Cases of the COVID-19 disease are rising worldwide and India is no exception. This surge has surprised many of us, but our fear-based alarmist reaction is only increasing the toll of the pandemic.
By mid-July, India recorded over a million cases and had the fourth highest number of infections. Yet, contrary to the majority of media coverage, the ever-increasing cases are not apocalyptic, either in India or any other country.
First, let’s look at the reason behind the rising numbers.
COVID-19 cases don’t have much to do with the phased reopening of economies. Why? Solitary confinement through lockdown is not possible, let alone feasible, for the people. Governments also agree that there are “essentials” goods that everyone needs. But most, if not all goods, need raw material. So numerous other “goods” should be on the list of “essentials,” which would require a substantial reopening of the economy.
The spread of the virus could, therefore, be unstoppable.
Besides, over time, the actual extent of the outbreak will be known and that will be more reflective of the real situation.
The U.S. Center for Disease Control and Prevention estimates cases and compares them with reported cases. For the state of Connecticut, it found that the number of people infected with SARS-CoV-2 was six times greater. And that was the lowest factor among all the states and regions for which data were available. On average, other areas had over 10 times (with the highest being 24 times) more cases than previously thought.
It is also unlikely that the increasing cases are due to the increase in testing. Of course, with more testing, there will be additional cases. Yet, as a report by STAT shows, for U.S. states, the increase is generally due to greater prevalence of the disease.
Even for the Indian capital of Delhi, a survey recently estimated that a large proportion (23 percent) of the 20 million residents were infected. India’s health ministry took credit for this, and said that that the affected population is only 23 percent due to its proactive measures.
However, it looks extremely unlikely that the government had a significant role in “limiting” COVID-19 infections to only 4.5 million (23 percent) people in Delhi. For instance, states in the U.S. that had different strategies with regard to lockdown did not see much difference in the number of infections. Indeed, the government response tracker, which measures the stringency of the lockdown, shows vastly different government responses for the U.K. and Sweden while the number of cases in the two countries are very similar.
A Better Response
The rising cases are being treated with great trepidation and COVID-19 is being characterised as an impending doom that will wipe away large swaths of the population without any discrimination. While it is pretty useful to know the fact that cases are rising, this information need not increase our fear. Quite the opposite.
The rise in infection is not accompanied by the rise in deaths caused by COVID-19 for the average population. In fact, careless data collection can even inflate COVID-19 deaths if the infected die later of non-COVID-related causes but are attributed to the coronavirus.
Effectively, the huge jump in cases without a corresponding increase in deaths implies that the fatality is substantially lower than earlier estimated. For India, the case-fatality rate or the number of people with known infection (and with symptoms) seems to be 2.5 percent. But this overestimates severity if infected (but asymptomatic) cases are much higher, as in Delhi.
Age-specific data for COVID-19-caused deaths are unavailable for India, but they seem to be declining across the world. Figures from Oxford University-based Our World in Data, given below, show that deaths are nowhere near in keeping pace with the increase in cases.
And for Delhi, the infection-fatality rate is no more than 0.1 percent given the more recent data that show 3,719 cumulative deaths. Perhaps there is undercounting of deaths, but even if the deaths were five times higher, the infection-fatality rate would be no more than 0.5 percent.
In fact, when excess deaths – the additional number of deaths over and above what is normally observed in preceding years – are examined, most of Europe is seeing a decline.
Economists who study human behavior and themselves use extensive statistical techniques, have highlighted the uncertainty of the model results and questioned the underlying assumptions. But they are not alone. Epidemiologists and scientists, including a Nobel laureate, Michael Levitt, a Stanford University professor, have questioned the efficacy of such prolonged lockdowns.
Focus on the Most Vulnerable
Rather than impose lockdown, which is, at best, a blunt “one-size fits all” strategy, policies that focus on protecting the most vulnerable are needed.
It has long been recognised that COVID-19 is extremely dangerous for specific groups of people – the elderly and those with pre-existing conditions as well as health-workers who increasingly come in contact with coronavirus patients.
Sunetra Gupta, Professor of Epidemiology at the University of Oxford, rightly states that the lockdown is a luxury the rich and the upper middle-class enjoy. Stanford’s Dr. John Ioannidis has been an early critic of the prolonged lockdowns and has argued for a nuanced approach.
A vibrant economy is likely to help rather than hinder health services. So, opportunities to open as many sections of the economy as possible would help.
COVID-19 infection is not a sure and certain death. Even for those above 75, there is, albeit, a smaller but high probability of recovery. It may be downright cruel to offer no hope to those who themselves, of their loved ones, are infected with COVID-19.
It’s true that the pandemic continues to cause grief and pain to those directly infected and their kin. But as lockdowns and fear psychosis continue, numerous more are going through trauma and economic hardship.
Deeming the situation apocalyptic seems no less than a universal suspension of disbelief.