The number of coronavirus disease (Covid-19) cases in India on Friday crossed the total count of infections in China, where the highly contagious disease originated late last year, even as experts pointed out that the outbreak has not been as deadly as in the neighbouring country at the same stage of transmissions.
The Covid-19 cases in the country rose to 85,709on Friday, according to HT’s dashboard, with 2,680 people having died so far of the respiratory illness. China has so far reported 82,933 Covid-19 cases, 4,633 of whom have died of the disease. Just four states – Maharashtra, Tamil Nadu, Gujarat and Delhi – together account for two-thirds of India’s cases.
India’s fatality rate was 3.23%, compared to the global death rate of 6.92%; the recovery rate was 34.06%, according to the latest figures released by the Union health ministry.
Experts say that a national lockdown imposed in India on March 25 to slow the spread of the disease appeared to have been effective in slowing the infections. However, with the gradual easing of restrictions – necessitated by sluggish economic indicators – they expect the cases to rise in the coming days.
China imposed a 76-day lockdown earlier this year in Wuhan, the city where the Sars-CoV-2 pathogen is believed to have jumped to humans. The move proved to be effective, with no Covid-19 death being reported in official figures in the neighbouring country over the last 30 days.
“Lowering the fraction of the people who test positive is a better indicator of whether new infections have been controlled than the doubling rate, which is flawed as it also takes into account old and active cases. A low fraction of positives among people tested indicates falling infection (rates) because as testing increases, so do the number of people who test positive,” said Dr K Srinath Reddy, president, Public Health Foundation of India.
The spread of Covid-19 has been slower in India than in China and other parts of the world, according to epidemiologists.
“The health systems in states haven’t been overwhelmed; there are no sudden unexplained hospitalisations and deaths, as seen during dengue or encephalitis outbreaks. The data from China is less reliable. There’s far more transparency in India, where attempts by some governments such as West Bengal to juggle death numbers have been quickly exposed,” said Dr Ambarish Dutta, associate professor of epidemiology and public health, Indian Institute of Public Health, Bhubaneswar.
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“We have more active cases (than in China) because the growth rate has been slow. The disease appears to be less severe in India; we still don’t have scientific evidence on why this is happening, it could be cross infections, it could be innate immunity or higher humidity and temperature, we still don’t know,” said Dutta.
India’s recovery rate improved to 33.6%, up from 32.83% on Wednesday.
Deaths in India are two per one million population, compared to three deaths per million in China. Data from the 50 countries with the most cases shows that deaths per million are the lowest in the two most populated nations in the world, except for Bangladesh.
“If performance of hospitals is being compared, case fatality rate matters, but to assess an epidemic, state of the epidemic is being assessed, deaths per million is the statistic that tells us whether a district or state is in a safer zone than another,” said Reddy.
With most states moving towards a staggered lifting of the lockdown, experts say the progress of the outbreak over the next few weeks will depend on the lessons learned so far.
“You can’t police social distancing; people must learn to protect themselves. The acid test will be how we behave as we exit from the lockdown in the next few days,” said Dutta.
Reddy said the lockdown imposed in China was largely effective in containing the infections. “China’s success is that it prevented the spread across the country with its rapid and complete lockdown. It locked down very quickly, and stopped domestic travel using the hukou system very rapidly, unlike India, where domestic travel was allowed till March 24, which led to multiple seeding of infection before lockdown,” said Reddy.
The hukou system is a family registration programme that works as a domestic passport and is used to regulate travel and control population distribution.
“The focus for India now is not rising cases, but the rate of spread of the disease. Covid-19 is here to stay, cases will go up; we have to be prepared for managing severe disease. India’s R0 is 1.4, we have to work to bring it below one to reverse the pandemic,” said an epidemiologist at the health ministry, requesting anonymity.
To transition into a “new normal” in which social and economic life can function, the WHO recommends identifying hot spots and clusters, and building capacity of systems and responders to find, isolate and care for cases. “There can be no illusions, we are in this for the long haul. Covid-19 importation to Thailand was on January 13, but early and aggressive measures, including unprecedented physical distancing measures, have helped keep the number of cases low in the region as compared to other parts of the world,” said Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia.