Decoding the Numbers: Life and Death in the Times of Covid-19

All of us are glued to the COVID statistics as if they are the IPL score of our favourite team. Or perhaps the points table showing matches, victories, losses and so on. How many new infections? What is the R₀ rate? Total number of tests conducted? Population test rate? Then there are the other figures like mortality rate, state-wise mortality rate, daily mortality rate, recovery rate and so on. The list can be quite long, and there are many websites providing tables, graphs, charts, maps and other kinds of data visualisation.

India is a much-maligned country for pandemics, where it has been the reason behind a humungous number of deaths in the past. They say 12 million died of the plague in India since it started in 1897 and persisted for a few years. An even larger number of 18 million died in a few months in 1918 due to the influenza pandemic. And this at a time when India’s population was quite low. Cholera was supposed to have originated here and we were among the last bastions for smallpox and polio. So as an aspiring global leader we need to be mindful about our past reputation and need to be extra-cautions in the current case.

We are seeing that the Covid pandemic can cause serious excess mortality as it is happening in Italy and Spain or even the mighty US of A where more than 1000 people have died in a day. If a similar death rate strikes us in India, these figures from Europe  will be Shami’s or Bumrah’s batting average compared to that of Kohli’s or Rohit’s.  For example, the current crude death rate in India is about 7 per 1000 population which translates into roughly 10 million deaths every year and 26000 deaths each day on a regular basis. In Italy by comparison the daily death count is about 1600 and for Spain which has a slightly lower population it is about 1100 on a regular basis. Covid 19 related deaths due to the pandemic are thus roughly equal to the regular daily death numbers and this is huge. In India at this point the daily death count from Covid 19 is still in two digits. That’s extremely good news and no reason to lower our guard.

But while we take guard and face this new virus steaming in from the other end, it may be useful to look around the ground and see if there is a Jonty Rhodes equivalent waiting to pounce upon an elegant drive or if there is a Solkar equivalent waiting the pouch what we thought was a well-considered defensive prod.  This may be useful preparation as we gear up to deal with the Covid 19 landfall of health emergencies. Surveying the field is what all good batsmen do when they get into bat.

Of the daily death score of 26000 here in India, nearly a fourth or a little more than 6000 daily deaths are from cardiovascular reasons. In addition are the other big hitters like cancers, diarrhoeal diseases, stomach ailments and accidents and injuries each of which account for roughly 5% or between 1000 to 1500 deaths every day. TB a disease which has been banished in countries in Europe and North America, alone kills another 1000 people every day and a similar number of babies die during or around the time of birth. Respiratory diseases and respiratory infections are also important causes of death and together are responsible for another 3000 deaths every day.

We thus have many killer health conditions scoring at a rate 1000 daily deaths or more on a regular basis. Each of these conditions require some level of hospital or health related care every day. I am worried that in the current situation of uncertainty and fear related to Covid 19 pandemic, whether our captains and coaches are tracking what is happening to these big players and some statisticians are feeding them the appropriate data. My fear is that while we try to devise tactics to dismiss an unknown batsman these heavy hitters may score more freely. For those few who do not follow the largest Indian religion of cricket, what this means is that some of the numbers associated with these known killers may actually increase if we do not keep a vigilance on what we know, while we focus our attention against an unknown opponent.

Another daily service the health system provides is related to childbirth or abortion, which are exclusively for women. These conditions are such that cannot wait and need to be addressed as soon as possible. We have nearly 25 million childbirths every year which translates to nearly 70,000 deliveries a day. According to the revised rules of the game, deliveries at home are no longer acceptable. Each and every delivery has to take place in a hospital since they are potentially risky and require attention for the mother or the baby. And it is the same whether the women live in cities, in villages, in apartment blocks, gated communities or in slums. Then there are also 15 million abortions taking place in India every year in India and many of them are unsafe. Now women who do not have access to abortion services when they need it, may either end up having an unintended baby or take desperate steps at home. We know unsafe abortions are an important reason behind maternal deaths. So, the consequence of this will be higher birth rates or higher unsafe abortion rates or even higher maternal mortality. Something similar happened after the influenza epidemic, when the birth rate crashed as many more women died because they were the care givers at home and so were more exposed to the virus.

We are developing very sophisticated technologies to track infections and contacts and ways of preventing spread and managing containment of Covid 19. Will stocking masks and PPE, separating the Covid non-Covid wards in hospitals and similar measures check the possible excess mortality and morbidity caused by Covid 19? The future will tell us whether these were timely and necessary. However, we do have the benefit of experience of many diseases and deaths and their scale of impact. While we gear up for unknown challenges, we need to assess the present dangers too. We fear excess mortality and morbidity and across the country we are tracking numbers anxiously. I wonder whether the surveillance and lookout systems that we are developing are sufficiently holistic or comprehensive. It may well happen that while we are guarding the door, the bigger threat may be lurking inside the home.

Let’s all stay safe!