Global Crisis, Local Response

Context: While India’s Case Fatality Rate (CFR) is standing low at 1.55% (less than many nations in Europe), Lancet has recently cautioned about the dangers of false optimism and misplaced complacence.

Reasons for High CFR in Europe: as compared to Asian Countries.

• Aged Population: 75% of the deaths were among those aged more than 75 years and living in care homes

• High prevalence of co-morbidities: like hypertension, obesity, chronic cardiovascular disease, cancer and habit of smoking.

• Infected health care providers: Disproportionate number of health care providers got infected early on (15% of total cases), rendering the health services weak.

• Shortage of diagnostic tests: and personal protective equipment.

The World Health Organisation’s Guidelines on COVID Death:

• Defining a COVID death: The World Health Organisation (WHO) defines “COVID death” as a death resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case.

• It should not include a death that cannot be related to COVID disease (e.g. trauma).
• A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of pre-existing conditions.

• Case estimates: The WHO estimates that  -

• 14% of infected cases are severe and require hospitalisation, 
• 5% of infected cases are very severe and require intensive care admission,
• 4% of the infected will die. 

Concerns for India

• Issues in tracking the cause of death: It is not clear whether all the states are following the WHO definition of death on the tracking of case fatality rates. 

• This is evident from the fact that many states have set up expert committees to re-examine and verify COVID-19 deaths.

• High Age-specific COVID-19 mortality rates: National Bureau of Economic Research has predicted that  India’s CFR with age-specific rates are too high and cautioned against misplaced complacence.

• An overwhelming concern with the overall CFR focuses on crude aggregates (and not age specific rates).

• Breach of benchmarked fatality rate : CFR has breached the 4% (WHO’s figure) mark in many regions of India. E. g- It was 4.89% and 5.20% in Mumbai and Ahmedabad respectively.

• Strained Health Services: 

• Few hospitals in Madhya Pradesh, Gujarat and Mumbai, had marginally reduced the oxygen flow to their patients to optimise use.

• Rapid antigen testing failure rate is high.
• Surges shall remain a constant challenge as all activities other than education, hospitality and entertainment sectors have resumed, with very little real restrictions. 

Way Forward: 

• Data Sharing and Disaggregation :

•  Need open and transparent data sharing with scientists, public health professionals and indeed the public at large.

• Emphasis must be on COVID data disaggregated by geographies and vulnerabilities.  This will enable framing responses “as local as possible”.

• Benchmarking the CFR with WHO’s fatality rate of 4% - and closely monitoring the rise in cases in the rural areas.