September 20, 2020

Harsh Vardhan Claims Empty Victories as India Becomes Epicentre of Covid-19 Pandemic

Prabir Purkayastha

SPEAKING in Lok Sabha and Rajya Sabha on September 15-16, Dr Harsh Vardhan, union health minister made a number of self-congratulatory claims regarding the “success” of the government’s lockdown and its Covid-19 policies. What was striking about his claims is its ostrich-like refusal to address the current reality of surging Covid-19 cases. He completely ducked the question why after a “successful” lockdown, India has currently the highest number of daily new cases, and is on course by October to overtake the US, the worst performing country in the world.

Broadly, Harsh Vardhan argued the success of the Modi government’s Covid-19 policies on the basis of avoided cases and deaths due to lockdown, the number of cases and deaths per million being low, and the lower case fatality ratio for India.

Harsh Vardhan’s claims of avoiding 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 the 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, the member health, Niti Aayog.

Common sense would make clear that a lockdown does not prevent deaths or infections, it only postpones infections. Three premier 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 earlier (May 25) had stated, “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 policy makers rather than a well thought cogent strategy with an epidemiologic basis.”

In other words, the lockdown failed. This is not the opposition criticising the government’s lockdown, but the leading public health experts and epidemiologists of the country, including some who are in government’s Covid-19 National Task Force Committees. In their view, the lockdown failed in its primary task of containing the pandemic. In all the major countries that have seen large outbreaks, the lockdowns controlled the pandemic by breaking or weakening the transmission links between the infected and the general population. The only exception is India, where in spite of 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 every 25-30 days, how many new cases are we likely to see by October? And how many deaths? If the number of new cases and new deaths continue on their current course, India is likely to see an additional 50 lakh cases and 80 thousand deaths by October, unless the 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. This is not a modelling exercise but simply looking at India’s graph of cases and projecting it forward. And 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 our 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 will show that among the 200 odd countries, (eg, Worldometer website), India is in the 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 that 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 also claimed that the other metric on deaths, the number of cases to fatalities – the case fatality ratio – is 1.67 per cent.  Both these – deaths per million or 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 a number of analysts, is that India’s registration of births and deaths are 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 given by the government and the actual figures from crematorium or graveyards. We had this discrepancy in Gujarat and Delhi earlier, which were later rectified. 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 administration simply cooking up figures to hide actual deaths.

Even if we grant the government benefit of doubt and accept that the figures for death as reported by the government, the figures of deaths per million are only going to increase as the cases of Covid-19 are rising continuously. Even by the government’s figures, India’s Covid-19 deaths are doubling every 40 days currently, 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 calculations of case fatality ratio. WHO has made clear that the case fatality ratio is based on number of deaths divided by the number of people who have recovered or have 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, underestimating the ratio by almost a third.

India has one of the youngest demographics in the world, India’s median age is 26.8 years compared to say Italy with a median age of 43.4 years. Since many more in the post 70’s age group die than in other age groups, India’s lower numbers are simply the reflection of a much younger population.

Why is India’s graph of new cases – unlike any other major countries or any other country in South Asia –still rising? 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 bogey of Pakistan and China. Even if both fail, there is always a pliant media and troll TV 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.