Missing pieces of data make it impossible to predict how the outbreak will unfold in the coming months.
It is difficult to predict how COVID-19 will affect India, and the numbers of people who will get sick, or unfortunately die.
The Indian Journal of Medical Research has published some predictions on how the COVID-19 epidemic might progress in the coming months, but the authors have restrained from providing any numbers on the scale of the epidemic in India. This is because our current knowledge on the behaviour of the virus has come from industrialised countries, where people, their living environment and health status are very different from what the virus will encounter in India.
In 2009, the influenza virus that triggered the swine flu outbreak in India caused nearly 30,000 laboratory confirmed cases, and over 1,700 deaths across the country. Whether the novel coronavirus, SARS-CoV-2, will have the same impact or not is difficult to predict, as several relevant pieces of data about the virus are lacking.
Till now, we know that older people are at a higher risk of hospitalisation and death. The 83 million people above the age of 65 years outline the magnitude of the challenge facing India. However, of greater concern are clinical studies reporting that young children are at an equally high chance of getting sick. There are 11 million children under five years of age in India, of whom, one-fifth are under-weight. Malnutrition is a known factor that increases the risk of illness and child death. Till now, the virus has affected countries where children are well-nourished. We still have no idea how the novel coronavirus will affect children living in impoverished conditions of developing countries.
People with non-communicable diseases of older ages, such as diabetes, heart conditions and asthma are also at higher risk of complications or death. Here again, the sheer numbers of people in India are of concern. About 10 percent of the Indian population have diabetes. Among the age group of 70-79-years, nearly 13 percent are diabetic. People with cardiac ailments are equally large, with heart diseases causing more than one-fifth of all deaths in India.
Additionally, we have no idea on the risk among the large numbers of people with tuberculosis, HIV or for that matter, pregnant women, priority diseases and health concerns of developing countries such as ours.
There are several other unknowns which will influence the way the epidemic plays out over the next few months. One of these unknown factors is the high population density. India has almost twice and thrice the number of people living per square kilometre of space as compared to, say, Italy and China. This population density can be favourable in an indirect way. For example, social distancing measures and home quarantine are quite impractical in the crowded environments of urban slums, providing the virus an opportunity to rapidly infect and sweep through these communities. This might bring about immunity, so that the spread of the virus would be checked.
Another unknown factor is the behaviour of the virus in the soaring summer temperatures of India. Like influenza, coronaviruses are winter viruses, with people mostly falling ill during the winter season. Till now, data on the virus is available from countries such as Australia, Thailand and Singapore, where the highest temperatures are around 30 degrees.
Adding to these uncertainties would be the situation where we lose track of the virus. Sick people tell us where the virus is lurking, and at present, we can locate the virus from government data on quarantined and sick people. The private health sector is now being roped in, and unless the private sector reports the data on patients and where they come from, we will not be able to know where the virus is spreading.
We can assume that the virus has reached several parts of the country, carried back by economic migrants fleeing lock down measures in big cities. It is likely that the novel coronavirus will disappear from sight in these parts of the country, as economic constraints will limit people from getting tested or accessing treatment. How long the virus will persist in these settings, and whether it will return to urban areas once the lockdown is over, re-starting new cases of Covid-19, has to be seen.
Like the lockdown, we can wait and watch in order to understand how the virus will behave, and how the epidemic will play out in the coming months in India.Anita Kar is former Director, Interdisciplinary School of Health Sciences, University of Pune. She works in the field of genetics, epidemiology and public health, with a special focus on congenital disorders and childhood disabilities. Views are personal.
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