Corona strategies under scrutiny – India: death toll massively underestimated

A woman in New Delhi, India, is vaccinated in October 2021 (AP Photo/Altaf Qadri) (picture alliance / ASSOCIATED PRESS / Altaf Qadri)

Fighting the corona pandemic is not a sprint, but a marathon. It is not yet possible to say which countries will do particularly well in the end, especially since new virus variants such as Omicron are constantly changing the situation. As a result, countries whose strategy initially seemed successful can suddenly fall behind.

How the corona strategies of selected countries have proven themselves so far is the focus of research this week in a five-part series. How strict were the measures? How effectively did they succeed in slowing down the spread of the virus and reducing the number of Covid deaths? In the third part of the series we look at India.

There was not one but two first and second wave strategies in the country. The coronavirus reached India in March 2020 and Prime Minister Narendra Modi decided to fight back, imposing a curfew that came into effect almost immediately. On the one hand, he was actually able to delay the first wave, which rose comparatively slowly. On the other hand, the social consequences were dramatic. Many millions of people lost their job opportunities in the cities and tried to get back to their home villages. Because there were hardly any buses or trains, they moved through the country in large treks and brought the corona virus to remote regions.

Narendra Modi stands at the microphone and raises his arms in the air in address.

Premierminister Narendra Modi (picture alliance / Pacific Press / Saikat Paul)

Modi apologized, the government launched an aid program to alleviate the shortage of food and money, and eased curfews again from May. Basically, the country then slowly let the virus run through the population. At the end of the first wave in September, ten million people in India had been infected and 150,000 had died. Then, in January 2021, a year ago, Prime Minister Modi declared that India had successfully controlled the coronavirus. Even more: The country would have imported masks and ventilators first, but from now on it would be ready to save the world – with two vaccines “Made in India”.

Cumulative confirmed COVID-19 cases per million people

Graphic shows number of Covid-19 cases in Germany, Italy, India, South Africa, USA and Australia

Due to limited testing, the number of confirmed cases is lower than the actual number of infections (Deutschlandradio / Andrea Kampmann)

India is considered the pharmacy of the world because the pharmaceutical companies produce many medicines and vaccines cheaply. Accordingly, the global vaccination program Covax has ordered large quantities of vaccine from the Serum Institute of India. The vaccine is manufactured there under license by AstraZeneca. So Modi’s announcement wasn’t far off the mark. But unfortunately things turned out differently. From April, a second, much larger wave of infection began, in which twice as many people became infected and twice as many died in a comparatively short time as in the first wave.

Cumulative confirmed COVID-19 deaths per million people

Graphic shows number of Covid-19 deaths in Germany, Italy, India, South Africa, USA and Australia

For some countries, the number of confirmed deaths is much lower than the actual number of deaths. This is due to limited testing and difficulties in assigning the cause of death. (Deutschlandradio / Andrea Kampmann)

After the first wave, the country felt safe. Politicians and experts assumed that herd immunity would be achieved after the first wave. The Guardian wrote that India was proud of a Corona special position. Accordingly, problems in health care were not addressed and emergency hospitals were closed. On the contrary, the country was in a celebratory mood. There were important religious holidays with huge crowds, campaign events, cricket tournaments in front of large audiences. All ideal conditions for the virus. The clinics were quickly overwhelmed, and some may still remember the pictures of desperate relatives trying to get hold of oxygen bottles.

In this situation, Modi adopted a new strategy: mass vaccination. To make this possible, there was an export ban for corona vaccines. Vaccine was thus plentiful in India, but the vaccination program was slow to start because little preparation was made after the first wave. Ultimately, the vaccination campaign helped break the second wave. Infections and vaccinations together ensured that in July 2021 two out of three Indians had built up immunity to SARS-CoV-2.

Percentage of population fully vaccinated against COVID-19

Graphic shows the number of Covid-19 vaccinations in Germany, Italy, India, South Africa, USA and Australia

Total number of individuals who received all doses required by the primary vaccination protocol divided by the country’s total population. Note: Alternative definitions of full vaccination, e.g. B. being infected with SARS-CoV-2 and having received a dose of a 2-dose protocol are ignored to maximize comparability between countries. (Deutschlandradio / Andrea Kampmann)

If you only look at the official figures, India did not fare so badly through the first two years of the pandemic. In absolute terms, there were a lot of infected people, more than 36 million. But India also has a very large population. The bottom line is that officially only 2.5 percent of all Indians had a positive virus detection. In Germany, the proportion is almost four times as high. In fact, far more people are likely to have been infected in India: there are many unreported cases because corona tests are scarce there. Similarly with deaths.

Officially, half a million corona deaths were counted in the pandemic, which is only a quarter of the German figure in relation to the population. But just in the past few weeks, several studies on excess mortality in India have appeared. For example, telephone surveys were used to ask about deaths or other statistics were evaluated

The different approaches all come to the same conclusion: the number of deaths was massively underestimated, between four and ten times as high as the official figures. So between two and five million dead. There are so many more that the global corona statistics will probably have to be corrected significantly upwards. Despite its young population, India does not occupy a special position. The measures, first curfew, then vaccination program were effective. But because they could not hold out or were not well prepared, they were far from being able to reduce the number of victims as much as hoped.

Also from the series

Corona strategies under scrutiny – USA: Trump and the “Chinese virus”
Corona strategies on the test bench – Italy: course of caution after a traumatic first wave

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