Heart diseases, chronic respiratory illnesses and strokes are the top three causes of death in India, together accounting for over 3 million deaths in the country in 2017, the last year for when all-cause mortality data is available.
This is roughly 30 times of the 100,000 deaths that have been recorded in India due to Covid-19 in the less than seven months that the viral illness began spreading and claiming lives. For the last 28 days, at least 1,000 people have died every day – a number that has been described as alarming. Taking known infections into account, the mortality rate (or the case fatality rate) comes to 1.56%.
“Covid-19 shouldn’t be a cause of worry as the death rate for India has been constantly dropping, and my assessment is that it will drop further. In absolute numbers it may sound big that one lakh people have died but we have to also look at our country’s population, and the number of people who got infected,” said Dr NK Mehra, former head, transplant, immunology and immunogenetics, All India Institute of Medical Science, Delhi.
“In India, the severity of infection is also low because our immunity levels are better modulated to fight off any infections as compared to Europeans and Americans. In fact, other viruses kill more. However, the infectivity rate of this virus is quite high so infections could go up in future. Deaths will remain low,” he added.
One of the key ways Covid-19 turns severe is when it comes an intense lower respiratory tract infection, although researchers say the most fatalities may be a result of a cytokine storm (when the immune system begins attacking organs). According to the Global Burden of Disease report published in The Lancet Global Health last year, data from 2017 (the latest period it has been available for), shows respiratory illnesses killed 0.34 million that year – nearly three-and-a-half times of the Covid toll seen till now.
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In terms of diseases with high case fatality rate in India are usually those with a CFR of 1% or above. Of the 11 such diseases, as documented in the National Health Profile 2019, at least eight diseases are with CFR that ranges from 100% to 2%. Covid-19’s CFR is around 1.5%.
Top infectious diseases with high CFR are rabies (100%), Japanese encephalitis (11%), influenza (A) H1N1 (7%), acute encephalitis syndrome (6%), encephalitis (5%), meningococcal meningitis (4%), tetanus neonatal (4%), diphtheria (2%), and viral meningitis, cholera and tetanus other than neonatal all three reporting 1% CFR.
“Covid-19 mortality rate of course needs to come below 1%, that goes without saying, as mortality is one of the factors that determine impact of disease. But, if you ask me, our bigger concern should be post-Covid complications, also called long Covid, because of the structural damage it does to the lungs and the brain. It affects the quality of life in long-term, and needs our focus,” said Dr Samiran Panda, head, epidemiology and communicable diseases, Indian Council of Medical Research.
ICMR recently launched National Covid-19 Registry in six regions from across the country to document long-term effects of the viral disease.
Doctors treating Covid-19 patients also say that the number of deaths is dropping. But with winter setting in, Covid-19 could pose a bigger problem.
“We have managed to keep things very much under control so far but there is evidence to suggest that pneumonia progresses differently during summers and winters. In winters, it becomes more severe, which is why coming months are going to be a challenge in terms of stopping Covid-19 numbers from rising,” said Dr VK Paul, chairman, one of the government empowered groups, to manage Covid-19 situation in the country, in a recent Covid-19 briefing.
“People need to be extra careful in coming days, with absolutely no scope for prevention fatigue. There is no other option but to adopt Covid-19 safe behavior such as wearing a mask, maintaining hand hygiene, and observing social distancing,” he added.