It is generally accepted that the mortality rate of the Indian Covida 19 is probably the lowest in the world. On the face of it, this seems generally reasonable, as India, at 2.8%, performs much worse than Italy, for example, at 14.3% and the cumulative accidental death rate (CACFR) is certainly much lower than in many countries, as shown in Figure 1. The CCCFR is the ratio between the cumulative number of deaths and the cumulative number of cases on a given date. Because death, if it occurs, occurs within a few days of the discovery of the case, the CBCRTC underestimates the risk of death because one is infected, especially if the number of cases increases. Ideally, the mortality rate should be calculated for each cohort, i.e. for the individuals grouped together to detect an infection. But it is difficult to measure and that is why the CCCFR is used worldwide as a global measure of the number of Covid-19 fatalities.
For this purpose, some adjustment may be made using a delayed CCFR (LCCFR), which indicates the ratio between the number of deaths accumulated on a given date and the number of deaths accumulated on an earlier date (in this case 15 days earlier). This will significantly increase the CBCRT when cases increase rapidly, as in the case of India, or something when they stabilize, as in the case of Italy. But even according to this indicator, India seems to be doing well, with a percentage of 5.9%, which is still far below that of many other countries and, of course, Italy’s percentage of 14.9%.
However, one of the few versions of Covid-19 is that the older the infected patient gets, the greater the chance of a fatality. Age-specific CBWACs are not easy to find, but they are currently being published, including in the magazine Onder. (2020) for Italy and China. Table 1 shows the key figures for both countries. In India, we have not published CFCs by age at the national level, but the Government of Maharashtra has introduced a new CFC policy with remarkable transparency given the growing impact of the pandemic on its 8th anniversary. In May, cases and deaths by age were available from which CFCs by age could be calculated (age groups with disabilities of one year, i.e. 31-40 instead of 30-39, compared to Italy and China).
However, India has data on the age before the age of 30. April, published inter alia in a recent article by the Director General of the Indian Medical Research Council (ICMR). This shows the number of cases in India in the same age group as the data for Italy and China in the city of Grozny. Amongst others. (2020) and the China Center for Disease Control and Prevention (CDC). This allows us to estimate the number of deaths that would have occurred in India if China and Italy had been dominated by RFCs of the same age as India. If the actual number of deaths in India is lower than these estimates, India performs better than these countries and vice versa. However, as China made a one-off correction in the number of deaths on Covida-19 in mid-April, we only use Italian figures, although the age data of the CCCFR are provided by China for comparative information.
Table 1 shows the critical figure in column (8). This figure is calculated by multiplying the age factor of the Italian ACC in column (3) by the number of cases by age in India in column (7). The estimated number of deaths that would have occurred if age-related mortality had been predominant in Italy is 535. The official death toll in India is 30. April at 1,074, twice as much as April 30. April.
We can reconcile the fact that the mortality rate in India is lower than in Italy in Figure 1 with the fact that the mortality rate in India is twice as high as expected when looking at the age distribution of the cases. Figure 2a shows that more than half of the patients in India and Maharashtra are under 40 years of age, while in Italy (where total case data are estimated using the CCCFR and the number of deaths), less than a seventh of cases are in this age group and 56 percent are in the age group over 60, where India has less than a seventh. Patients with Indian covidosis are much younger and would therefore be less likely to die in Italy or China which, as shown in Table 1, have a very low percentage of HFCC for patients under 60 years of age.
This is evident in Maharashtra, the only state that has established age-related CBCRTs. The ACC of Maharashtra for people under 60 years of age is much higher than in Italy, as shown in Figure 2b, although the total ACC of Italy, at 7,2 %, is much higher than that of Maharashtra, at 3,8 %. Had Maharashtra CCCFR been available, the number of deaths in Italy would have decreased by two thirds due to age characteristics, and the use of Maharashtra CCCFR in India would have increased the number of deaths in the country by 50%.
The fact is that our total RRC is low because we have more small patients than other countries that do not expect to die. In India, however, they are dying much faster than expected, which means that the PRCC in India is much higher than it should be, based on the experience of other countries. Instead of being among the lowest, the age-adjusted mortality rate in India is in fact higher than in Italy, which has one of the highest aggregated SCCRs, as shown in Figure 1.
Why is that? Is it because our hospital system is not equipped to treat Covid-19 (there is no consensus on the treatment of Covid-19, only support for the patient while his immune system tries to fight the infection)? Or because we don’t have sufficient resources, such as oxygen support, etc. Or because our immune system is threatened by a lack of nutrients, poor water and air quality or many related diseases?
It will be difficult to understand these factors, but if we don’t recognize our problem, we won’t even start asking such questions and continue to believe we are lucky. States can start this discussion by making the age-related CFSRFs available to the public. The ICRM should also reduce age-related stress. Only then can we take corrective action in due course.