The death count is what we should focus on since other covid numbers at this point are unreliable
Over the last few weeks, we have been drowned every day in waves of projections on the likely spread of covid-19. Since the beginning of the national lockdown, with much more time on our hands, many of us have possibly got obsessed with these. This could be leading to more fear, fed by uncertainty, since the projections vary widely, from the apocalyptic (on 20 March, epidemiologist Ramanan Laxminarayan predicted that India could see 1-3 million deaths in the next three to eight weeks, that is, 10 April-15 May) to “Indians have nothing to fear". But even as the time spent on looking at graphs grows more exponentially than the disease, most people could be missing the point. The one number that really matters, which we should pay close attention to, is the number of fatalities. Various fatality rates (FR) are being bandied about, but the only lab-like conditions case we have till now is of the Diamond Princess, the cruise ship that was quarantined at Yokohama. It was a closed system where each of the 3,711 people on board was tested, and all the infected given medical care. Of all the infected people, 0.91% could not be saved. Among those 70 years and older, the FR was 7.3%. Extrapolating these numbers to the Chinese population, a team at the London School of Hygiene and Tropical Medicine calculated the FR for China to be about 0.5%. A similar study for the US found the FR to be even lower. The media and others are demanding testing in India to be increased by many orders of magnitude. Certainly, we need far more people to be tested, and one hopes that the lockdown has given the Indian government the time it needs to get hold of a large number of testing kits. But rather than the volume of tests, what is important is how we go about the testing. Diamond Princess’s demographics were heavily skewed towards the older, more-at-risk cohort. The ship’s average age was 58, and 33% were 70 or above. India’s population has a much younger profile (even with respect to China and the US). Also, almost everyone must have had the common flu at some time, a huge number of us have had malaria, and since 1985, India has been running a universal tuberculosis vaccination programme. Some scientists are of the view that all this could perhaps have given Indians a bit more immunity to the virus than Europeans and Americans. Almost everybody in India—whatever their level of literacy and income—now knows about covid-19 and its symptoms. They should all be wanting to get well through medical help, and will approach a doctor when they need to. They will be tested, and if found corona-positive, their contacts will be traced, tested and quarantined. So other than these people, who do you test? We will never be able to test all Indians. Therefore, the testing kits must be used intelligently, through random sampling, using well-proven statistical methods, while focusing more on vulnerable groups. The fight against epidemics needs both medical wherewithal and statistical expertise. Obviously, the more people one tests, the more cases one will find, and the case graph will go up. But what would that graph tell us? Because anyway, all of us know that the actual number of cases is much higher than what the graph shows, but also have no idea how much higher, 100% or 10,000%. But deaths are very difficult to hide, unless you have an authoritarian regime like China’s, and thus the most accurate picture you can get of the contagion. Combined with the age profile and pre-existing medical condition of the dead (these details, of course, may not be easily available to the average citizen), one can get a fair estimate of the threat, and where and how to combat it. Yes, a few people under the age of 30 have died, and we’re still at an early stage and various statistics could shift, but if one looks at the number of deaths for India so far, there is no need to panic so long as we follow the essential social distancing and hygiene regimen. But while we take precautions for covid-19, what about people sick with something other than this virus? I had written about this last week too, of how bureaucratic myopia is depriving thousands of people every day of critical diagnostic tests and the right treatment, which could lead to a large number of deaths. With hospitals closing their outpatient departments, and postponing all non-emergency surgeries and procedures, countless Indians are in grave danger. Critical chemotherapy and dialysis sessions are being cancelled. Even when services are available, the police are often stopping patients from reaching hospitals. HIV-positive people may be going without anti-retroviral medicines because they cannot get to the few clinics which stock these drugs. No one knows how many Indians will die from diseases other than covid-19 while the system treats them as a distraction. These deaths are going unnoticed, but I fear that, in the end, they might number more than the ones due to SARS (Severe Acute Respiratory Syndrome)-Cov-2. A silent medical crisis and national tragedy is unfolding, but its victims may not even get the minimal dignity of “collateral damage" in the public consciousness.