Silver lining as Covid-19 recoveries see big spike
The number of people who have recovered from Covid-19 in India crossed the 1.1 million mark over the weekend when over 100,000 people were declared free of the virus, the highest numbers recorded yet over two days in what is being seen as a sign of the country’s disease mitigation strategy being effective in avoiding a high number of fatalities.
HT’s dashboard of Covid-19 data from across the country showed that 51,845 recovered on Saturday and 40,449recovered on Sunday, bringing the proportion of recoveries to 65.76%. As on Sunday, of the 1,803,267 infections in all, 38,159 people have succumbed to the viral disease, translating to a case fatality ratio (CFR) of 2.12%. As of Sunday night, the doubling rate of cases – the number of days it takes for infections to double – across the country is 21.2 days.
Coordinated implementation of “effective containment strategy, aggressive testing and standardised clinical management protocols” resulted in a consistent trend of rising recovery rate and progressively reducing CFR, said a statement by the Union health ministry on Sunday.
The trends indicate India’s response to the pandemic is “improving at various levels of care including at the societal level as well as in hospitals,” said Niti Aayog member VK Paul, who heads the national task force on Covid.
“It suggests that we have learnt to take care of our positive cases; we have learnt how soon to act and what works and what doesn’t. We are able to provide more organised and systematic treatment clinically. Those involved in Covid-19 management are learning by the day by reading and from each other,” Paul added.
To be sure, India’s recovery rate is expected to eventually soar to over 90% — since current trends indicate the final fatality rate could lie between 2-3% — once the outbreak nears its end. For instance Germany, which has had over 200,000 infections but at present has around 8,300 active cases, has a recovery rate of 92%.
A look at infection, recovery and fatality rates from the top 10 countries with the highest cases shows only the United States — at around 50% — has a lower rate of recovery than India.
In India, the 579,183 active cases (as of August 1) account for 32.12% of the total case load. At the current rate in which new cases are reported, active cases are doubling in 27.3 days, and new hot spots emerging in three large-population states of Andhra Pradesh, Karnataka and West Bengal, threatens to bring this number down – thereby accelerating the speed at which the outbreak grows.
The current CFR also masks the potential fatalities that could be recorded from among the over 500,000 active cases at present. According to a study in Lancet based on case progression among patients in China, it takes around 17 days for people who develop critical Covid-19 infections to succumb to the illness.
The 38,159 deaths seen till August 2 will thus correspond, roughly, to the 1,004,652 cases seen 17 days ago on July 16. This brings India’s lagged case fatality ratio to 3.8% — a number consistent with what has been seen in countries that have largely been able to keep its health care systems from being overwhelmed.
Italy and Spain, two European nations that were hit hard in the second peak of the global pandemic and accounted for larger populations of more vulnerable people, have a CFR of over 14% and 8%, respectively.
“India’s mortality rate is low; under 3%, which means around 97-98% of those who get infected will eventually recover. The recovery rate is also linked with the case load; if the case load is higher, the recovery will take longer as it will also include higher percentage of serious cases,” said a senior epidemiologist with the Indian Council of Medical Research (ICMR), requesting not to be named as he is not authorised to speak to media.
The official said the numbers also reflect the accuracy in reporting, which could vary between states.
“If the number of positive cases goes up then recovery rate will automatically slow down, and that explains why states like Maharashtra, Karnataka, Kerala, etc, have low recovery rate. Also, for states and UTs having higher recoveries, it could also indicate fewer new infections being reported on a daily basis in comparison,” he added.
Another set of epidemiologists say that it could also mean in certain regions there probably are fewer severely ill cases, leading to faster recovery, which needs to be analysed.
“Looks like more number of discharges have taken place in the last two to three weeks. And most of these can be asymptomatic too, so might discharge faster. The pattern needs to be studied if it’s area specific and what could be the cause,” says Dr Giridhara Babu, professor, epidemiology, Indian Institute of Public Health, Public Health Foundation of India.
Out of the total active cases currently, 0.28% patients are on ventilator, 1.61% require intensive care unit (ICU) support, and 2.32% are on oxygen support – trends that officials said reflected the level of preparations.
“What has also worked for India is that we have been prepared well in advance that has ensured our health system is not overwhelmed, and there is buffer, cushion and headroom that helps in saving lives. Faster recoveries are also because of increased testing because of which we are able to detect cases early and act accordingly,” he added.
The country’s maximum case load, which is about 80% of the cases, is restricted to 50 districts out of about 740 total districts.
Experts said this could also indicate that the way Covid is affecting Indians – the disease has been established to hit countries with older populations harder – may be different from the way it has in countries like Italy and Spain.
“This is a good sign that people are getting better and our mortality is low. Most positive cases do not require hospitalisation, and those needing intensive care is actually a minuscule number. Most people in hospitals have moderate disease with good chances of recovery. The need is to take care of our old and vulnerable population with co-morbidities that is at high risk of developing severe illness,” said Dr Rommel Tickoo, senior consultant, department of internal medicine, Max Healthcare.
The government is now shifting its focus to emerging hot spots and rural pockets, Niti Aayog’s Paul said.
“Rural India needs special focus because if we have advantages like low population density and better surveillance… there are also challenges like limited access to health care facilities [in these regions]. The long distances can work to our disadvantage, which is why it is important to ensure rural areas are not severely affected. Right now we are managing fine, and watching the situation closely,” he added.