Recovering early

An improved recovery rate is positive news, but reducing new infections is crucial

02/05/2020

Data for COVID-19 is still a long way from giving a complete picture, but it is encouraging that the basic metric of the number of those recovering as a share of confirmed infections is showing improvement in India. The Health Ministry has said that the percentage of recoveries currently stands at just over 25, almost double of what it was two weeks ago. National data on other parameters appear similar to disease trends witnessed globally, with the worst outcomes encountered among elderly patients — translating into a case fatality rate of 51.2% for Indians older than 60. What is important to note, however, is that whether it is recovery or death, not all cases are recorded for a variety of reasons. There may be untested people who have recovered. Also, in the long term, most recover from the infection. It is therefore imperative to find positive cases early and assess the pace of recovery accurately. Among the countries moving to a mass-testing strategy after a measured lockdown and successful control over viral transmission is New Zealand. In terms of deaths, there could be unknown fatalities caused by COVID-19 outside hospitals. Doctors in the United States have made a contrasting determination: of people who had the virus, but died of unrelated causes. These findings and trends underscore the importance of research on the progression of the pandemic in India.

The comparatively low death rate from COVID-19 in India, officially estimated at 3.2%, remains a topic for systematic study. Even accounting for inability to identify all virus-caused deaths and misclassified fatalities, the absence of a large number of severely distressed patients in hospitals stands in contrast to the experience abroad, notably in the U.S., as well as many countries in Europe. The Johns Hopkins database gives the fatalities per 100 confirmed cases as 15.7% for the U.K. and Belgium, for example. There are many hypotheses for the less dismal outcome in India based on the impact of climate, benefits of immunisation, and other possible factors, but they remain untested. While India’s fatalities may be low, and an improved recovery rate will help revive the economy, there is genuine worry that patients with non-COVID-19 conditions are at greater risk for poor health outcomes due to lack of access to care during the pandemic. The public health strategy for COVID-19 has to sharply focus on helping people determine their infection status through widely available testing. This will enable selective quarantining, planning of welfare measures and participation of people who have recovered in trials for potential therapies such as convalescent plasma transfusion. With a relaxation of the lockdown, India’s strategy will need precise and intensive measures to drive down the reproduction number for the virus.