Here's why Coronavirus will not be fatal for India

The Novel Coronavirus pandemic has created an uncommon fear in the common man. The virus has claimed over 95,000 lives (as of April 9) worldwide, enough to strike terror in the hearts of people. Leaders across the world have been trying to control the loss of life and get back to normalcy, albeit met with limited success. India, on the other hand, is emerging as a bright spot that is successfully controlling the COVID-19 outbreak sooner than expected. Here's why:

Data signals a positive trend

The narrative on Coronavirus needs to shift focus from the number of active cases to global death rate comparison and seriously ill patients (those needing ventilation support). Please note the timeline of the first reported cases in each country and their growth into a full-fledged crisis.

Out of 95,000 deaths, more than 40% of the deaths have been reported from Italy, the United States of America, and Spain. A continent wise segregation on new daily deaths points to North America reporting 2,000 new average daily deaths, and Europe 3,500. Whereas the new death rate in Asia and Africa is disproportionately low — 300 and 51 respectively.

A country-wise breakdown of new daily deaths gives a clearer picture:

Country	Average new death reported
USA	1,900+
Italy	500+
Vietnam	0
United Kingdom	700+
Sri Lanka	1
India	20+

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The data points to a difference in quantum of new death between North America and European countries on one hand, and South Asian and African on the other. The mortality rate in India is not even 3% compared to the US. Other South Asian countries fair even lower compared to American and European counterparts.

The overall pattern suggest a vast difference in virulence of the Coronavirus in Asia, and Africa compared to European and North American countries. Research done by doctors in the US also signals how countries having mandated BCG (anti TB) vaccination have displayed a minimum death rate. Another research points to continents impacted by malaria in the past having less tendency to contract COVID-19 at a faster pace. However these researches only draw correlation to explain the current pattern, there is no conclusive evidence yet.

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India's case

India under Prime Minister Narendra Modi has been prompt to impose a complete 21-day lockdown, and completely stop international passenger flights. State governments have responded to the evolving situation with strict enforcement and public policy measures to contain the spread. After the initial hiccup in implementation which saw migrant labours attempting to move back in huge numbers from Delhi, the administrative execution deserves credit. This has helped in continuously tracking the initial carriers.

Leaving the standalone spike in Coronavirus cases because of violation by Tablighi Jamaat in Delhi, other cases in the country have seen a gradual steady growth with a very low death rate. The 21-day lockdown has also delayed India's movement into stage 3, and helped identify, isolate initial symptomatic carriers, and engineer a coordinated centre state health response in case of emergency.

The Indian model of response to Coronavirus is also giving direction to the world. Countries like the USA, Brazil have thanked India for the timely supply of hydroxychloroquine drugs. With the initial goals of a lockdown being met, standalone enforcement of lockdown is not the only solution to contain coronavirus spread in the coming months.

The likelihood of the virus naturally resurfacing during different times of the year, even after the world successfully develops a vaccine cannot be denied. This has been the trajectory with any global pandemic in the past. TB is a prime example that continues to impact the globe even now. The world registered 10 million TB cases in 2018 with a fatality of 1.5 million. India accounted for 27% of TB cases, and China 9%. Overall 54% of the global TB cases were reported in Asia.

COVID-19 is giving a similar trajectory in European and North American countries. The two account for more than 65% of the total cases, where COVID is more virulent and adaptive. These are times when we have to think global and act local.

India has responded to the pandemic in its own indigenous way. It advised people to wear masks that reduce risk of infection significantly, it is giving preference to cross learnings from the different states, forming a district-wise micro plan, and is continuously adapting its response. When other countries were exploring lockdown, India was already in lockdown.

India should now emerge as the leader in implementing an exit plan that becomes a trailblazer for the world. India's post lockdown plan should also not be dictated by the impact of the COVID-19 in Europe and USA, but take into consideration its local and regional resources and response to the current crisis. India should factor in the response of the virus in tropical countries and the feedback from the state governments. There is no guarantee that COVID-19 will not resurface, but the success lies in controlling it and making it harmless.

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Exit plan from lockdown

The exit plan needs to be swift and has to have clearly defined phases. It should also have the ability to adapt and learn with the constant dynamic changes that may be encountered in this process. Isolation of hotspots, isolation of vulnerable (age above 70, underlying diabetes, Hypertension cardiovascular disease, asthma & COPD ) restricting unnecessary travel.

Phased return to work with the monitoring of employees at work is a better option than no work at all. Monitoring of employees at work with a simple temperature check and institution of strict hand hygiene and social distancing will go a long way to control the disease.

Isolation of the identified source and societal hygiene must be a regular year-long exercise. Just like India plans for awareness, and treatment for other communicable and non-communicable diseases, it needs to have a similar annual COVID plan. Incidence of Coronavirus should not create fear, treatment should be treated as a routine exercise. India has historically contained health pandemics in the past, COVID-19 will not be any different.

If the latest weekly average daily new death rate in India (23.5) has to be extrapolated with a third-order expansion factor, India will still fall to less than 5,200 total death at the end of May as a worst-case scenario (provided many super spreader incidents do not happen). This by far will be a big achievement considering that the current average daily death rate in the US stands at 1900, and Europe at 4500 plus.

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(The above article is co-authored by Jan Ki Baat founder Pradeep Bhandari and Dr Debashis Ghosh- Head, Breast Services Royal Free, London. The views and opinions expressed within this article are the personal opinions of the author. The facts, analysis, assumptions, and perspective appearing in the article do not reflect the views of Republic TV/ Republic World/ ARG Outlier Media Pvt. Ltd.)

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