India’s new crown mortality “paradox” revealed

Is the “paradox” of death from new coronary pneumonia in India disappearing? At the beginning of April this year, at a small rural hospital about an hour’s drive northeast of Pune, India, staff were loading various equipment on the vehicle. They drove 20 minutes to Karandi Village. They spent more than an hour collecting blood samples in a house where three generations lived together, and then looking for antibodies to the new coronavirus in the blood samples.

Gilish Dema, a scholar who oversaw the project, said the survey showed that the proportion of these villagers who produced antibodies to the new coronavirus was as high as 40%. “People used to think that rural areas were not severely affected,” Daimar said, “but these data are very important to convince decision makers that we need to take interventions in rural areas.” Studies like this are useful for determining the terrible number of deaths in India. Whether it is really below expectations, as some researchers believe, is also critical.

The “paradox” may be disappearing

At the beginning of February this year, as the number of new confirmed cases per day fell below 10,000, India cancelled prevention and control measures, and politicians held large-scale gatherings. Masks are difficult to find in many crowded occasions. However, the catastrophic surge in cases since the end of March has led to a self-defeating claim that India may be approaching herd immunity. The controversy has subsequently become heated, including whether this is related to the mutant virus or caused by the decline in immunity, but the most controversial is how many people died of new coronary pneumonia. Official data show that compared with other countries, India’s reported mortality rate for patients with new coronary pneumonia is relatively low.

“‘The Indian paradox is indeed quite puzzling,” said Prabat Jaa, an epidemiologist at the University of Toronto. Related explanations include underestimation of the number of deaths, the effect of demographic factors (mostly young people), and environmental factors. But now, as hospitals struggle to find enough oxygen for COVID-19 patients, crematoriums are overwhelmed, and the media deliberately underreport the death toll to make the current turbulent epidemic seem less terrible, that paradox may be disappearing.

As early as April last year, the concept of the “Indian Paradox” appeared. A study carefully analyzed the data of 450,000 Indians from the 12 most populous cities in India who sought testing for the virus from June to the end of 2020. The study headed by Jia A found that their seroprevalence ratio increased from about 17.8% to 41.4% during this period, which means a surge in cases. However, even counting the 30% global average underreporting rate of new coronary pneumonia deaths, the research team calculated that about 41 people died of new coronary pneumonia per 100,000 people, which is less than half of the corresponding figure in the United States.

Young people are a big factor

Other studies believe that the different outbreaks of the epidemic in different age groups in India can explain this anomaly. One of the studies conducted a detailed analysis of the new coronary pneumonia cases reported in the Indian states of Andhra Pradesh and Tamil Nadu in the spring and summer of last year and found that although the elderly are at the highest risk of dying from the new coronary pneumonia, the number of deaths among the elderly in India is relatively small. , The deaths over 75 years old accounted for only 17.9%. In contrast, the proportion in the United States is as high as 58.1%. One reason is that the proportion of young people in India is higher. In addition, the rate of infection among the elderly in India is very low, which may be related to the fact that Indians who can live to that age are generally wealthier. According to the study’s first author Ramana Raxminarayan, other factors also help explain India’s seemingly low mortality rate. In the first wave of the epidemic in India, the infection spread mainly among the urban poor, many of whom had to go out to work even during the lockdown. Compared with wealthier urban residents and rural residents, they are younger and have a lower obesity rate, and all these factors are related to the lower mortality rate of new coronary pneumonia. However, Laxminarayan believes that the actual death toll in other Indian states is much higher than the reported data.

Those who think India’s death rate is unusually low also point to several factors. Jaa said that one of the factors is the family structure. Three generations living under one roof is the norm in many families in India. The relatively small number of older people in India means that young people are most likely to bring home the new coronavirus, and they tend to carry lower amounts of the virus and are usually asymptomatic. Therefore, the immune system of the elderly is more likely to contain the virus. Some scientists also believe that genes may also play a role. Anurag Agrawal, head of the Institute of Genomics and Integrative Biology of the Indian Council of Science and Industrial Research, said that Indians living in the United States and the United Kingdom suffer from the same severe virus assaults and high mortality rates. Appears in countries with better air quality. Smokers and many Indians living in heavily polluted air have an enzyme variant in their bodies that may be overexpressed to “detoxify” the lungs.

India needs to persist

With the current surge in cases of new coronary pneumonia in India, the mortality rate may change. This time, it seems that the new crown virus is not only causing serious illnesses more frequently among young people, but also embarrassing the wealthier population. But Jaya said that these trends still cannot deny the “Indian Paradox.” Recent data from the state of Maharashtra indicate that the death rate from COVID-19 has not changed significantly.

Only more and more complete data can explain whether India is benefiting from the paradox, and if it does, whether the paradox will continue to exist. Agrawal said that India is in a “wait and see” state. He predicted that if the model from other countries also applies to India, then this wave of epidemics will begin to subside in mid-May, “before that, we need to persist.”