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Business News/ Science / Health/  Opinion | Corona: Look at the numbers, get few answers
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Opinion | Corona: Look at the numbers, get few answers

We haven’t yet reached a peak in the count of infections, as there are still plenty of susceptible people who are open to covid. That’s a cause for worry

Illustration: Jayachandran/MintPremium
Illustration: Jayachandran/Mint

The Director of the All India Institute of Medical Sciences in Delhi, Dr Randeep Guleria, was quoted last week expressing some concern about covid-19. We’ve “flattened the curve" of infections, it looks like, thereby buying time for our doctors and our medical facilities more generally. But he’s worried that we haven’t yet reached the peak in the count of infections. In short, that count is still increasing. The day before I began this essay, for example, we had the largest single-day count in new cases ever, over 4,300. (Just under 3,600 the next day).

There are several ways to look at that number.

The first is with alarm. The largest daily count ever! How did we come to this? But then you should know that we could have made that remark 12 times since the middle of April and 19 times since 1 April, when we had just over 2,000 cases in total. A generally rising count will produce local spikes like those. So, we may make the same remark a few more times before we are done with this virus.

But if we have “flattened the curve", how come we are still setting new records every few days for daily infections? Well, that’s simple — it’s because we now have a much larger pool of infected people: nearly 40 times larger than on 1 April. So, since new infections are almost always generated from already infected people, a larger pool is going to produce more infections than a smaller one. So, it should be no surprise to see new records. As long as the number of infections continues to rise—as long as they are still to peak—we are likely to see headlines saying “highest rise in cases in a single day".

A second is with perspective. That there are new cases of the disease every day is worrisome, no doubt. That they number in the thousands and are increasing is also worrisome. But the way to consider them is not as absolute increments, but as fractions, or percentages. The 4,300 cases I mention above—the increase on Sunday, 10 May—was the largest single-day increase ever in absolute terms, certainly. But it was a jump of 6.86%, nowhere close to the largest single-day increase ever in percentage terms. As recently as 6 May, India had seen a higher percentage jump, 7.29%. And if you started on 15 April and went back in time, you’d see double-digit percentage jumps all the way to 15 March, when we had just 113 cases countrywide, a mere 5.6% increase over the previous day.

In other words, 6.86% is actually a relatively low increase, compared to the growth figures we’ve seen since the outbreak began. Think of it: at the beginning of April, we were seeing daily percentage increases in the 20s. Through April, that subsided to the single digits, to as low as 5.44% near the end of the month. Again, this is what an ever-increasing pool of infected people will do. We might have exactly the same number of new cases every day—2,000, say— but that will translate into an ever-decreasing daily percentage jump.

Which brings us to a third way to consider that 4,300 number. Perspective is a funny thing: the longer you pore over the data, the more facets you will find it has. So yes, 6.86% is low compared to the 20+% numbers of early April, and that is a relief. But focus in on just the last couple of weeks and check what the percentage numbers have been doing. They rose steadily from 5.44% on 29 April to 8.55% on 4 May. Went down on 5 May, but rose again the next day. Declined for four days, then rose again. And yes, a decline to 5.35% on 11 May.

Is this variation, these increases, a concern?

Well, the increases may be just a blip in the overarching trend of decline. After all, there have been other such blips and variations. For example, 13 April was the first of three straight days of decline, followed by a slight increase on 16 April, followed by a decrease on 17 April, followed by two days of increase. Even so, over that week, the daily percentage increase dropped from 13.49% to 10.05%, contributing to that overall April decline. That’s the nature of statistics: trends are never smooth.

And yet, even with perspective, the rise from 29 April to 4 May rang alarm bells, for it lasted longer than previous upticks. Six days in a row trending upwards, taking the growth to a figure we had not seen since the middle of April: more than a blip. It was enough to suggest that the drop on 5 May— an increase of just under 3,000 cases, or 6.39%—was itself a blip in an upward trend. Since then, more like that. And by the time this column appears, we’ll have fleshed out this story of blips and trends even more.

I trust all this gives you a sense of the interpretations number junkies like me come up with when we pore over the data from a pandemic.

But what does it all mean?

Well, for one thing, and to repeat, we have “flattened the curve" at least to this extent: the disease has not spread in this country like it could have. We have not seen the dramatic, alarmingly rising numbers that Italy, Spain, the US and the UK have had to grapple with. While there are any number of stories of overworked Indian nurses and doctors, at least our clinics and hospitals have not been overwhelmed by floods of covid patients.

This is a relief too, because we have far fewer facilities per capita than most of the countries that have been badly hit by covid. Had we seen numbers like they have, the chaos and misery would have been extreme. That’s even before adjusting those numbers to reflect our much greater population. For example, the country worst-affected by the disease is the US: they have racked up about 1.4 million cases and over 84,000 deaths. India has four times the number of people the US does, so if corona had spread here like it has there, we might have had 5.5 million cases and 300,000 deaths so far. Our healthcare system cannot cope with that kind of spike in demand. Instead, and luckily, we have just about 1% of those potential numbers.

Yet even so, there’s the worry that we’re sitting on a time bomb. Some wonder: Have we tested enough Indians? Well, we’ve done nearly two million tests now—about one in every 750 Indians has been tested. That ratio still lags behind much of the world. The US has tested nearly 10 million people, or one in every 35 Americans. And yet the mathematics does not make a compelling case for much more widespread testing. Should we test everyone, even people with no covid symptoms at all? Is that a reasonable strategy, given the numbers and costs involved? Or should we follow lessons from the law of conditional probability—this is a mathematical disease, let me remind you—and test only those who are likely covid patients? That’s material for another column, but for now I’ll say this: suppose testing reveals whole swathes of people who are infected and hadn’t realized it. What happens then? What will that mean for our healthcare facilities?

But the larger worry is indeed what Dr Guleria touched on. We haven’t yet reached a peak in the count of infections. Why? Because there are still plenty of susceptible people, open to infection, out there.

With no prospect of a vaccine any time soon, there’s little to prevent them being infected. Will another lockdown extension do it? Possibly, but should we balance that against the staggering human and economic costs of the lockdown? For example, should any analysis of the success or failure of the lockdown account for migrant workers streaming home on foot and in concrete mixers, and if so how?

Besides, what happens after we lift the lockdown? Without any drug that will fight the virus, it will hang around, ready to infect more people who are no longer as diligent about social distancing and wearing masks. What will that do to our corona numbers? (In fact, can we attribute occasional increases in numbers to people tiring of lockdown restrictions and taking risks they wouldn’t have even a few weeks ago?) Then again, maybe we can count on a so-called “herd immunity" to corona. But how long will that take to evolve, to the point that it is an effective tool against new infections?

All in all, the takeaway from all the corona numbers is simple: we had better reach that peak—that really flattened curve —that Dr Guleria speaks of soon. Very literally then, and only then, we’ll be over the hump.

Once a computer scientist, Dilip D’Souza now lives in Mumbai and writes for his dinners. His Twitter handle is @DeathEndsFun

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Published: 14 May 2020, 10:45 PM IST
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