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Monday, March 01, 2021

A year with Covid-19: peak behind India

Covid-19 in India: The decline in numbers looks terminal, but the end may be still some distance away, and it is not yet clear how long immunity will last. Tracing India’s journey to the peaks in case counts and deaths, followed by the decline.

Written by Amitabh Sinha | Pune |
Updated: January 30, 2021 10:18:47 pm
Unoccupied beds at a Covid care centre in Ahmedabad. (Express Photo: Nirmal Harindran)

One year after the first case of coronavirus infection was detected in the country, India is staring at a possible early exit from the pandemic that has already claimed more than 1.5 lakh lives, caused massive economic disruption and resulted in loss of livelihoods for millions of families. Although between 12,000 and 14,000 new cases are still getting detected every day, the decline in the numbers does look terminal, having continued for more than four months now.

Scientists and health experts say while the worst may be behind us, we are still quite a distance from the end.

Epidemics usually have a long tail, and it might be several months before the numbers come down to zero. There is an additional threat: Scientists still do not know how long immunity against the disease, gained either through natural infection or vaccination, lasts. Short-term immunity would mean the risk of re-emergence remains. That is the reason scientists and health authorities have been insisting that people must continue to wear masks and follow the simple rules of physical distancing.

Daily cases

This has been the most tracked number during the pandemic — the number of people found infected with the virus every day. India has followed an unusually smooth bell-curve, with a well-defined peak (Figure 1).

Figure 1

The numbers rose exponentially in the initial couple of months, slowed down a bit due to the lockdown, reached a peak in the middle of September, and then began a decline that has continued for the last four months. The outbreak in India, in effect, began on March 2, with the detection of two cases, one in Delhi and the other in Hyderabad, even though three infections had earlier been detected in Kerala between January 30 and February 3. At its peak, India had been reporting over 90,000 cases every day, the maximum being 97,894 on September 16. At that time, no other country had reported more than 75,000 cases in a day. After that, of course, the United States went much beyond that number, consistently reporting more than 2 lakh cases every day since December.

Brazil went past 80,000 a day while the UK recorded more than 60,000 cases in a day. Some European countries — Spain, Italy, France — also registered their maximum single-day count in November and December.

The epidemic followed very different trajectories in these countries. The United States, and countries in Europe, for example, experienced multiple waves with no sharply defined peak. The curve in China, on the other hand, had a sudden and a dramatic end.

Even within India, states have had very different trajectories. Maharashtra is the only major state to have had a curve similar to that of the country as a whole. Delhi has had three distinct waves with very sharp peaks, while Kerala started slowly but is having an unusually flat and extended peak.

India’s curve of daily cases, ironically, is very similar to what the trajectory of an epidemic would look like if it spread in a uniformly distributed population without any intervention to contain it.

Daily deaths

India’s first coronavirus-related death was reported on March 12 last year, when a 76-year-old man from Kalaburgi in Karnataka, who had returned from Saudi Arabia a few days earlier, died in a government hospital. The man was asthmatic and suffered from hypertension.

Figure 2

The deaths, not surprisingly, have followed a trajectory similar to the daily detection of cases (Figure 2). At its peak, more than 1,000 deaths were being reported from across the country every day. On September 15, a total of 1,290 deaths were reported, which remains the highest single day casualty figure. In the last couple of months, the United States has reported more than 3,500 deaths in a day on several occasions. Even the United Kingdom has reported more deaths than India’s peak.

There is usually a lag of a few days in reporting of deaths. Also, states often bunch together unreported deaths from several previous days, leading to unusual increases. On June 16, for example, Maharashtra reported more than 1,400 deaths, while Delhi reported 437 deaths, both a result of a data cleaning exercise. That led to an unusual spike in the graph. Similarly, Tamil Nadu reported 522 deaths on July 22, which shows up as another spike in the curve.

As of January 28, more than 1.54 lakh coronavirus-related deaths have been recorded in the country. In the last few days, the death count has been mostly below 150.

India’s current case fatality ratio, or the deaths as a percentage of total number of confirmed infections, stands at 1.44, well below the global average of 2.15. But considering that a far greater number of people would have been infected, though not detected, the actual fatality ratio would be much lower than that, even if accounting for some under-reporting in the deaths as well.

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Active cases

This is the number of people who are currently sick and yet to recover from the disease. This is the effective burden on any country’s health system, and also the potential spreaders of the disease since those who have recovered would no longer transmit the virus to others.

Active cases have also followed a trajectory very similar to the daily new cases, and peaked almost simultaneously (Figure 3). At its peak in September, India had more than 10 lakh active cases. But there has been a steady decline after that, and as on January 28, there were a little more than 1.71 lakh cases, an almost 85% decline from the peak. This is the number of active cases that previously existed around June 20 last year.

Figure 3

Since September 17, there have been fewer than 15 days when the number of new cases has exceeded the number of people being declared to have recovered from the disease. On every other day, more people have recovered from the disease than have fallen sick. As on January 28, more than 97% of the people in India who were known to have been infected with the virus had recovered from the disease. About 1.4% of the infected people died of the disease, while the rest are currently sick.

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