Mounting human cost

FM makes a journey through the killing fields of COVID-19 at a time when the fatality of SARS-CoV-2 crosses the 1 million mark

Mounting human cost

COVID-19 fatalities crossed the one-million milestone on 28 September as per the COVID-19 case tracker maintained by Johns Hopkins University of the US — .

“an agonizing milestone”, as described by UN Secretary-General António Guterres.

What makes the figure “mind-numbing” is the fact that it was reached in just about 10 months from the time the new coronavirus was first detected in the city of Wuhan in China. It shows how powerful the devastation of the pandemic is, experts say. 

The infection may already have overtaken tuberculosis and hepatitis as the world’s deadliest infectious disease, and is still growing fast.

With no parallel in more than a century, COVID-19 continues its rampage, infecting millions of people and afflicting entire economies.

Many people believe that the actual figures on COVID-19 deaths could be far, far higher than reported, as different countries record infections and deaths in their own way.

WHO’s top emergencies expert Mike Ryan says the reported numbers probably underestimate individuals who either contracted or died due to COVID-19.

According to some unofficial estimates, about 6.4 percent of the people infected with the virus have now died worldwide.

Based on these trends, some models even suggest that the number of fatalities could exceed 3 million by January if the virus is allowed to spread unhindered.

One of the noteworthy characteristics of COVID-19 mortalities is that most of these deaths occurred in developed countries and not in developing ones.

Many of these deaths could have been avoided had people shown compliance with national mandates such as wearing face masks and maintaining social distancing, epidemiologists say.

The US reported the highest number of deaths in the world, accounting for nearly 15 percent of the recorded global fatalities, followed by Brazil and India.

Latin America is the current hot spot, accounting for more than one in three of all new deaths, fuelled by a surge in COVID-19 fatalities in Brazil, Mexico and several other countries in Central and South America.

Europe’s coronavirus-related death rates overtook those in Asia in early March, with Italy, Spain and the UK becoming global hotspots. From mid-April, the focus shifted to the US, where the number of deaths has remained consistently high, although the focus of the epidemic has shifted from the northeast of the country to southern and western states.

What is the true toll?

Experts think the reported COVID-19 deaths do not reflect the true scale of coronavirus-related mortality around the world.

Inconsistencies in the number of coronavirus cases and deaths among nations are the result of various factors, including the ways countries test and report cases and record deaths.

Some researchers say that these methodological problems can be fixed by measuring excess deaths. This measure utilizes the number of people who die from any cause in a given region and period, and then compare it with the recent historical average.

Going by this measure, the number of excess deaths across Europe since March to September was found to be about 170,000, according to data from EuroMOMO, a network of epidemiologists who collect weekly reports on deaths from all causes in 24 European countries.

The overall rate of excess deaths per 100,000 people in America has been found lower than that of many western European countries despite large regional disparities. When COVID-19 hit cities on the east coast hard in March and April, most other states were able to stall major outbreaks through quick lockdown measures.

Data about excess deaths are seldom available outside western Europe and the Americas. Most countries in Africa and Asia do not release such information.

Fatality rates based on comparing deaths, though easy to calculate, can overestimate the true lethality of the virus, epidemiologists say.

How many more

Studies say that the number of deaths can go either way depending on the manner governments respond to the pandemic.

The numbers could go up to 2.5 million in total by next January if the current trends continue, estimates Institute for Health Metrics and Evaluation (IHME) at University of Washington. They might still fall dramatically if the countries go in for measures like universal mask-wearing. On the other hand, the toll can further worsen to 3.3 million by January 2021 if governments remove precautions like social distancing and restrictions on social gatherings etc.

Further, the number of deaths from non-COVID-19 causes, like the poor availability of treatment, non-vaccination, alcohol consumption and drug abuse during the pandemic can also inflate total death numbers. As such, determining death rates in the midst of a pandemic is not easy.

Besides, the case fatality rate of this disease has been one of the biggest mysteries surrounding this pandemic due to the extreme variations seen from country to country. The death rate stands at about 13 percent in Italy, but it is one-tenth of this figure in neighboring Germany. In the US, it is around 4.3 percent. Again, it varies widely among US states. The number is around 7 percent in Michigan while it is about 0.7 percent in Wyoming. In South Korea, 2 percent of people who tested positive for the virus have died. The death rate in Wuhan in China is estimated to be 1.4%, whereas in India it is close to 1.5% according to official figures.

Epidemiologists, however, maintain that anything above 1% means very many deaths. The fatality rate for the flu virus is 0.1%. A small percentage of a big number is still a very big number, they point out. 

The US already has the highest number of cases in the world and the most recorded deaths of any country. Though its 330 million people only represent roughly 4.25 percent of the world’s population, the country accounts for just over 20 percent of the deaths from COVID-19.

As the daily coronavirus death tolls continue to go up in many places in the world with the onset of colder weather in the northern hemisphere and the reopening of more and more workplaces and schools, the counts are set to increase.

Eventually, most viruses lose their virulence due to lack of hosts, mutations that make them less deadly, or new treatments or vaccines. The novel coronavirus will too, experts say, but it is a question of when and at what cost.

 

Behind India’s low COVID-19 mortality

India has reported nearly 8 million cases of COVID-19 in the fourth week of October 2020, with 118,000 officially confirmed deaths.

According to the health ministry, the national recovery rate has been continuously increased to 90% and the case fatality rate is down to 1.51%. Indian Council of Medical Research (ICMR) guidelines stipulate that deaths of people with suspected or probable COVID-19 should be included in mortality data, based on WHO ICD-10 codes for COVID-19-related deaths. The guidelines, however, are only advisory and not mandatory. Consolidated data is not available in the public domain. In India, healthcare is the responsibility of the states and it is up to individual states to follow the reporting guidelines.

Only 22% of all deaths happening in India are medically certified under the civil registration system as most of the deaths occurring in rural India are outside hospitals. More than 70% of India’s population lives in the hinterlands.

However, public-funded serological surveys suggest at least 10 times the official number of people may have already been infected. This could mean that many deaths could have gone unreported.

Despite concerns around under-reporting, studies point to several factors that work in tandem to lower the COVID-19 mortality numbers in India. First, the bulk of the Indian population is young, with a median age of 28.4, according to the UN World Population Report. Public health experts say that older people, who are more likely to have comorbidities such as diabetes or hypertension, are more likely to die from COVID-19.

The Indian government slapped lockdown restrictions at a time the pandemic was already raging in Italy and other regions of Europe. This time lag might have helped Indian doctors learn from the experience of other countries to manage the pandemic in a better way.

Another theory going round is that other endemic viral diseases such as dengue fever might have given the population some antibody protection against the coronavirus.

Greater toll accuracy is possible if there is more testing and better recording of deaths, and post-mortem examinations are carried out on suspected victims. Experts say that even though health is a state responsibility, the centre can enforce standards.

Monitoring the number of deaths above “normal” levels and deaths at home could help, experts said.

Mumbai, the country’s worst-hit city, found 13,000 excess deaths in March-July compared with the same period last year, reports said.

Deaths may also have increased as the pandemic has made it harder for doctors to treat other conditions other than COVID-19.

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