As Covid-19 cases surpass 2.6 million globally, with over 1,84,000 fatalities, the unpredictable virus continues to wreak havoc in 200 countries, taking a toll on lives as well as livelihoods. Countries must unite and pool resources and knowledge to jointly combat this pandemic. However, it is important to understand the progression and behaviour of the virus in different countries to combat it effectively.
The NITI Aayog undertook an extensive and rigorous analysis of data from India and the world to understand the differential impact of the virus, and found that its effect in India has been relatively muted thus far.
Global comparison
In terms of chronology, while the coronavirus originated and spread from China, countries such as India, the US, the UK, France, Italy, and Germany reported their first cases within a 10-day timeframe. And yet the trajectory has differed for India. As of April 22, fatalities in India were 640 compared to 45,063 in the US and 24,648 in Italy. Of over 1,84,000 deaths reported globally, India’s share is just 0.4 per cent.
Interestingly, Italy reported its first case a day after India, but in its fourth week since, Italy recorded 216 per cent growth, while it was still almost zero in India. Italy peaked on Day 22 while India started experiencing slow growth only from Day 46; to date, the daily growth rate in cases of Italy was 1,300 times that of India. Even today, when Italy has peaked and flattened out, its virus fatalities remain nine times higher.
If one were to look at the cumulative number of cases in the US, UK, China, Germany, France, India and Italy, India has remained consistently lower. While other countries picked an upward trend as early as the second week since their first case, India did not witness any major rise until the fourth week. India is now in Week 12, and the analysis shows that in 12 weeks, since the first recorded cases in each country, cases in the US, Germany and France are 39, nine and 11 times higher than India, respectively.
In order to avoid any extreme variations that may be caused due to spike in cases on a particular day, we also consider the five-day moving average of the total cases and found that this parameter for India was the lowest as compared to the US, UK, Spain and Italy. As on April 22, India’s moving average stands at 1,384 while the US is at 28, 065 cases.
Similarly, India witnessed a consistently lower trend in the five-day moving average of fatalities. The first death in India was reported on March 13; total number of deaths in Italy were over a 1,000 on this day despite the country reporting its first case after India.
Testing controversy
A debate raging in India has been on the issue of testing. We believe that lower testing volumes are not reason enough to conclude that positive cases could be much higher. The positive case detection rate (positive cases divided by total tested) has been just 4.35 per cent. It would be incorrect to assume that higher testing implies higher positive detection rate. A case in point is Germany, which is carrying out the highest number of tests per million population (approximately 25,000) ,and yet detection remains at 7.26 per cent.
India has been carrying out focussed testing, and given that most previous testing has been done on symptomatic individuals, the low positive rate is welcome news. India has ramped up testing and in the last four days, almost 1 lakh additional tests have been performed. On average, we are conducting 30,000 tests a day and in the last ten days, testing has grown by over 130 per cent.
Our analysis finds that the rate of growth in positive cases and fatalities has been consistently lower, linear but non-exponential. While it would require detailed research to understand what led Italy, which reported its first case after India to end up with over 1,87,000 cases, 25,000 deaths and an overwhelmed health system, we can comment upon what potentially worked for India.
What worked for India
First, India has been very stringent and proactive in responding to the virus and had started curtailing incoming flights and screening passengers early on. A few States started imposing restrictions even prior to the one-day voluntary janata curfew which was announced by the Prime Minister; this was followed by the nationwide lockdown.
The stringency of our measures is apparent in the stringency score that has been calculated by Oxford University as part of a study that analyses the response of various governments to Covid-19. India was one of the few countries with a score of 100 early on during the situation. Despite the severe impact of the virus in Italy, the US, the UK, Germany, France and Iran, their stringency score still remains below India (see Charts).
As a result of the strict and decisive measures taken by India, the doubling rate improved from 3.5 to 7.5 days. In fact, as compared to 6.3 days in Week 11 since the first reported case, the weekly doubling rate has improved to 10.13 days currently.
Second, India, with a median age of just 27.9 years, is one of the youngest countries in the world. This may be of particular importance, especially since those above 60 are considered to be a high-risk group. India has 77 people over 60 per 1,000 people as compared to 265 in Italy and 264 in Germany.
Third, our experiences and initiatives have prepared us better. Kerala has dealt with the Nipah virus while Orissa has experience in dealing with natural disasters regularly. Such experiences have strengthened the ability of some States to respond to this threat effectively. Further, the Integrated Disease Surveillance Program (IDSP) ,which was launched in 2004 to detect and respond to epidemic outbreaks, has also facilitated quick identification and isolation of Covid cases through weekly IDSP data and an institutionalised set-up.
These results, while encouraging, should not drive us to lower our guard. We must continue to increase pooled sample testing and make technology the backbone of our fight. The rollback of the lockdown must be phased while emphasis should be on hyper-localisation to ensure that infected areas remained isolated to save lives while unaffected areas open up to save livelihoods. Social distancing must become the new norm and wearing of masks, the new fashion.
India must show the rest of the world how an epidemic must be controlled, and won over with a combination of bold measures, technology, citizen engagement and intelligently-calibrated strategies.
Kant is CEO, Mothkoor is M&E Specialist and Sinha is Young Professional with NITI Aayog.
Views are personal.
A detailed study on the subject is available on NITI Aayog’s website