A woman leans against a stretcher holding her husband in the emergency ward of Jawaharlal Nehru Medical College and Hospital, during the COVID-19 outbreak in Bhagalpur, July 2020. Photo: Reuters/Danish Siddiqui.
Any disease is generally evaluated by its contribution to the number of deaths due to all causes. If a disease is causing, say, 5% or more of all deaths in a population, it can be considered to be a major public health issue. The top ten causes of deaths in India include heart disease, lung diseases, tuberculosis, cancer, diabetes and diarrhoea.
Now, every day for the last four or five months, news reports have been full of the numbers of COVID-19 cases, deaths and other parameters. These numbers are each becoming worse and that is worrying. The country had a nationwide lockdown for over two months to arrest the novel coronavirus’s spread. The average age of India’s population is also lower than in most of the world. According to data published by the government, India’s mortality due to COVID-19 has also been lower in many other parts of the world.
However, all health services that addressed diseases other than COVID-19 came to a grinding halt during the lockdown. They are only just reopening, and resuming tending to other illnesses.
To understand the COVID-19 epidemic in India and our response to it, we are tracking cases, recoveries, deaths, death rates, tests, test rates and the doubling time. Experts in different fields, including economics, mathematics, epidemiology, cardiology, pathology, etc., have been opining about what is happening and what should be or could have been done. Many are saying that we should increase testing. TV news channels have also been discussing interesting statistics, projections, etc.
The people themselves are stunned, depressed. Many have lost jobs and many aren’t able to afford two square meals a day. The global economy seems to be shrinking into a major recession as international trade and tourism has been crippled.
Against this background of gloom and doom, let’s ask ourselves a simple public health question (which few others have asked thus far, to our surprise): How many of those people who died in the last five months – from March to July – died due to COVID-19?
We obtained the population of each country and the crude death rate per 1,000 people per year, and calculated the expected number of deaths in that country for the five months. Then, we compared this figure to the number of deaths due to COVID-19. This is what we found:
To our surprise, the proportional mortality due to COVID-19 varied from a maximum of 26.8% in Peru – followed by Chile (20.3%) and the UK (17.6%) – to a minimum of 1.3% in India. The US has a proportional mortality due to COVID-19 of 13%. India’s figure drops further to 1% if we assume our epidemic began in March instead of April.
That is, India’s 41,500 deaths thus far due to COVID-19 is only 1% of the total number of expected deaths by all causes in five months. Even if we assume India is under-reporting COVID-19 deaths by two-thirds, the proportional mortality only comes to 3%. Conversely, in the last five months, 99% to 97% of all deaths in India have been due to non-COVID-19 causes. Even the US, which has reported the most deaths due to COVID-19 in the world, such deaths constitute only 13% of all deaths, and 87% of deaths were due to non-COVID-19 causes.
This is a fairly simple calculation compared to many that are being computed and discussed. However, we are not attempting to trivialise COVID-19 or say that governments are wrong. We must fight COVID-19 to the fullest following the evidence, with the requisite intensity and skills. But our simple message is that we must not forget the forest for the trees. We must not neglect all the other diseases, accidents and events responsible for 99% of deaths during the pandemic. In trying to defeat COVID-19, we can be Arjun of the Mahabharata for a while, seeing only the bird’s eye that he wanted to shoot at – but we can’t afford to ignore the whole picture of health and other ailments.
We must resume all health services, including public health services like immunisation, antenatal care, cancer and heart disease screening and treatment, etc. If we don’t, we may lose many, many more lives in an effort to limit the number of deaths due to COVID-19 – which is around 1% of the total. There is no point in winning the battle but losing the war.
Note: The headline of this article was changed at 5:15 pm on August 17, 2020.
Dr Dileep Mavalankar is the director and Divya Nair is a faculty member at the Indian Institute of Public Health, Gandhinagar.