Featured image: Workers walk past an Indo-Tibetan Border Police officer, New Delhi, June 26, 2020. Photo: Reuters/Danish Siddiqui.
Data from the ‘Our World in in Data’ website shows that India’s COVID-19 case fatality rate on July 2 was 2.95%. In Bhutan, Nepal, Maldives, Sri Lanka, Bangladesh, Pakistan, and Afghanistan, the case fatality rates on June 26 were 0%, 0.21%, 0.38%, 0.54%, 1.26%, 2.05% and 2.43%, respectively.
The case fatality rate (CFR) is the number of people who die due to COVID-19 for every 100 people who developed COVID-19. It is an imperfect measure of the risk of death due to the disease, but it does provide important information about underlying health conditions in a country, region, state or city, during an ongoing epidemic.
A high CFR in a country implies that a high fraction of the reported COVID-19 patients are succumbing to the disease. It highlights shortcomings in healthcare strategies related to the general quality of health, access to healthcare, early detection of patients, proper triage, care of critical patients, etc.
Converted to number of deaths due to COVID-19, the CFR could mean that for every 10,000 recorded COVID-19 patients, approximately 0, 21, 38, 54, 126, 205, 243 and 295 have died so far in Bhutan, Nepal, Maldives, Sri Lanka, Bangladesh, Pakistan, Afghanistan and India, respectively.
That is, the COVID-19 CFR in India is significantly higher than in other South Asian countries. The gap between India and next-worst affected country, Afghanistan, is close to 50 deaths per 10,000 infected patients. Caveat: Fatality undercounting, underreporting and improper deaths registration could be confounding the data from all these countries.
India’s performance with regard to COVID-19 fatality has not suddenly worsened in recent days. The country has been consistently the worst performing South Asian country in terms of the COVID-19 CFR for the past several weeks. The chart below shows this (the plot for each country begins on the day its total number of reported cases crossed 50).
India has consistently recorded the highest COVID-19 CFR among the eight South Asian countries since the 36th day. For the last 77 days, India has consistently performed worse than its neighbouring countries, many of which are much poorer and have far worse infrastructure (see the caveat). And for close to two months, the CFR has been higher than in Afghanistan and Pakistan by close to a full percentage point.
This performance should be a matter of concern, especially since Afghanistan is also beset by war and is about four times poorer than us. But in the last 30 days or so, Afghanistan’s CFR has been rising steadily; if this trend continues, it will soon overtake us.
It’s also surprising that this comparative position has escaped the media’s attention. Whenever the government has discussed its response to the COVID-19 epidemic within the national borders, it has always compared India with European and North American countries. The media should challenge the construction of this comparison group in official and unofficial discourse, and bring the spotlight closer home, to include our geographic neighbours.
An important dimension when comparing COVID-19 CFRs is the population’s age-structure. Data from many countries indicates that the CFR rises dramatically with age. As a result, a country with a relatively younger population should have fewer deaths due to COVID-19. India has significantly more younger people than most European, North American and South American countries. This could help explain India’s lower CFR relative to, say, Italy, Spain, the UK, Brazil and the US.
However, the South Asian countries have a broadly similar demographic distribution. So comparing India’s CFR with other South Asian countries could provide a better sense of the Indian government’s response strategies and their performance. Doing so could also explain why government officials as well as a pliant media avoids comparisons with India’s neighbours.
Existing strategies to deal with the pandemic in India have been far less successful than they are often made out to be – in terms of the humanitarian and economic crises brought on by an ill-planned lockdown as well as in terms of the immediate impact of the pandemic on lives lost to the disease.
Deepankar Basu is an associate professor in the department of economics, University of Massachusetts Amherst.