FM November2020 Digital P

social distancing and restrictions on
social gatherings etc.
Further, the number of deaths
from non-COVID-19 causes, like the
poor availability of treatment, nonvaccination,
alcohol consumption and
drug abuse during the pandemic can
also inflate total death numbers. As such,
determining death rates in the midst of
a pandemic is not easy.
Besides, the case fatality rate of this
disease has been one of the biggest
mysteries surrounding this pandemic
due to the extreme variations seen
from country to country. The death rate
stands at about 13 percent in Italy, but it
is one-tenth of this figure in neighboring
Germany. In the US, it is around 4.3
percent. Again, it varies widely among US
states. The number is around 7 percent
in Michigan while it is about 0.7 percent
in Wyoming. In South Korea, 2 percent of
people who tested positive for the virus
have died. The death rate in Wuhan in
China is estimated to be 1.4%, whereas
in India it is close to 1.5% according to
official figures.
Epidemiologists, however, maintain
that anything above 1% means very
many deaths. The fatality rate for the flu
virus is 0.1%. A small percentage of a big
number is still a very big number, they
point out.
The US already has the highest
number of cases in the world and the
most recorded deaths of any country.
Though its 330 million people only
represent roughly 4.25 percent of the
world’s population, the country accounts
for just over 20 percent of the deaths
from COVID-19.
As the daily coronavirus death tolls
continue to go up in many places in the
world with the onset of colder weather
in the northern hemisphere and the
reopening of more and more workplaces
and schools, the counts are set to
increase.
Eventually, most viruses lose their
virulence due to lack of hosts, mutations
that make them less deadly, or new
treatments or vaccines. The novel
coronavirus will too, experts say, but it is
a question of when and at what cost.
BEHIND INDIA’S LOW
COVID-19 MORTALITY
India has reported nearly 8 million
cases of COVID-19 in the fourth week
of October 2020, with 118,000 officially
confirmed deaths.
According to the health ministry,
the national recovery rate has been
continuously increased to 90% and
the case fatality rate is down to 1.51%.
Indian Council of Medical Research
(ICMR) guidelines stipulate that deaths
of people with suspected or probable
COVID-19 should be included in
mortality data, based on WHO ICD-10
codes for COVID-19-related deaths. The
guidelines, however, are only advisory
and not mandatory. Consolidated data
is not available in the public domain.
In India, healthcare is the responsibility
of the states and it is up to individual
states to follow the reporting guidelines.
Only 22% of all deaths happening
in India are medically certified under
the civil registration system as most
of the deaths occurring in rural India
are outside hospitals. More than
70% of India’s population lives in the
hinterlands.
However, public-funded serological
surveys suggest at least 10 times the
official number of people may have
already been infected. This could mean
that many deaths could have gone
unreported.
Despite concerns around underreporting,
studies point to several
factors that work in tandem to lower the
COVID-19 mortality numbers in India.
First, the bulk of the Indian population
is young, with a median age of 28.4,
according to the UN World Population
Report. Public health experts say that
older people, who are more likely to
have comorbidities such as diabetes or
hypertension, are more likely to die from
COVID-19.
The Indian government slapped
lockdown restrictions at a time the
pandemic was already raging in Italy
and other regions of Europe. This time
lag might have helped Indian doctors
learn from the experience of other
countries to manage the pandemic in a
better way.
Another theory going round is that
other endemic viral diseases such as
dengue fever might have given the
population some antibody protection
against the coronavirus.
Greater toll accuracy is possible
if there is more testing and better
recording of deaths, and post-mortem
examinations are carried out on
suspected victims. Experts say that even
though health is a state responsibility,
the centre can enforce standards.
Monitoring the number of deaths
above “normal” levels and deaths at
home could help, experts said.
Mumbai, the country’s worst-hit city,
found 13,000 excess deaths in March-
July compared with the same period last
year, reports said.
Deaths may also have increased as
the pandemic has made it harder for
doctors to treat other conditions other
than COVID-19.
1.5%
people with COVID-19
die in India, according to
official estimates
November 2020 / FUTURE MEDICINE / 59