Speaking in the Lok Sabha and Rajya Sabha on 15 and 16 September, Dr. Harsh Vardhan, the Union Health Minister, made many self-congratulatory claims regarding the “success” of the government’s lockdown and its Covid-19 policies. What is striking was his ostrich-like refusal to address India’s surging Covid-19 cases, which have now crossed five million. He completely ducked the question why after a “successful” lockdown India has the highest number of daily new cases currently and is on course to overtake the United States by October, as the worst-performing country in the world.
Broadly, Harsh Vardhan argued the success of the Modi government’s Covid-19 policies based on having avoided cases and deaths due to the lockdowns, the number of cases and deaths per million being low, and the lower case fatality ratio for India.
Harsh Vardhan’s claims of having avoided cases and deaths are supposedly backed by an exercise that the Ministry of Statistics and Programme Implementation has carried out. True to this government’s usual practice on data, the details of this exercise have not been shared with the public. The Health Minister claims that imposing a nationwide lockdown helped in preventing an additional 37-38 thousand deaths and 14-29 lakh people from getting infected. These figures have been advanced earlier, also by Dr. Vinod Paul, who is Member, Health at the Niti Aayog.
Common sense would make clear that a lockdown does not prevent deaths or infections, it only postpones infections. Three premiere public health organisations—the Indian Public Health Association (IPHA), the Indian Association of Preventive and Social Medicine (IAPSM), and the Indian Association of Epidemiologists (IAE), in their highly-critical statement on the lockdown issued on 25 May had said, “India’s nationwide ‘lockdown’ from March 25, 2020, till May 30, 2020, has been one of the most stringent; and yet Covid-19 cases have increased exponentially throughout this phase, from 606 cases on March 25 to 138,845 on May 24… India is paying a heavy price both in terms of humanitarian crisis and disease spread. The incoherent and often rapidly shifting strategies and policies especially at the national level are more a reflection of ‘afterthought’ and ‘catching up’ phenomenon on part of the policymakers rather than a well thought cogent strategy with an epidemiologic basis.”
In other words, the lockdown failed. This is not the Opposition that is criticising the government’s lockdown, but the leading public health experts and epidemiologists of the country, including some who are in the government’s Covid-19 National Task Force Committees. In their view, the lockdown failed in its primary task of containing the spread of the Novel Coronavirus, which causes the Covid-19 disease. In all major countries that have seen large outbreaks, lockdowns controlled the epidemic by breaking or weakening the transmission links between the infected and the general population. The only exception is India, where even with a draconian lockdown our numbers never flattened and have been growing over the last few months, doubling every 25-30 days.
Since India’s numbers are doubling roughly every month, how many new cases are we likely to see by October? And how many deaths? If new cases and new deaths continue increasing at their current rate, India is likely to see an additional 50 lakh cases and 80 thousand deaths by October. Unless these numbers start to flatten. The Institute for Health Metrics and Evaluation (IHME) at the University of Washington has predicted that based on current projections, in another two-and-a-half months, India’s total deaths could be as high as 650,000 dead. This is not a modelling exercise but simply looking at India’s graph of cases and projecting it forward. It would change if we are indeed able to flatten the curve.
The second set of figures that Harsh Vardhan has quoted are cases and deaths per million population. According to him, we have been able to limit cases and deaths to 3,328 cases and 55 deaths per million, which is one of the lowest in the world.
As long as Covid-19 cases and deaths continue to rise, how does the Health Minister even argue that we are limiting our cases and deaths? We can only talk about “limiting” our numbers when we stop or at least slow down new cases, not when there is a surge of Covid-19 cases in the country.
Let us examine the number of 3,328 cases per million, which according to the Health Minister is one of the lowest in the world. A quick look at any Covid-19 database, (for example, the worldometers website), will show that among the 200-odd countries, India is in 129th place, meaning 128 countries have better numbers than ours. Add to that we are showing the fastest rise in new cases, far above any other country, which means we will not only double our case numbers but also have about 6,600 cases per million.
The Minister also talked about 55 deaths per million being low compared to others. He claimed that the other metric on deaths, the number of cases to fatalities—the case fatality ratio—is 1.67%. Both these—deaths per million and the case fatality ratio—are well below the global average.
Let us first examine the claim of 55 deaths per million, which is indeed lower than other similarly placed countries. One reason, which has been pointed out by many analysts, is that India’s registration of births and deaths is poor, particularly in states like Uttar Pradesh, Madhya Pradesh, and Bihar. One out of five deaths are not registered, nor have a cause of death identified. There is also a significant difference between Covid-19 death figures provided by the government and the actual figures from crematoriums and graveyards. We have seen this discrepancy in Gujarat and Delhi, which were widely reported. Similar or worse discrepancies exist in many states, where death is recorded due to other reasons even if the patient was suffering from Covid-19. There are also cases of state or district administrations simply cooking up figures to hide the numbers of actual deaths.
Even if we grant the government the benefit of doubt and accept the figures for deaths are as it claims, the figures of deaths per million are only going to increase as the cases of Covid-19 rise. Even by the government’s figures, currently, India’s Covid-19 deaths are doubling every 40 days, so by October we are going to see double the deaths per million than we now have. So how have we limited our deaths as the Minister claimed in Parliament?
There are also issues with the government’s calculation of the case fatality ratio. The WHO has made clear that the case fatality ratio is the number of deaths divided by the number of people who have recovered or died; or what are called cases that have been “resolved”. Indian government computes the case fatality ratio not as deaths divided by resolved cases, but as deaths divided by the total number of cases, which underestimates the ratio by almost a third.
India has one of the youngest demographics in the world, with a median age of 26.8 years compared to, say, Italy, with a median age of 43.4 years. Since many more in the 70 and above age group die than any other age groups, India’s lower numbers are simply a reflection of a much younger population. In Italy, for example, the number of fatalities among those younger than thirty is virtually zero, while in those above 80 years, it was 25%. A calculation of Italy’s case numbers with their death rates for each age group, but using India’s age profile, would show that India’s case fatality ratio is about one-third of Italy’s.
Why is India’s graph of new cases—unlike any other major countries or any other country in South Asia—still rising? No explanation was offered by the Health Minister to what is a burning question before us. The minimum we expect of the Health Minister is to tell the Indian Parliament of the steps being taken to stop the epidemic, or at least slow it down. This is what the country’s Health Minister should be doing, instead of patting himself on the back, claiming empty victories.
Using the emergency powers of the central government under the Disaster Management Act, this government believes that it can ride roughshod over the Opposition and hoodwink the people; or, if that does not work, use the bogeys of Pakistan and China. Even if both fail, there is always a pliant media and troll TV channels like Republic TV and Times Now to distract the people. Hard numbers show that India is now the epicentre of the global pandemic, and the Modi government has failed the coronavirus test. No amount of propaganda and diversion can hide this ugly reality.