As Covid cases surge in India, epidemiologists, both within the government and outside, say the key metric to watch now may be the death toll — a crucial marker both of the course of the epidemic and the success of state governments in tackling it.
Over two days next week, June 16 and 17, Prime Minister Narendra Modi will interact with state chief ministers , with the second day of the video-conferencing set aside for CMs from states such as Maharashtra, Delhi, West Bengal, Tamil Nadu, Gujarat and others, which are seeing a spurt in cases and death numbers.
The death toll has been rising over the last few weeks. Sample this: 87 deaths on May 11, rose to 157 a week later on May 18, and remained in the 140-160 range for some time before showing a spurt again. On May 31, there were 265 deaths and now, on June 12, the numbers touched a new high – 396 deaths and 2,97,535 total cases.
"No higher than tomorrow, right?" said Dr Jayaprakash Muliyil, epidemiologist and former principal of CMC Vellore, when asked about what the rising cases and deaths. His prescription, therefore, is to concentrate resources on preventing deaths by preparing oxygen beds etc, instead of the old formula of testing as many as possible and isolating them.
"Many diseases have sub-clinical infections, we do not call them 'cases' when most people recover spontaneously without treatment… Here we are counting Covid cases and the numbers are looking very impressive, whereas what many other countries are doing is asking patients to stay home, come to the hospital when they have breathing difficulty, check oxygen saturation in the car park and take a call. In Mumbai, Delhi, Chennai, there is no point finding positive cases and testing everybody where there is obvious community transmission. By the time the whole thing is over, 60 crore will be infected. Counting that doesn't help us much, it only scares people. If you want to change the picture, you need to concentrate on beds and prevent worsening of cases and things will get better," says Dr Mulyil.
At 2.86%, India's death rate from Covid is far lower than the international experience. The infection fatality rate, as given out by results of the first phase of antibody tests by ICMR released on Thursday, is an even lower 0.08%. Infection fatality rate is the percentage of deaths among all people exposed to the virus, not just those that tested positive in the RT-PCR test.
Epidemiologists agree the new situation calls for new measures.
In Delhi, for example, the Union health ministry's consistent position has been that there is not enough contact tracing happening.
Said an epidemiologist involved in tracking infectious diseases, "In Delhi and Mumbai, why are you still talking about contact tracing and testing? That stage is long gone. There will be people who get the disease and recover without knowing. What is the point of testing them? On the other hand, it is people who have breathing difficulty that need to be addressed quickly so that they do not deteriorate. Spread the word that anybody with symptoms should quarantine, tell them when to come to the hospital and prepare the hospitals. Preventing deaths is the priority now."
Dr Giridhara R Babu, Head, Lifecourse Epidemiology, Indian Institute of Public Health, Bengaluru, is optimistic about the death numbers. But, he says, "We should stop looking at absolute number of cases. More than recovery rate, deaths per million (DPM) in India is a better indicator. Currently, the DPM for India is 6.70, compared to 351 and 608 in the US and UK. This is better only in Singapore and Australia, which have only have a DPM of 4. The case fatality proportion is an indicator of early detection, timely treatment and the overall prognosis. It is 2.8%, this too is less than half of the global average (5.8%)."
He added that how states are performing currently is a function of what they did during the lockdown to beef up medical infrastructure. "Lockdown was only necessary to contain the transmission to a few urban areas and prepare the health system for a surge in cases. The states which used the lockdown period for improving their surveillance systems, containment measures and developing the health system for handling surge in cases are doing relatively better in overall progress compared to others. I can think of Andhra Pradesh and Karnataka using the lockdown to prepare well," he said.
Meanwhile, the Ministry of Health said in a statement, "Recovery rate of Covid positive cases continues to increase and is currently at 49.47%. A total of 1,47,194 individuals have been cured and recovered vis-a-vis 1,41,842 individuals who are under active medical supervision. 6,166 individuals have recovered of COVID-19 in the last 24 hours. The doubling rate/time continues to improve and has increased from 3.4 days at the beginning of lockdown to 17.4 days currently."
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