Covid-19 cases in India exceed 100,000, but low fatality ratio offers hope

The number of known coronavirus disease (Covid-19) cases in India crossed 100,000 on Monday, two-and-a-half months after the outbreak began taking hold in the country, which then went into an unprecedented lockdown that slowed the outbreak to a significant extent.

The milestone was a grim reminder of the challenge India, which has the second highest population in the world, faces as it rolls back some of the curbs in place since March 25 to allow economic activity to resume.

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In the 78 days since the outbreak began, total infections were at 100,311 and 3,081 people succumbed to the disease till Monday, but the trend indicates the situation may be less serious than the global scenario, where the proportion of deaths is double what has been seen in the country on an average.

“We have successfully managed to delay the peaking of the curve by imposing lockdown and other public health measures in a timely manner. There are several mathematical models which are predicting the course of the pandemic in India, but till now, we have managed to avoid the dramatically high numbers that several models predicted,” said.

Union Health minister Harsh Vardhan. “It is difficult to predict numbers as they will depend on the adherence of restrictions on mobility and inter-mingling, personal hygiene, and prevention of exposure to infection by people in different areas. Additionally, it will also depend on the proportion of those infected among migrants and travellers from outside and within.” he added.

In the national capital, 299 new cases pushed Delhi’s tally above the 10,000 mark. As on Monday, Delhi has 10,054 cases and 160 deaths, putting the mortality rate close to 1.6%, which is roughly half of the national average of 3.09%.

Delhi has one of the highest testing rates in the country, with 6,919 tests per million population. The national testing rate for India is 1,540 tests per million population, according to Indian Council of Medical Research.

Based on data reported till Monday evening, India’s case fatality rate stood at 3.07%. Across the world, where 4.8 million infections have led to at least 317,000 deaths, the fatality rate is at 6.57%. In United States, the country now hardest hit, the fatality stood at 6%. For China, where the virus first began spreading, the figure is 5.56%,

“The Covid-19 outbreak in India could have been far worse. If you look at the number of deaths we have averted, India has done remarkably well. This is mainly because of early measures like the nationwide lockdown,” said Dr Giridhar R Babu, professor and head of life course epidemiology, Public Health Foundation of India.

As India relaxes some more of the curbs that were put in place on March 25, experts said the coming weeks will be crucial to determine whether the country can hold onto these gains. “Lockdown helped reduce the rate of transmission, but what we do now will be of utmost importance. The focus should be on problem states like West Bengal, Gujarat, Delhi, Madhya Pradesh and Maharashtra, particularly Mumbai,” Babu added.

A weekly tracker of Covid-19 infection trends by disease modeling experts at Imperial College London indicated that the rate of transmission of the disease in India came down to below 1 (the authors identified it as 0.98), a threshold that is key to stop the virus from growing exponentially.

On May 11, the model predicted there would be 801 deaths in India for the week ending on Sunday. Reported deaths for the week, based on HT’s dashboard of cases, stood at 812.

In the week till Sunday, the speed at which the outbreak grew would take India 13.7 days to double its number of cases. But that could change for the worse as the country allows more offices to reopen and public transport to resume.

New infections among the hundreds of thousands of migrants returning to their villages and hometowns from urban centres is also feared to seed cases in rural parts of the country that had till now been largely free of infections.

A second expert said that India’s aggressive measures need to continue. “Careful risk assessments should identify hotspots and clusters, and continued efforts should be made to further strengthen capacities to respond, especially at sub-national levels. The core public health measures for Covid-19 response remain, rapidly detect, test, isolate, treat and trace all contacts,” said Dr Poonam Khetrapal Singh, regional director, World Health Organisation South East Asia Region, of which India is a part.