Tag Archives: facemasks

Dharavi slum in Mumbai

India’s Low COVID Death Rate Is Puzzling

Though the COVID-19 crisis hit India hard – over 9 million cases have been reported and more than 138 thousand people have died  – the mortality rate from COVID-19 is inexplicably lower compared to other countries.

For instance, while the US leads the world with more than 14 million cases and over 276 thousand deaths, according to the John Hopkins Coronavirus Research Center, India accounts for only 10% of deaths globally and has the highest number of recovered patients of COVID-19 at 94%, even though its coronavirus caseload is second only to the US.

With such a significant share of the world’s coronavirus cases, shouldn’t COVID-19 have been more devastating in India?

Krishnaraj Rao

“Then again it has not,” announced Krishnaraj Rao, an investigative journalist from Mumbai, India, at an EMS briefing (November 20) on the pandemic.

“Something strange has been happening within the Indian subcontinent and neighboring regions,” said Rao. “For some strange reason our mortality rate per million is one eighth and our total cases seem to be in the region of one sixth per million.”

As COVID-19 began its inexorable spread across the world, the WHO recommended safety precautions to protect against the virus – physical distancing, wearing a mask, well ventilated rooms, avoiding crowds and close contact, and regularly washing hands.

But in an outcome that has puzzled epidemiologists and scientists alike, India seems to be experiencing a low mortality rate from the coronavirus, stated Rao, despite the crowded conditions in which many urban Indians live.

A large proportion of urban dwellers in a developing country like India lack access to adequate healthcare facilities and maintain poorer sanitation and hygiene practices which are known to be responsible for a higher incidence of communicable diseases.  So the virus was expected to have caused many more deaths in densely populated communities in India than it has.

Urban Indians are ‘badly housed,’ explained Rao, using Mumbai as an example to explain why crowded Indian cities offer a fertile petri-dish for catastrophic coronavirus outbreaks.  “I would say that close to 60% of the population of urban India lives closely packed together in slums.”

In a metropolis like Mumbai, home to over 20 million and India’s largest city, nearly one million people live cheek by jowl in Dharavi, one of the world’s largest slums.

“Houses are no more than two feet apart. Each house is no larger than a 10 by 12 room,” said Rao.

Each home houses about 10 to 12 people, closely packed together. It makes social distancing nearly impossible, while access to basic hygiene essentials, including toilets and hand washing are limited.

“There is only one public toilet per every two or three hundred slum dwellers,” explained Rao, highlighting the less than hygienic conditions in slums like Dharavi. “Face masks, social distancing…are close to non-existent. We take things like face masks, temperature checks and sanitizing very lightly,” he claimed.

“If it were a pandemic that was ravaging us because of a lack of social distancing,” asked Rao, why are the slums relatively less impacted than expected? And, despite overcrowding on the suburban railways, he adds, “the crisis has hit us less hard than anticipated.”

While epidemiologists attribute India’s low mortality rate to under-reporting, and even though Rao himself expected undercounting, he alleged that at least in Dharavi, there is no evidence of it. “I don’t see the bodies piling up in the streets… or the hospitals,”  nor has he noted any alarming rises in the body count.

Rao claimed he is voicing “a mainstream belief” felt across economic classes and demographics in India, that the coronavirus is not causing the high mortality rates that were anticipated.

In Dharavi, officials say that concerted public health efforts to trace, track, test and treat cases, have helped to contain community spread.

Now, recent research by Indian scientists seeking to explain why India’s death rate is so low, suggest that more Indians may be immune to COVID-19 because they live in unsanitary conditions which have created an unexpected shield from the virus.

According to one study, more than 70 percent of all COVID–19 deaths have occurred in high income countries like Italy, Spain, UK, France and USA. It hypothesized that more people died in richer countries with older populations, because better hygiene and safe sanitation practices lowered levels of immunity and made people more susceptible to the virus.

In another study scientists report, “It appears that countries with better health care, clean environment, clean food and water have higher COVID associated mortality, whereas developing and underdeveloped countries have lower mortality in terms of deaths per million population.”

Both research studies (not yet peer reviewed), suggest that in low GDP countries like India, lives of people in densely populated areas may have been saved because of poor hygiene and sanitation practices.  Unsanitary conditions and exposure to diseases from childhood may have increased their ability to ward off infections, and boosted immunity against COVID-19. Experts also suggest that the early lockdown and a younger population helped stave off a higher death toll in India.

The science is intriguing. Does greater exposure to a variety of viruses in the slums of low income countries provide a better level of protection against the coronavirus, than the overly sanitized environments of richer nations?

“Paradoxically, better sanitation leads to poor immune training and thus could be leading to higher deaths per million,” says the study. But it cautions that while the research offers a possible explanation, poor hygiene is not a solution to the pandemic.

India, and Dharavi in particular, may have pulled off a remarkable reprieve against COVID-19 for now. But the pandemic is far from over and science is still learning about this young virus. So, public health experts warn, SMS (social distance, mask, and sanitize) must remain the global mantra to keep Covid 19 at bay, until vaccines become easily available to the general public.


Meera Kymal is the contributing editor at India Currents.

photo credit: Baron Reznik

AAPI Fights the ‘Rakshas Virus’

Nearly 100,000 Physicians of Indian origin in the United States serve every seventh patient across the United States – This powerful statistic shared by  Dr. Anupama Gotimukula, Vice president of AAPIUSA at a recent teleconference, underscores the significant numbers of Indian American medical professionals involved in the fight against the novel coronavirus.

The teleconference on Friday, March 27, 2020  was jointly organized by AAPI, the Indian Embassy in Washington, DC, and the National Council of Asian Indian Americans (NCAIA).

“While COVID-19 continues to disrupt life around the globe, AAPI is committed to helping its tens of thousands of members across the US and others across the globe,” said Dr. Suresh Reddy, President of AAPI. “We do acknowledge that these are challenging times, more than ever for us, physicians, who are on the frontline to assess, diagnose and treat people who are affected by this deadly pandemic, COVID-19. Many of our colleagues have sacrificed their lives in order to save those impacted by this pandemic around the world.”

The numbers are grim. Coronavirus deaths in the US  are over 3000  (exceeding the initial death toll of September 11), while over 175,000  people have tested positive for the virus – more than double that announced by China.

In response to the pandemic, AAPI has embarked on several initiatives, the most effective being a twice weekly conference call attended by  over 2,000 physicians from across the United States,  to share expertise and best care practices with other professionals from the healthcare sector.

Nearly 200,000 Indian students in the US are impacted by the pandemic, said Anurag Kumar, Minister of Community Affairs, who outlined efforts to give them assistance.

“We are coordinating with the community and hotels owned by AAHOA members in arranging accommodation for students, “ he said. “Everyone is advised not to travel abroad and back to India, stay where you are until things get better.”

Speakers on the forum highlighted the need for the people to recognize that Covid-19 is an aggressive type of virus. “Everyone needs to take appropriate precautions. Even if symptoms are negative, one is likely they carry symptoms,” advised Dr. Bharat Barai.

Social distancing matters cautioned Dr. Prasad Garimella, a critical care medicine specialist . “Social distancing is not isolating. Keep in touch with loved ones. Stay busy and stay connected. Filter and assess the news, look for credible sources to rely upon. Everyone needs to act like a health care professional and need to have the best attitude in order to defeat this deadly virus.”

Emergency medicine specialist Dr. Arunachalam Einstein endorsed  self-quarantine and masks as a way to prevent spreading. “Go out only for essential things,” he advised. “ Everyone coming to ED symptomatic and non-symptomatic and the staff must wear mask, which will prevent droplets from affecting others.   Even when going out to grocery shopping use masks.”

Dr. Sudhakar Jonnalagadda, expressed concern about the adverse effect of inadequate testing for at risk seniors, as well as for physicians  and healthcare workers fighting infection on the frontlines, stating  “It’s essential to create a wholesale expansion of free COVID-19 testing available in order for identifying asymptomatic carries and then isolating them.”

A rising number of people across age groups are affected by the highly infectious virus, said Dr. Usha Rani Karumudii, an infectious disease specialist, reporting that “People of all ages are prone to the disease. Hand hygiene and social distancing will help prevent. Precautions while shopping, reduce trips. wash and decontaminate hands after going out.”

AAPI also has launched a DONATE A MASK PROGRAM – a major initiative to protect the medical fraternity as they combat the “rakshas” virus.  Members were requested to donate generously to fight “this ferocious virus which has put basic existence of entire human race at stake.”

A severe shortage of GS masks and other protective gear is impacting  “the foot soldiers and front line physicians,” some of whom have succumbed to the deadly virus. A donation box labelled “DONATE A MASK,” has been added to the AAPI website ands a task force established to identify hospitals and direct supplies of Masks/PPE.

Updates  on AAPI initiatives  can be found at  www.appiusa.org