Global Crisis, Local Response

The Indian Express     8th October 2020     Save    

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.