India's Covid-19 deaths to reach appalling proportion

India has just breached the one million mark in Covid-19 infection cases with 36,247 new cases taking the country's official tally to 10,04,652, and 690 new fatalities putting the death toll in the four-and-a-half months of the outbreak at 25,594. Public health experts believe the figures likely understate the full magnitude of the pandemic — or its death toll — in India, as the country has one of the lowest testing rates of any major economy. India's journey to a million cases took 137 days, and half of these were in a hard nationwide lockdown announced in the early days of the outbreak — a strategy that officials and experts said bought the country precious time to set up isolation centres, add hospital beds and beef up testing infrastructure.

With crippling economic costs piling up, the country began unlocking in June, and the outbreak was soon on a sharp upward trajectory. Experts estimate the next million to take about 20 days — the doubling rate stands at 20.6 days — and say the focus now needs to shift to rural parts of the country that traditionally have been beyond the reach of adequate healthcare mechanisms, and where new hot spots are now feared to pop up. The case fatality rate (CFR) — the proportion of people who succumbed to the illness from among known infections — for India is 2.5%.

The US, which has 3,648,250 cases and 140,518deaths, has a fatality rate of 3.9%; and Brazil, with 1,978,236 cases and 75,697 infections, is at 3.8%. The fatalities in India are expected to increase in the coming weeks. In the last week, India has added an average of 30,076 cases a day, up from 23,895 a day in the seven-day period before that. At least two States, Bihar and Assam, announced they will be re-imposing lockdowns while Uttar Pradesh — the State with the highest population — said it would follow a weekend shutdown.

At the current rate, Covid-19 infections are on track this year to surpass the roughly 2.4 million tuberculosis infections recorded in India in the 12 months of 2019, and lead to a comparable number of deaths. TB, widely regarded as the deadliest infectious disease in India, led to the deaths of around 79,000 people, according to the Union government's India TB Report 2020, although the World Health Organisation (WHO) estimates this number to be over 4,00,000. India's average weekly test positive rate has risen from 7.7% in mid-June to 10.1% at present. While major cities such as Delhi and Mumbai were among the initial hotspots of the virus in India, newer cases are emerging in rural areas where healthcare infrastructure is much weaker. India's public healthcare system is one of the most chronically underfunded in the world - annual spending is Rs 1150 ($15) per person - and hospital access is at its lowest in rural areas. On an average, there are only 0.2 public hospital beds per 1,000 people in rural India, with the World Health Organisation recommending a safe level of 5 beds to 1,000 citizens. India's rural concerns, hence, are dominant in this regard.