The lockdown commenced on the 23rd of March 2020 in India. We are now in the fifth week of confinement and beginning to wonder when does this end. No one seems to have a clear answer whether the virus will become endemic or will have a definite containment date.
In continuation of articles written earlier, I will give a few charts to give the reader a sense of the proliferation of the SARS-COV2 virus in India and the comparison with the rest of the world. The methodology has been explained in the previous articles and is accepted statistically. The representation here varies as the choice of the period for data analysis is 5 day cycles and averaging of the rates involved.
Figure 1 - COVID 19 Proliferation in India
The average rate of transmission of the virus in India is 1.86. It indicates that the disease is growing within India at a slower rate than earlier. According to ICMR, 80% of the cases being found in India are asymptomatic essentially implying it is hard to trace and track the disease within the population. The Mortality rate is 2% of the total number of infections detected. The total number of infections stood at 17,265 and the number of deaths at 543 on the 20th of April.
Figure 2 - Global Transmission Rate Comparison
(Primary Data Source - WHO)
While comparing the average transmission rate of India with other highly affected countries it was observed that the only other country with higher transmission is United States with an average transmission rate of 2.11. Highly affected countries where the disease is still proliferating are Spain (1.85), Germany (1.80), UK (1.58) and France (1.26) in the comparable nations set.
The Global average transmission rate stood at 0.402 with the total number of cases at 2,314,621. In the comparable nations set, there are three countries where the disease is not proliferating rapidly, Iran (0.906), Italy (0.795) and China (0.005).
India is relatively better off in the total number of cases it has had to deal with compared with developed nations. The highest number of cases by the 20th April were witnessed by United States at 723, 605 followed by Spain (195,944), Italy (178,972), Germany (141,672) and France (111,463).
It is notable to mention and also visible from the trendline above, the Global and comparable nations average over the last ten days has been under 1. This essentially means a slowdown in the growth of the disease. The disease maybe slowing down but the number of cases is cumulatively increasing.
Figure 3 - Global Mortality Rate Comparison
(Primary Source Data - WHO)
The Indian average mortality rate (2%) compared with the Global average of 4.96% is lower. Within the comparable nation set of highly impacted nations, Italy has the highest average mortality at 9.88% followed by France (8.08%), Spain (6.82%), UK (6.88%) and Iran (5.89%). These nations have the average mortality rate higher than the global. The reason for such high rates can only be understood in time due to comorbidities or other short comings in treatment.
India has a relatively low mortality burden at the moment comparable with Germany (1.15%) and United States (3.22%). The mortality rate in China has stablised at 4.12%. A recent spike in cases was noticed in China due to adjustment of deaths that were not accounted for earlier due to one reason or another.
In absolute numbers, the total deaths across the world stood at 157,847. The highest number of deaths, even with a low mortality rate, has been witnessed by United States at 34,203. This is followed by Italy (23,660), Spain (20,453), France (19,689) and UK (16,060). China (4,642) and Iran (5,118) have comparable number of deaths. Even with a relatively higher number of transmission cases, Germany is an outlier with a lower mortality rate thus few deaths at 4,404.
It is remarkable to observe that even though the average transmission rate is declining, the average mortality rate is increasing in the comparable nations set with the exception of China and Iran.
In summary, the world has been gradually containing the proliferation of the virus in various communities. We may have temporarily slowed down the viral movement with simultaneous lockdowns across the world, we have not been able to find a cure or a vaccine that provides adequate protection.
As the world braces for reopening no matter how gradual, we will witness a spike in transmission rates and mortality. The greatest fear is the return of viral transmission in autumn similar to the 1918 Spanish flu pandemic. The pandemic took the largest number of lives during that winter. India had the worst fatal loss of life in the world through the winter of 1918.
We must remember the lessons from history. All we can do at this stage is to prepare as intensively as we can for when the healthcare system will be overwhelmed with cases. In a highly populated country such as India with very dense urban enclaves, it will be a tremendous challenge. Thus far rural India has not been as impacted. Our Achilles heel is our weak primary care system and healthcare capacity in rural parts of the country.
The social cost of exposing a large population in developing herd immunity to the SARS-COV2 virus will be just too high. Until such time a vaccine can be a viable measure in 2021, we must prepare for at least a year of social distancing measures, a graded opening plan for the economy and keeping healthcare capacity mobilised.
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