysed in 8 five day periods starting from 1st of March (1/03 to 06/03) until the 10th of April. The source of this data is the report generated by the Disease Surveillance unit of the World Health Organisation. The data used for India are similar 5 day periods only a day earlier, 29th February till 4th March cycle. The figures are averaged for the 8 periods therefore are comparable. The output has been analysed and presented in the figures below.
The Global average mortality rate derived from the data over the last 40 days is 4.53% of the total infections. The highest average mortality rate has been recorded in Italy at 9.06 %. This is followed by France (5.86%), Iran (5.8%), Spain (5.8%) and UK (5.29%). Countries below the global average mortality rate are China at 3.97%, USA at 2.9%, India at 1.7% and Germany at 0.71%.
It is remarkable to note that USA despite over 425,000 cases has kept the rate of mortality low with respect to other highly impacted nations. Two countries that stand out in the data set are India and Germany. The number of infections in India is almost two orders of magnitude less than USA, Italy and Spain at this stage. It is at least an order of magnitude less that other comparable nations in this data set. The average mortality rate of India is 1.7% is the second lowest in the data set.
The most remarkable study is that of Germany where the derived average mortality rate is only 0.71%. It is the lowest in the comparable nations mortality rate even though it has been climbing gradually since 1st of March. The number of cases of transmission are relatively high at 113,525 at an average transmission rate of 2.2. It stands fourth in the absolute number of COVID19 cases higher than China and third in the average rate of transmission. Yet it has managed to keep the mortality rate very low. It speaks volumes of the clinical management of the hospitals in the country. It is a cause of hope for rest of the world. Germany may perhaps be one of the national populations that may develop herd immunity.
It is also note worthy to mentioned that the Global average mortality rate has been climbing over the last 40 days. The rate for the last 5 day period stands at 6.1%. Four countries in particular have witnessed very high mortality rate in the last 5 day period, France at 14.28%, Italy at 12.73%, UK at 12.26% and Spain at 10.00%. All of these countries have witnessed an increase in mortality rate over the last 40 days. Even those these countries have started to flatten the transmission curve and reduce the number of new cases, the average mortality rate has been climbing.
The mortality rate of other highly affected countries such as US had a large spike (6.76%) at the start and it has gradually decreased in all of March. It has started climbing steadily again in April. Even at that, the average mortality rate remains low at 2.9% in the comparable nations set.
Iran is the only trendline exception in the entire set, it has the third highest average mortality at 5.8%. The mortality rate sharply climbed and it has gradually decreased over the last 10 days. The absolute number of deaths is effectively more than that of China at 4,110 deaths on the 10th April, even though infection cases at yet to reach the same high. The average transmission rate in Iran is much higher (1.104) than that of China (0.005) for the comparable period.
The mortality rate in China has been consistent for the last 40 days averaging at 3.97% of the transmission cases. To give a sense of comparison with India, on the 10th of April, the cumulative deaths in China stood at 3,345 and total infections at 83,305. India has 199 deaths for 6,412 infections. The mortality in India is almost one order of magnitude less than that of China. The mortality rate has flattened in China, it is on the increase in India. While both countries have comparable populations, the health systems have entirely different capacity. It remains to be seen whether the number of infection cases and deaths in India will rise to similar proportions.
Therefore in being able to decide on the extension of the lockdown, we must critically see the data from other comparable nations. Factors such as flattening of the transmission and mortality curve are not consistent. While the transmission curve may be getting flattened, the mortality curve may keep rising.
The only evidence of a Lockdown exit is from China. It was the first to be highly impacted and it managed to flatten the curve of both transmission and mortality. The country also managed to keep it flat for at least 4 weeks before it came out of the lockdown.
India must pay heed to the evidence from other countries, its average rate of transmission is the fourth highest in the world, it should continue to remain in a state of national lock down for atleast another 4 weeks. It may consider an extended lockdown for 6 weeks till the end of May to ensure the complete flattening of both the transmission and mortality curve.
The goal must be to reach an average transmission rate of less than 0.1 and stay at that level for 3 weeks before we can comfortably open up. India's average mortality rate is currently 1.7% but with better clinical and hospital management it can be brought under 0.5%.
The extended Lockdown would no doubt impact the economy, livelihoods and sustainability especially at the bottom of the human pyramid. The government must announce further measures to care for those who are the weakest. Only then we could emerge from this grave hour of national and global crisis with our head held high. We are still 8 weeks away from when we can conclusively say India is in the safe zone and ready to return to normalcy.
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In this article, I am aiming to draw conclusions about the continuation of the lockdown in India based on comparison of the transmission rate and the mortality rate of the patients who have acquired the SARS-CoV2 virus in their bodies. The rates being compared are those of the 8 nations that have had the highest proliferation and mortality. The highly impacted country transmission and mortality rates were compared with the Global and India average rates to draw conclusions.
The methodology used has been the same as that mentioned in the previous article. The source data for countries such as USA, UK, Italy, Spain, France, Germany, Iran, China has been analysed. The figures were analysed in 8 five day periods starting from 1st of March (1/03 to 06/03) until the 10th of April. The source of this data is the report generated by the Disease Surveillance unit of the World Health Organisation. The data used for India are similar 5 day periods only a day earlier, 29th February till 4th March cycle. The figures are averaged for the 8 periods therefore are comparable. The output has been analysed and presented in the figures below.
Figure 1 - COVID19 Transmission Rate Comparison of Highly affected countries with India
(Primary Data Source -WHO)
The transmission rate of India compared with rest of the highly impacted nations and the global average clearly demonstrates that India (yellow line above) is the only country in this data set for which the last 10 day average is higher that rest of the nations. The average Indian transmission rate is 2.16. Infact the rate of transmission for the last five day period is 0.9. It has been consistently higher than all other highly impacted countries over the last 10 days as shown in the chart above.
During the last 40 days, the average transmission rate is observed to be the highest for USA (2.558) followed by Spain (2.282), Germany (2.215), India (2.160) and UK (1.881). Other countries that are highly affected are France (1.542), Iran (1.104), Italy (0.965) and China (0.005). The Global average transmission rate is 0.444. The transmission rate effectively implies the unbroken chain of pandemic transmission from one person to another. Figures less than 1 imply a break in transmission of the pandemic virus.
The most notable number is that of China where the rate of transmission is consistently extremely low over the period compared. China recently exited the Lockdown after flattening the curve and staying at that level for several weeks. The average transmission rates are noteworthy for countries such as USA, Spain, Germany, India, UK and France that are beginning to see explosive proliferation.
Countries such as Germany which had a very large spike in transmission like India in the first week of March have gone on to have very large number of cases. USA, Spain and Germany which have high number of cases have managed to bring down the transmission rate under 1 by the first week of April.
India has effectively observed a periodic upturn and followed by control in infection transmission. During the last five days, the transmission rate appeared to have come down to 0.9, this may increase in the month of April as the government increases the testing effort.
India has effectively observed a periodic upturn and followed by control in infection transmission. During the last five days, the transmission rate appeared to have come down to 0.9, this may increase in the month of April as the government increases the testing effort.
USA has crossed 425,000 cases while Spain (152,446), Italy (143,626) and Germany (1,13,525) stand are at a distant second, third and fourth with infected patients and overwhelmed healthcare establishment. These countries have far exceed the number of infections in China (83,305) which was first nation to be seriously impacted. The vast difference in numbers can clearly be attributed to the strict and intense lockdown China undertook. It has successfully flatted the curve for transmission of infections.
The average transmission rate of India is comparable with USA, Spain and Germany. Spain and Germany have flattened the transmission curve in the last 20 days, while USA has commenced the flattening over the last 10 days. Other highly impacted countries France and UK have started flattening the curve over the last 15 days. Even though Italy had high proliferation in the population, it has brought the transmission rate down over the last four weeks. Even Iran after an initial spike in transmission has brought the transmission rate under control.
The most remarkable flattening of the curve is of course in China. It has consistently kept the transmission rate low over the last 6 weeks before it chose to open the lockdown. It is encouraging to note the global transmission rate climbed up and again has flattened over the last 2 weeks. From the data, it evident that nations which have locked down to flatten the transmission curve and maintained it for several weeks, have been able to contain COVID-19 disease through public management.
Figure 2 - COVID19 Mortality Rate Comparison of Highly affected Nations with India
(Primary Data Source - WHO)
The Global average mortality rate derived from the data over the last 40 days is 4.53% of the total infections. The highest average mortality rate has been recorded in Italy at 9.06 %. This is followed by France (5.86%), Iran (5.8%), Spain (5.8%) and UK (5.29%). Countries below the global average mortality rate are China at 3.97%, USA at 2.9%, India at 1.7% and Germany at 0.71%.
It is remarkable to note that USA despite over 425,000 cases has kept the rate of mortality low with respect to other highly impacted nations. Two countries that stand out in the data set are India and Germany. The number of infections in India is almost two orders of magnitude less than USA, Italy and Spain at this stage. It is at least an order of magnitude less that other comparable nations in this data set. The average mortality rate of India is 1.7% is the second lowest in the data set.
The most remarkable study is that of Germany where the derived average mortality rate is only 0.71%. It is the lowest in the comparable nations mortality rate even though it has been climbing gradually since 1st of March. The number of cases of transmission are relatively high at 113,525 at an average transmission rate of 2.2. It stands fourth in the absolute number of COVID19 cases higher than China and third in the average rate of transmission. Yet it has managed to keep the mortality rate very low. It speaks volumes of the clinical management of the hospitals in the country. It is a cause of hope for rest of the world. Germany may perhaps be one of the national populations that may develop herd immunity.
It is also note worthy to mentioned that the Global average mortality rate has been climbing over the last 40 days. The rate for the last 5 day period stands at 6.1%. Four countries in particular have witnessed very high mortality rate in the last 5 day period, France at 14.28%, Italy at 12.73%, UK at 12.26% and Spain at 10.00%. All of these countries have witnessed an increase in mortality rate over the last 40 days. Even those these countries have started to flatten the transmission curve and reduce the number of new cases, the average mortality rate has been climbing.
The mortality rate of other highly affected countries such as US had a large spike (6.76%) at the start and it has gradually decreased in all of March. It has started climbing steadily again in April. Even at that, the average mortality rate remains low at 2.9% in the comparable nations set.
Iran is the only trendline exception in the entire set, it has the third highest average mortality at 5.8%. The mortality rate sharply climbed and it has gradually decreased over the last 10 days. The absolute number of deaths is effectively more than that of China at 4,110 deaths on the 10th April, even though infection cases at yet to reach the same high. The average transmission rate in Iran is much higher (1.104) than that of China (0.005) for the comparable period.
The mortality rate in China has been consistent for the last 40 days averaging at 3.97% of the transmission cases. To give a sense of comparison with India, on the 10th of April, the cumulative deaths in China stood at 3,345 and total infections at 83,305. India has 199 deaths for 6,412 infections. The mortality in India is almost one order of magnitude less than that of China. The mortality rate has flattened in China, it is on the increase in India. While both countries have comparable populations, the health systems have entirely different capacity. It remains to be seen whether the number of infection cases and deaths in India will rise to similar proportions.
Therefore in being able to decide on the extension of the lockdown, we must critically see the data from other comparable nations. Factors such as flattening of the transmission and mortality curve are not consistent. While the transmission curve may be getting flattened, the mortality curve may keep rising.
The only evidence of a Lockdown exit is from China. It was the first to be highly impacted and it managed to flatten the curve of both transmission and mortality. The country also managed to keep it flat for at least 4 weeks before it came out of the lockdown.
India must pay heed to the evidence from other countries, its average rate of transmission is the fourth highest in the world, it should continue to remain in a state of national lock down for atleast another 4 weeks. It may consider an extended lockdown for 6 weeks till the end of May to ensure the complete flattening of both the transmission and mortality curve.
The goal must be to reach an average transmission rate of less than 0.1 and stay at that level for 3 weeks before we can comfortably open up. India's average mortality rate is currently 1.7% but with better clinical and hospital management it can be brought under 0.5%.
The extended Lockdown would no doubt impact the economy, livelihoods and sustainability especially at the bottom of the human pyramid. The government must announce further measures to care for those who are the weakest. Only then we could emerge from this grave hour of national and global crisis with our head held high. We are still 8 weeks away from when we can conclusively say India is in the safe zone and ready to return to normalcy.
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